Subjective functional outcomes in oropharyngeal cancer treated with induction chemotherapy using the MD Anderson Symptom Inventory (MDASI)

Abstract

Objectives: Evaluate the use of induction chemotherapy (IC) in oropharyngeal cancer (OPC) and its impact on subjective functional outcomes using a validated MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) survey tool. Methods: A single institution retrospective review of OPC patients who received IC, including reasons given for using IC, regimens employed, responses, and patientreported outcomes (PRO). The latter included pain, distress, dysphagia, xerostomia, and feeding tube placement and dependency. PRO's were assessed using the validated MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) conducted at baseline, during treatment, and at six-month follow up. Results: One hundred and twenty-five patients were evaluable. They were more likely to have large primary and/or bulky or low neck nodal disease as a reason for IC. A taxane-containing regimen was most common. Primary tumor response was seen in 83.2% and the nodal response in 81.6%. Pain and xerostomia improved with IC, dysphagia was not adversely affected with IC. These symptoms all increased with consolidation chemoradiotherapy (CRT) but returned to baseline by 6 months post treatment. Feeding tube placement did not increase with IC but did with CRT, most patients were no longer feeding tube dependent at 6 months. Conclusion: This retrospective review of subjective functional outcomes, especially swallowing and feeding tube dependency, using the MDASI survey tool in 125 oropharyngeal cancer patients with large primary tumors and/or bulky adenopathy treated predominantly with platinum-taxane based induction chemotherapy showed This study was conducted entirely at

Xerostomia: An easily ignored symptom induced by induction chemotherapy in patients with nasopharyngeal carcinoma

“…In those with oropharyngeal cancer (OPC), Mott FE et al also found that the baseline of xerostomia was observed in 42% of patients before IC, and the probability of patients reporting xerostomia after IC decreased to 36%. 14 Although <10% of the total saliva amount is secreted by the minor glands, it is important in lubricating the oral cavity. 10,18 In OPC patients, the baseline of xerostomia may be caused by the destruction of the minor glands owing to OPC cells.…”

“…Several previous studies regarding breast cancer have shown that chemotherapy may impair the submandibular gland (SMG), which produces two-thirds of the unstimulated saliva. 11,14 However, there was no prospective study to assess the prevalence of IC-related xerostomia in NPC patients. In light of this, this study aimed to investigate the prevalence and predictive factors of IC-related xerostomia for NPC patients.…”

“…In our clinical work, patients with NPC complained of xerostomia at night during IC, which was in an unstimulated state. Several previous studies regarding breast cancer have shown that chemotherapy may impair the submandibular gland (SMG), which produces two‐thirds of the unstimulated saliva 11,14 . However, there was no prospective study to assess the prevalence of IC‐related xerostomia in NPC patients.…”

Perioperative symptom burden and its influencing factors in patients with oral cancer: A longitudinal study

“…Similar results were also found by Mott et al, where pain, xerostomia, and dysphagia all increased with combined radiochemotherapy. 42 Both radiotherapy and chemotherapy are toxic and can damage the normal oral physiological structure and function of the oral cavity, increasing the symptom burdens. Patients with higher NRS scores exhibited more serious symptoms.…”

Novel Systemic Treatment Modalities Including Immunotherapy and Molecular Targeted Therapy for Recurrent and Metastatic Head and Neck Squamous Cell Carcinoma

“…R/M HNSCC that is not treatable with surgical resection or definitive radiotherapy is treated with palliative systemic therapy that includes platinum-based chemotherapy, cetuximab, and/or immune checkpoint inhibitors (ICIs) with anti-programmed death 1 (PD-1) antibodies ( Figure 1 ). Conventional therapy for locally advanced HNSCC often results in permanent impairments in chewing, swallowing, and tasting, along with a dry mouth, feeding tube dependence, and aspiration pneumonia [ 20 , 21 ]. These adverse events for survivors, coupled with the poor outcomes for R/M HNSCC, demonstrate the need for novel therapies with less toxicity and more efficacy.…”