BackgroundGiven the potential for older patients to experience exaggerated toxicity and symptoms, this study was performed to characterize patient reported outcomes in older patients following definitive radiation therapy (RT) for oropharyngeal cancer (OPC).MethodsCancer-free head and neck cancer survivors (>6 months since treatment completion) were eligible for participation in a questionnaire-based study. Participants completed the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). Those patients ≥65 years old at treatment for OPC with definitive RT were included. Individual and overall symptom severity and clinical variables were analyzed.ResultsOf the 79 participants analyzed, 82% were male, 95% white, 41% T3/4 disease, 39% RT alone, 27% induction chemotherapy, 52% concurrent, and 18% both, and 96% IMRT. Median age at RT was 71 yrs. (range: 65–85); median time from RT to MDASI-HN was 46 mos. (2/3 > 24 mos.). The top 5 MDASI-HN items rated most severe in terms of mean (±SD) ratings (0–10 scale) were dry mouth (3.48 ± 2.95), taste (2.81 ± 3.29), swallowing (2.59 ± 2.96), mucus in mouth/throat (2.04 ± 2.68), and choking (1.30 ± 2.38) reported at moderate-severe levels (≥5) by 35, 29, 29, 18, and 13%, respectively. Thirty-nine % reported none (0) or no more than mild (1–4) symptoms across all 22 MDASI-HN symptoms items, and 38% had at least one item rated as severe (≥7). Hierarchical cluster analysis resulted in 3 patient groups: 1) ~65% with ranging from none to moderate symptom burden, 2) ~35% with moderate-severe ratings for a subset of classically RT-related symptoms (e.g. dry mouth, mucus, swallowing) and 3) 2 pts. with severe ratings of most items.ConclusionsThe overall long-term symptom burden seen in this older OPC cohort treated with modern standard therapy was largely favorable, yet a higher symptom group (~35%) with a distinct pattern of mostly local and classically RT-related symptoms was identified.Electronic supplementary materialThe online version of this article doi: (10.1186/s13014-017-0878-9) contains supplementary material, which is available to authorized users.

Oral intake in HNC survivorship is a multidimensional issue and functional outcome that is impacted not only by dysphagia but also by dental status. Symptom drivers of oral intake likely differ in acute survivorship. Nonetheless, these findings highlight the lack of specificity in this end point and also the need for multidisciplinary supportive care to optimize oral intake in survivors.

Objectives: To evaluate whether the use of oral stents during intensity modulated radiation therapy (IMRT) for oropharyngeal cancer (OPC) is associated with long-term patient reported symptoms. Materials and methods: Data was obtained from a prospective observational study of disease-free head and neck cancer survivors. Radiation-associated patient reported symptoms were assessed using the MD Anderson Symptom Inventory Head and Neck module (MDASI-HN). Scores of 5 (11-point Likert scale, 0-10) were considered moderate/severe. Stratification was performed regarding IMRT volume (uni-versus bilateral neck) and stent utilization, with non-parametric analyses between groups. Results: 462 OPC survivors formed the cohort (54% tonsil, 46% base of tongue primaries). A tonguedeviating stent was used in 17%, tongue-depressing stent in 46%, and no stent in 37%. Median prescribed dose to the high dose clinical target volume was 66.0 Gy. Median follow-up from RT to MDASI-HN assessment was 68 months. Twenty percent had received unilateral neck RT (all had tonsil primaries), in whom a significant improvement in the proportion of patients with moderate/severe taste impairment (2% vs. 15%, p = 0.047) and lack of appetite (0% vs. 9%, p = 0.019) was associated with the use of tonguedeviating stents compared to no oral stent. In those who had received bilateral neck RT, a significant improvement in the proportion of patients with moderate/severe difficulty swallowing/chewing was associated with use of a tongue-depressing stent (21% vs. 31% without oral stent, p = 0.013). Conclusion: Disease-site specific select use of oral stents during IMRT was associated with reduced longterm patient reported symptoms in OPC survivors.

Background Two patient‐reported outcomes (PROs) of swallowing and their correlation to quality of life (QOL) were compared in long‐term survivors of oropharyngeal cancer (OPC). Methods Scores on the single dysphagia item from the 28‐item, multisymptom MD Anderson Symptom Inventory‐Head and Neck (MDASI‐HN‐S) were compared with scores on the dysphagia‐specific composite MD Anderson Dysphagia Inventory (MDADI) and the EuroQol visual analog scale (EQ‐VAS) in 714 patients who had received definitive radiotherapy ≥12 months before the survey. An MDASI‐HN‐S score ≥6 and an MDADI composite score <60 were considered representative of moderate/severe swallowing dysfunction. Results Moderate/severe dysphagia was reported by 17% and 16% of respondents on the MDASI‐HN‐S and the composite MDADI, respectively. Both swallow PROs were predictive of QOL, and the MDASI‐HN‐S model was slightly more parsimonious for the discrimination of EQ‐VAS scores compared with MDADI scores (Bayesian information criteria, 6062 vs 6076, respectively). An MDASI‐HN‐S cutoff score of ≥6 correlated best with a declining EQ‐VAS score (P < .0001) and was associated with increased radiotherapy dose to several normal swallowing structures. Conclusions In this cohort, the single‐item MDASI‐HN‐S performed favorably for the discrimination of QOL compared with the multi‐item MDADI. A time‐efficient model for PRO measurement of swallowing is proposed in which the MDADI may be reserved for patients who score ≥6 on the MDASI‐HN‐S.

Highlights Age at treatment for OPSCC is a strong predictor of chronic radiation associated dysphagia (RAD). For swallowing regions of interest (ROIs), dose to ROI and age impact patients’ risk of chronic RAD. For patients at high risk for RAD more intense prophylactic swallowing therapies may be warranted.

Background and purpose: Taste impairment is a common radiation-induced toxicity in head and neck cancer (HNC) patients acutely. However, data on the potential for recovery and the time dependent course of late taste impairment are limited. Materials and methods: As part of an IRB-approved observational prospective study, HNC patients underwent serial surveys including the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). For our analysis, we extracted MDASI-HN taste item results from oropharyngeal cancer patients treated with intensity-modulated radiotherapy or volumetric modulated arc therapy and at least two taste assessments after !1 year from end of radiotherapy (RT). Results: 1214 MDASI taste items from 326 patients between 1 and 13 years post-RT were included. Median prescribed dose to the high-dose clinical target volume (CTV1) was 66.0 Gy, with 180 patients (55%) receiving chemotherapy. Taste markedly improved in the first years from end of RT, but plateaued after year 5. In patients with taste assessment in subsequent years, a significant reduction in taste impairment was found from the second to the third year (p = 0.001) and tended towards significance from the third to the fourth year (p = 0.058). Multivariate analysis revealed treatment site as significant factor in the sixth year from RT and CTV1 dose and age in the seventh year. Conclusion: Radiation-induced taste impairment may improve over an extended time interval, but becomes relatively stable from year 5 post-RT. Direct characterization of RT-induced taste impairment and the calculation of normal tissue complication probability should include consideration of the timedependent course in taste recovery.

Treatment of hypertension in the elderly has hitherto been considered to be potentially dangerous. Three recent studies have clearly shown that in selected elderly hypertensives, blood pressure reduction very effectively reduces cardiovascular complications without causing unacceptable adverse effects. The impact o n non-fatal stroke was most striking although a reduction in coronary events was also achieved. Thiazide diuretics were used in all three trials, and /3-blockers were used in two. Thiazide diuretics had a major beneficial effect. In this review the applicability of these results to the whole unselected population of elderly hypertensives is considered, and the choice of therapy in different subgroups of patients discussed.