Emotional Quality of Life After Radiation Therapy for Oropharyngeal Carcinoma

Abstract

PurposeSubstantial research exists on the physical toxicities from radiation therapy (RT) for oropharyngeal cancers, but emotional quality of life is understudied. The purpose of this study is to map the effects and time course of radiation-related changes in mood and anxiety and to investigate the physical factors that drive these changes.Methods and materialsWe prospectively collected University of Washington Quality of Life questionnaires and identified patients with oropharyngeal cancer who were treated with curative-intent RT between 2013 and 2016 and had completed questionnaires within 12 months after RT (n = 69). We analyzed swallow, saliva, taste, chewing, speech, pain, mood, and anxiety scores, using a scale from 0 to 100. We conducted a multivariate regression analysis to identify physical functioning predictors of worse emotional scores.ResultsPhysical functioning scores declined from before RT to 3 months after RT and then began improving but did not rebound to baseline levels within 12 months. Patient mood slightly declined, but anxiety improved immediately after RT, with both generally improving such that scores were higher at the 12-month follow-up than at initial consult. Analysis showed that longer duration of treatment is associated with a higher likelihood of worse mood scores at 12 months (odds ratio [OR], 1.446; P < .01). Worse swallow score is associated with a greater likelihood of worse mood score at 3 months (OR, 0.971; P < .01) and 12 months (OR, 0.975; P < .01). A worse taste score is associated with a greater likelihood of worse anxiety score at 3 months (OR, 0.979; P < .05) and 12 months (OR, 0.982; P < .05).ConclusionsEmotional changes are associated with certain treatment-associated toxicities. A patient's emotional health is complex and likely multifactorial in nature. Our study identified key associations and time points to potentially intervene upon.

Patient-Reported Outcome Measures of Psychosocial Quality of Life in Oropharyngeal Cancer Patients: A Scoping Review

“…Janz’s prospective cohort study exploring differences between HPV-associated OPSCC patients (n = 21) and HPV-negative oral cavity cancer patients who smoke (n = 17) found that, at 12 months, the HPV-associated OPSCC cohort had an improved depression score on the CES-D [ 28 ]. Rajeev-Kumar conducted a retrospective analysis of OPSCC patients treated with RT (n = 69) using the University of Washington QOL (UW-QOL) questionnaire and noted that anxiety and mood scores improved at 12 months compared to pre-treatment values [ 29 ].…”

“…Several other studies did not associate worsening mental health with HPV status (Qualliotine on CES-D initial screen, Rajeev-Kumar on UW-QOL, and Shinn using both the PHQ-9 and the CES-D) [ 29 , 31 , 34 ]. Shinn performed a prospective cohort study on 130 patients with OPSCC [ 34 ].…”

Treatment-Related Dysgeusia in Oral and Oropharyngeal Cancer: A Comprehensive Review

“…Nevertheless, almost all patients experience a significant loss of taste acuity at a dose of 60 Gray. Dysgeusia typically occurs within 3-4 weeks of treatment and some studies have shown complete recovery within 3-12 months, depending on the volume of the irradiated tissues [6,12,15,16]. Especially moderate taste alterations start during the 2nd week of RT, involving 40% of patients, while severe dysgeusia is experienced from the 3rd week onward, reaching the peak of rate and severity of symptoms in the 5th week [11].…”

“…Especially moderate taste alterations start during the 2nd week of RT, involving 40% of patients, while severe dysgeusia is experienced from the 3rd week onward, reaching the peak of rate and severity of symptoms in the 5th week [11]. Unfortunately, some patients exhibit incomplete or no recovery even several years later [6,12,15,16]. Indeed, significant worsening of taste function both at short (within 1 year) and long term (up to 11 years) follow-up was shown in survival and non-survival patients with OSCC who have undergone adjuvant RT, compared to the baseline [6,17,28].…”

“…Their side effects include a wide range of acute and late toxicities, such as orofacial pain, oral fibrosis and/or mucositis, dysphagia, dysgeusia, xerostomia, salivary impairments, osteonecrosis of the jaws, nausea, fatigue, and dermatitis. These alterations can become chronic issues and negatively influenced patients' quality of life (QOL) [6][7][8][9][10][11][12][13]. Taste disorders include hypogeusia (reduced taste sensation), ageusia (loss of taste sensation), dysgeusia (altered taste sensation), phantogeusia (taste alteration without external stimulus) and parageusia (distortion to a specific stimulus).…”