The symptom burden of treatment‐naive patients with head and neck cancer

Abstract

Background Treatment for head and neck cancer (HNC) may cause substantial local and systemic symptomatic morbidities, but many patients have high symptom levels before treatment begins. Knowledge of disease-related (treatment-naive) symptom status would aid evaluation of the symptomatic benefit or burden of HNC therapies. Methods We retrospectively examined symptoms, quality of life, and health status reported by HNC patients who were naïve to any treatment. We explored symptoms by anatomical site and correlated disease factors with symptom severity and interference. We used a clustering algorithm to identify a subset of highly symptomatic patients and examined the effects of disease site, tumor stage, and demographic variables on membership in this high-symptom group. Results We identified 748 treatment-naïve patients with mucosal (n=434), nonmucosal (n=272), or skull-base (n=42) tumors who had rated symptoms using the MD Anderson Symptom Inventory. Most were white non-Hispanic (82%) and male (68%) with a median age of 59 years. Approximately one third had high pretreatment symptom burden. Pain, fatigue, distress, and disturbed sleep were the most-severe symptoms, regardless of tumor stage or site. Symptom burden was higher in patients with more-advanced disease. Predictors of high symptom burden included having a mucosal tumor and being female. Conclusions The high prevalence of moderate-to-severe symptoms in this study demonstrates the importance of assessing patient-reported symptoms routinely before treatment is initiated and emphasizes the need for symptom management in parallel with disease treatment. Baseline characterization of symptom status should be incorporated into clinical trials that may affect symptom burden.

Cohort study of oncologic emergencies in patients with head and neck cancer

“…A recent study found that HNC patients with lymph node metastases were more likely to report severe pretreatment pain compared to patients without lymph node involvement, and that this was significantly correlated with measures of overall quality of life and increased symptom burden. 4 Pre-treatment pain has been associated with poorer overall survival in patients with HNSCC 18 thus suggesting the need for prompt pain treatment and management.…”

“…10 This study identifies gastrointestinal symptoms as the primary reason for emergency department presentation and one of the primary discharge diagnoses in this population, consistent with known symptoms of head and neck cancer treatment. 4,11,12 Dysphagia (impairment of the swallowing process) is common in patients with HNSCC, and is often underdiagnosed and improperly treated, 13 resulting in dehydration and malnutrition 14 and may necessitate the use of nonoral nutritional support. A recent study aimed at understanding the management and prevention of acute and late effects because of head and neck cancer therapy, in particular, treatment associated effects related to swallowing, suggested that precautions can be taken before, during, and after treatment in order to minimize the impact of dysphagia.…”

“…3 However, these treatments are associated with significant toxicities that compromise patient functionality and quality of life and present significant management challenges for the clinical staff. 2,4 Emergency departments are now a frequent site of care for many patients with cancer. 5 Visiting the emergency department may potentially reflect inadequacy in addressing or managing expected side effects or complications during routine care.…”

Association between patients' perception of the comorbidity burden and symptoms in outpatients with common solid tumors

“…We defined the symptom burden as the number of severe symptoms rated as 7 on the MDASI's 0 to 10 scale on the basis of results from various studies. 18,20…”

Psychometric Validation of the M. D. Anderson Symptom Inventory–Head and Neck Module in the Spanish Language

“…Commonly, head and neck tumors produce many symptoms and disturbances in patients. In a recent study with 748 head and neck cancer patients, Hanna et al 1 demonstrated that more than 30% of treatment-na€ ıve patients reported moderate to severe symptoms related to sleep disturbances, distress, and fatigue. Gunn et al 2 also demonstrated that specific symptoms related to tasting, swallowing, speech, and mucus in the throat can increase in frequency by three-to seven-fold after treatment.…”