Patient preferences for oropharyngeal cancer treatment de‐escalation

Brotherston, Drew; Poon, Ian; Le, Tuyen; Leung, Martin; Kiss, Alex; Ringash, Jolie; Balogh, J; Lee, Justin; Wright, James R.

doi:10.1002/hed.22930

Cited by 56 publications

(39 citation statements)

References 68 publications

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“…It has been shown that late dysphagia was the major correlate of decreased QoL [42], and before and after treatment patients prioritize swallowing abilities among other functional outcomes [43]. Scientific literature about patient preferences in head and neck oncology is scarce outside of larynx preservation [44] but when asked about their preferences, head and neck cancer patients ultimately prioritize survival over QoL [45]. It might be hypothesized, although this remains to be proven, that the reduction of subacute and chronic side effects observed in IMPT patients could reduce some of the costs associated with the delivery of this advanced technique [39].…”

Section: Discussionmentioning

confidence: 99%

Intensity-modulated proton beam therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for patients with oropharynx cancer – A case matched analysis

Blanchard

Garden

Gunn

et al. 2016

Radiotherapy and Oncology

192

152

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Background Due to its physical properties, intensity-modulated proton therapy (IMPT) used for oropharyngeal carcinoma patients has the ability to reduce the dose to organs at risk compared to intensity-modulated radiotherapy (IMRT) while maintaining adequate tumor coverage. Our aim was to compare the clinical outcomes of these two treatment modalities. Methods We performed a 1:2 matching of IMPT to IMRT patients. Our study cohort consisted of IMPT patients from a prospective quality of life study and consecutive IMRT patients treated at a single institution during the period 2010–2014. Patients were matched on unilateral/bilateral treatment, disease site, HPV status, T and N stages, smoking status and receipt of concomitant chemotherapy. Survival analyzes were performed using a Cox model and binary toxicity endpoints using a logistic regression analysis. Results Fifty IMPT and 100 IMRT patients were included. The median follow-up time was 32 months. There were no imbalances in patient/tumor characteristics with the exception of age (mean age of 56.8 years for IMRT patients and 61.1 years for IMPT patients, p-value = 0.010). Statistically significant differences were not observed in overall survival (hazard ratio (HR) = 0.55; 95% confidence interval (CI): 0.12–2.50, p-value = 0.44) or in progression free survival (HR = 1.02; 95% CI: 0.41–2.54; p-value = 0.96). The age-adjusted odds ratio (OR) for the presence of a Gastrostomy (G)-tube during treatment and at 3 months post-treatment are respectively (OR = 0.53; 95%CI: 0.24–1.15; p-value = 0.11) and (OR = 0.43; 95%CI: 0.16–1.17; p-value = 0.10). When considering the pre-planned composite endpoint of grade 3 weight loss or G-tube presence, the odds ratios at 3 months and 1 year were respectively (OR = 0.44; 95%CI: 0.19–1.0; p-value = 0.05) and (OR = 0.23; 95%CI: 0.07–0.73; p-value = 0.01). Conclusion Our results suggest that IMPT is associated with reduced rates of feeding tube dependency and severe weight loss without jeopardizing outcome. Prospective multicenter randomized trials are needed to validate such findings.

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Section: Discussionmentioning

confidence: 99%

Intensity-modulated proton beam therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for patients with oropharynx cancer – A case matched analysis

Blanchard

Garden

Gunn

et al. 2016

Radiotherapy and Oncology

192

152

View full text Add to dashboard Cite

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“…When studying de‐escalation, however, it is important to re‐emphasize the need for equivalent disease control. A structured interview of advanced‐stage OPSCCA patients receiving concurrent CRT has shown that patients are only willing to accept a maximum of 5% reduction in survival to mitigate treatment‐related complications . Survival analysis of over 43,000 OPSCCA patients from 1998 to 2009 had demonstrated improved survival with surgery or CRT compared to radiation therapy alone, highlighting the ability to choose between the two with respect to overall survival (OS) outcome.…”

Section: Introductionmentioning

confidence: 99%

The impact of transoral robotic surgery on the overall treatment of oropharyngeal cancer patients

et al. 2015

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“…1,7 Although the standard treatment for HPV-positive and HPV-negative oropharyngeal cancer continues to be similar, prospective trials are under way to determine whether therapy can be stratified solely on the basis of HPV status. 8–10 …”

mentioning

confidence: 99%

Competing Causes of Death and Medical Comorbidities Among Patients With Human Papillomavirus–Positive vs Human Papillomavirus–Negative Oropharyngeal Carcinoma and Impact on Adherence to Radiotherapy

Hess

Rash

Daly

et al. 2014

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Survival of patients with head and neck cancer can be affected by competing causes of mortality, as well as comorbidities that result in radiation treatment interruptions. OBJECTIVE To discern how differences in preexisting medical and psychosocial comorbidities potentially influence adherence to radiation therapy according to human papillomavirus (HPV) status. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis at a comprehensive cancer center of 162 consecutive patients with locally advanced squamous cell carcinoma of the oropharynx treated with primary chemoradiation (n = 95) or primary surgery followed by adjuvant radiation (n = 67). Immunostaining for p16 was used to determine HPV status. MAIN OUTCOMES AND MEASURES Difference in alcohol, tobacco, and marijuana use was compared between patients with HPV-positive and HPV-negative tumors, as well as the prevalence of the following comorbidities: diabetes mellitus, chronic obstructive pulmonary disease (COPD), anxiety disorder, and major depression. The number of total missed treatment days was analyzed as both a continuous and categorical variable. RESULTS Rates of self-reported heavy alcohol use (47% vs 16%; P = .02) and any marijuana use (47% vs 23%; P = .003) were significantly higher among HPV-negative patients. Fifty-four percent of HPV-positive patients self-identified as never smokers, compared with only 12% of HPV-negative patients (P < .001). HPV-negative patients had more missed treatment days (mean, 2.8 vs 1.7 days; P = .02), as well as an increased rate of at least 5 missed days (24% vs 10%; P = .04), and higher prevalences of COPD (12% vs 7%; P = .37) and anxiety disorder (12% vs 6%; P = .35). CONCLUSIONS AND RELEVANCE Pronounced differences exist in lifestyle habits between patients with HPV-negative and HPV-positive oropharyngeal cancer at diagnosis. These differences, as well as those of medical and psychosocial burden, may contribute to observed discrepancies in treatment adherence and need to be considered in outcomes reporting and clinical trial design.

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Patient preferences for oropharyngeal cancer treatment de‐escalation

Abstract: Patients accept little difference in survival between treatments to avoid toxicity.

Cited by 56 publications

References 68 publications

Intensity-modulated proton beam therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for patients with oropharynx cancer – A case matched analysis

Intensity-modulated proton beam therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for patients with oropharynx cancer – A case matched analysis

The impact of transoral robotic surgery on the overall treatment of oropharyngeal cancer patients

Competing Causes of Death and Medical Comorbidities Among Patients With Human Papillomavirus–Positive vs Human Papillomavirus–Negative Oropharyngeal Carcinoma and Impact on Adherence to Radiotherapy

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