Long‐term quality of life after treatment in sinonasal malignancy: A prospective, multicenter study

Abstract

BackgroundQuality of life (QOL) for individuals with sinonasal malignancy (SNM) is significantly under‐studied, yet it is critical for counseling and may impact treatment. In this study we evaluated how patient, treatment, and disease factors impact sinonasal‐specific and generalized QOL using validated metrics in a large cohort over a 5‐year posttreatment time frame.MethodsPatients with SNM who underwent definitive treatment with curative intent were enrolled in a prospective, multisite, longitudinal observational study. QOL was assessed using the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and University of Washington Quality of Life Questionnaire (UWQOL) instruments at pretreatment baseline and multiple follow‐ups through 5 years posttreatment. Multivariable modeling was used to determine demographic, disease, and treatment factors associated with disease‐specific and generalized physical and social/emotional function QOL.ResultsOne hundred ninety‐four patients with SNM were analyzed. All QOL indices were impaired at pretreatment baseline and improved after treatment. SNOT‐22 scores improved 3 months and UWQOL scores improved 6 to 9 months posttreatment. Patients who underwent open compared with endoscopic tumor resection had worse generalized QOL (p < 0.001), adjusted for factors including T stage. Pterygopalatine fossa (PPF) involvement was associated with worse QOL (SNOT‐22, p < 0.001; UWQOL Physical dimension, p = 0.02). Adjuvant radiation was associated with worse disease‐specific QOL (p = 0.03). Neck dissection was associated with worse generalized physical function QOL (p = 0.01). Positive margins were associated with worse generalized social/emotional function QOL (p = 0.01).ConclusionDisease‐specific and generalized QOL is impaired at baseline in patients with SNM and improves after treatment. Endoscopic resection is associated with better QOL. PPF involvement, adjuvant radiation, neck dissection, and positive margins were associated with worse QOL posttreatment.

SNOT‐22 subdomain outcomes following treatment for sinonasal malignancy: A prospective, multicenter study

“…A piecewise linear regression model was used to evaluate patient SNOT-22 outcomes at early (baseline to 2 years) and late (2-5+ years) time window to account for an inflection in SNOT-22 total scores observed at 1-2 years as noted in our group's previously published findings. 20 Individual models were developed for each subdomain of the SNOT-22. Scores were treated as continuous outcome variables with score ranges for each subdomain as follows: rhinologic: 0-30, extra-nasal rhinologic: 0-15, ear/facial: 0-25, psychological dysfunction: 0-35, and sleep dysfunction: 0-25.…”

“…For this study, the postoperative timepoints were defined as follows: baseline (pretreatment), acute (3 months posttreatment), short term (6-9 months post treatment), medium term (1-2 years posttreatment), and long term (2-5 years posttreatment), as depicted in our prior studies. 20…”

“…Recently, the Cole-Reagins Registry for Sinonasal Cancer (CORSICA) published on long-term QOL trends in patients with SNM based on the 22-item Sino-Nasal Outcome Test and University of Washington Quality of Life Questionnaire (UWQOL). 20 Findings from this multi-institutional collaboration identified significant baseline QOL deficits, improvement from 3 months up to 5 years post-treatment, and worsened QOL associated with adjuvant radiation, neck dissection, and pterygopalatine involvement. 20 In the present study, we aim to perform a detailed assessment of sinonasal QOL outcomes based on SNOT-22 subdomains to identify the factors that drive these changes in patients who have undergone treatment with curative intent for SNM.…”

The role of induction chemotherapy for orbital invasion in sinonasal malignancies: A systematic review

“…8 However, OE carries significant morbidity and decreased quality of life. [9][10][11] Recently, multimodal therapies to achieve improved survival without OE has been investigated. One approach is the use of induction chemotherapy (IC), a promising treatment modality that may allow for OP treatment without compromising patient oncologic outcomes.…”

Utility of hospital frailty risk score in predicting postoperative outcomes of sinonasal malignancies

“…Sinonasal malignancies often involve critical structures such as the skull base, orbit, and carotid artery. 1 Considering the significant risk of surgical resection, a comprehensive preoperative risk stratification index is needed to prognosticate and pre-habilitate patients. 2 While various tools are available to stratify patients for risk of postoperative outcomes, frailty has emerged as a strong predictor as it converges on a variety of physical, psychological, and socioeconomic factors.…”