Long-term patient reported outcomes following radiation therapy for oropharyngeal cancer: cross-sectional assessment of a prospective symptom survey in patients ≥65 years old

Abstract

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.

Single‐item discrimination of quality‐of‐life–altering dysphagia among 714 long‐term oropharyngeal cancer survivors: Comparison of patient‐reported outcome measures of swallowing

“…With a median follow‐up of nearly 7 years, the current study highlights that >15% of patients may experience long‐term QOL‐altering dysfunction in swallowing after treatment. Although it was not analyzed longitudinally in our study, patients have previously demonstrated marked worsening in swallowing function at 6 months to 1 year after definitive IMRT for OPC, with partial recovery by 2 years . By limiting our cohort to those who completed treatment 1 year or more before the survey, we largely excluded those who had acute or subacute symptoms of dysphagia that may recover.…”

“…Although these have been explored for other symptoms on the MDA S I‐HN (dry mouth scores ≥6 for xerostomia 15 ), to the best of our knowledge, a clinically meaningful MDA S I‐HN‐S cutoff score has not yet been validated. Because no consensus cutoff score for the MDA S I‐HN‐S has been identified, a value ≥6 to represent moderate/severe symptoms was chosen based on published data of optimal cutoff points from composite items and other single items on the MDA S I‐HN . In RPA, an MDA S I‐HN‐S cutoff score of ≥6 was validated to best distinguish QOL‐altering dysphagia symptoms, as measured by the EQ‐VAS.…”

“…Although it was not analyzed Cancer May 15, 2019 longitudinally in our study, patients have previously demonstrated marked worsening in swallowing function at 6 months to 1 year after definitive IMRT for OPC, with partial recovery by 2 years. 16 By limiting our cohort to those who completed treatment 1 year or more before the survey, we largely excluded those who had acute or subacute symptoms of dysphagia that may recover. In our cohort, patients who reported moderate/severe dysphagia tended to have a longer time since treatment interval, which may suggest continued and persistent deterioration in function many years after treatment, or it could be a surrogate for older and less conformal treatment techniques.…”

“…Because no consensus cutoff score for the MDASI-HN-S has been identified, a value ≥6 to represent moderate/ severe symptoms was chosen based on published data of optimal cutoff points from composite items and other single items on the MDASI-HN. 16,17 In RPA, an MDASI-HN-S cutoff score of ≥6 was validated to best distinguish QOL-altering dysphagia symptoms, as measured by the EQ-VAS. Regarding the MDADI, a score of 60 was previously proposed as a clinically meaningful cutoff point 17,23 and is used as an endpoint for patient-reported swallowing dysfunction on the NRG Oncology head-and-neck trial (NRG HN-002), a recent randomized trial of IMRT in patients with OPC.…”

Impact of Clustering Oral Symptoms in the Pathogenesis of Radiation Caries: A Systematic Review

“…Seven studies (63.6%) assessed patients with heterogeneous HN topographies [Murphy et al, 2010;Xiao et al, 2013;Rosenthal et al, 2014;Kirca and Kutlutürkan, 2017;Barnhart et al, 2018;Chiang et al, 2018;Ridner et al, 2018], 2 studies (18.2%) assessed patients with oropharyngeal/laryngeal tumors [Haisfield-Wolfe et al, 2012;Eraj et al, 2017], and 2 studies (18.2%) assessed patients with nasopharyngeal tumors [Xiao et al, 2017;McDowell et al, 2018]. Eight studies (72.2%) reported specific information on patients' stage of disease, from which 6 (54.5%) assessed patients in clinical stage I-IV [Haisfield-Wolfe et al, 2012;Rosenthal et al, 2014;Eraj et al, 2017;Kirca and Kutlutürkan, 2017;Xiao et al, 2017;McDowell et al, 2018] and 2 (18.2%) assessed patients with advanced disease (clinical stage III/IV) [Xiao et al, 2013;Chiang et al, 2018].…”