Long-term Patient-Reported Outcomes in a Population-Based Cohort Following Radiotherapy vs Surgery for Oropharyngeal Cancer

Abstract

ImportanceOncologic outcomes are similar for patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery or radiotherapy. However, comparative differences in long-term patient-reported outcomes (PROs) between modalities are less well established.ObjectiveTo determine the association between primary surgery or radiotherapy and long-term PROs.Design, Setting, and ParticipantsThis cross-sectional study used the Texas Cancer Registry to identify survivors of OPSCC treated definitively with primary radiotherapy or surgery between January 1, 2006, and December 31, 2016. Patients were surveyed in October 2020 and April 2021.ExposuresPrimary radiotherapy and surgery for OPSCC.Main Outcomes and MeasuresPatients completed a questionnaire that included demographic and treatment information, the MD Anderson Symptom Inventory–Head and Neck (MDASI-HN) module, the Neck Dissection Impairment Index (NDII), and the Effectiveness of Auditory Rehabilitation (EAR) scale. Multivariable linear regression models were performed to evaluate the association of treatment (surgery vs radiotherapy) with PROs while controlling for additional variables.ResultsQuestionnaires were mailed to 1600 survivors of OPSCC identified from the Texas Cancer Registry, with 400 responding (25% response rate), of whom 183 (46.2%) were 8 to 15 years from their initial diagnosis. The final analysis included 396 patients (aged ≤57 years, 190 [48.0%]; aged >57 years, 206 [52.0%]; female, 72 [18.2%]; male, 324 [81.8%]). After multivariable adjustment, no significant differences were found between surgery and radiotherapy outcomes as measured by the MDASI-HN (β, −0.1; 95% CI, −0.7 to 0.6), NDII (β, −1.7; 95% CI, −6.7 to 3.4), and EAR (β, −0.9; 95% CI −7.7 to 5.8). In contrast, less education, lower household income, and feeding tube use were associated with significantly worse MDASI-HN, NDII, and EAR scores, while concurrent chemotherapy with radiotherapy was associated with worse MDASI-HN and EAR scores.Conclusions and RelevanceThis population-based cohort study found no associations between long-term PROs and primary radiotherapy or surgery for OPSCC. Lower socioeconomic status, feeding tube use, and concurrent chemotherapy were associated with worse long-term PROs. Further efforts should focus on the mechanism, prevention, and rehabilitation of these long-term treatment toxicities. The long-term outcomes of concurrent chemotherapy should be validated and may inform treatment decision making.

Head and Neck Cancer: A Study on the Complex Relationship between QoL and Swallowing Function

“…Thus, these data support the hypothesis that function and QoL are independent of the treatment decision, except when the therapy is transoral surgery only. This finding aligns with previous research reporting that surgery only in oropharyngeal cancer is beneficial and highlights the potential of reducing radiation doses in HNSCC [40][41][42][43]. However, it is important to consider that the stage of the tumor correlates with the escalation of therapy.…”