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      Symptom Burden Associated With Late Lower Cranial Neuropathy in Long-term Oropharyngeal Cancer Survivors

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          Abstract

          <p class="first" id="d4994581e429">This cross-sectional survey study of oropharyngeal cancer survivors investigates the association of late lower cranial neuropathy with severity of cancer treatment–related symptoms and general functional impairment. </p><div class="section"> <a class="named-anchor" id="ab-ooi180058-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d4994581e435">Question</h5> <p id="d4994581e437">What is the association between late lower cranial neuropathy and severity of cancer treatment–related symptoms and general functional impairment among long-term oropharyngeal cancer survivors? </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180058-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d4994581e440">Findings</h5> <p id="d4994581e442">In this cross-sectional survey study of 889 oropharyngeal cancer survivors, those with late lower cranial neuropathy reported significantly worse cancer treatment–related symptoms compared with those without late lower cranial neuropathy. </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180058-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d4994581e445">Meaning</h5> <p id="d4994581e447">Further efforts may be necessary to lessen symptom burden associated with late lower cranial neuropathy experienced by oropharyngeal cancer survivors. </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180058-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d4994581e451">Importance</h5> <p id="d4994581e453">Lower cranial neuropathy (LCNP) is a rare but potentially disabling result of radiotherapy and other head and neck cancer therapies. Survivors who develop late LCNP may experience profound functional impairment, with deficits in swallowing, speech, and voice. </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180058-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d4994581e456">Objective</h5> <p id="d4994581e458">To investigate the association of late LCNP with severity of cancer treatment–related symptoms and subsequent general functional impairment among oropharyngeal cancer (OPC) survivors. </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180058-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d4994581e461">Design, Setting, and Participants</h5> <p id="d4994581e463">This cross-sectional survey study analyzed 889 OPC survivors nested within a retrospective cohort of OPC survivors treated at MD Anderson Cancer Center from January 1, 2000, to December 31, 2013. Eligible survey participants were disease free and completed OPC treatment 1 year or more before the survey. Data analysis was performed from October 10, 2017, to March 15, 2018. </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180058-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d4994581e466">Exposures</h5> <p id="d4994581e468">Late LCNP defined by onset 3 months or more after cancer therapy.</p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180058-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d4994581e471">Main Outcomes and Measures</h5> <p id="d4994581e473">The primary outcome variable was the mean of the top 5 most severely scored symptoms of all 22 core and head and neck cancer–specific symptoms from the MD Anderson Symptom Inventory Head and Neck Cancer Module (MDASI-HN). Secondary outcomes included mean MDASI-HN interference scores and single-item scores of the most severe symptoms. Multivariate models regressed MDASI-HN scores on late LCNP status, adjusting for clinical covariates. </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180058-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d4994581e476">Results</h5> <p id="d4994581e478">Overall, 36 of 889 OPC survivors (4.0%) (753 [84.7%] male; 821 [92.4%] white; median [range] age, 56 [32-84] years; median [range] survival time, 7 [1-16] years) developed late LCNP. Late LCNP was significantly associated with worse mean top 5 MDASI-HN symptom scores (coefficient, 1.54; 95% CI, 0.82-2.26), adjusting for age, survival time, sex, therapeutic modality, T stage, subsite, type of radiotherapy, smoking, and normal diet before treatment. Late LCNP was also significantly associated with single-item scores for difficulty swallowing or chewing (coefficient, 2.25; 95% CI, 1.33-3.18), mucus (coefficient, 1.97; 95% CI, 1.03-2.91), fatigue (coefficient, 1.35; 95% CI, 0.40-2.21), choking (coefficient, 1.53; 95% CI, 0.65-2.41), and voice or speech symptoms (coefficient, 2.30; 95% CI, 1.60-3.03) in multivariable models. Late LCNP was not significantly associated with mean interference scores after correction for multiple comparisons (mean interference coefficient, 0.72; 95% CI, 0.09-1.35). </p> </div><div class="section"> <a class="named-anchor" id="ab-ooi180058-10"> <!-- named anchor --> </a> <h5 class="section-title" id="d4994581e481">Conclusions and Relevance</h5> <p id="d4994581e483">In this large survey study, OPC survivors with late LCNP reported worse cancer treatment–related symptoms, a finding suggesting an association between late LCNP and symptom burden. This research may inform the development and implementation of strategies for LCNP surveillance and management. </p> </div>

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              Cancer and its treatment produce multiple symptoms that significantly distress patients and impair function. Symptoms caused by treatment may delay treatment or lead to premature treatment termination, and residual treatment-related symptoms often complicate posttreatment rehabilitation. When treatment is no longer possible, symptom control becomes the focus of cancer care. Patient ratings of symptom severity and impact are important patient-reported outcomes (PROs) in cancer clinical trials and comprise a subset of a larger domain of PROs generally referred to as health-related quality of life (HRQOL). Symptoms rarely occur in isolation; rather, there is now ample evidence that symptoms frequently occur in clusters. The impact of these multiple symptoms upon the patient can be described as "symptom burden," a concept that encompasses both the severity of the symptoms and the patient's perception of the impact of the symptoms. The distress caused by symptoms is a subject of much investigation, and several validated measures of the severity and impact of multiple symptoms are now available. Symptom measures are generally brief, thereby reducing respondent burden, and can be administered repeatedly during a trial to give a relatively fine-grained picture of the patient's status across time. In many instances, information on trial-related changes in symptom burden, or comparison of symptom burden between arms in a clinical trial, may provide sufficient self-report data for clinical trial consumers (patients, clinicians, and regulators) to make treatment choices or to evaluate new therapies, without measuring other HRQOL domains.
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                Author and article information

                Journal
                JAMA Otolaryngology–Head & Neck Surgery
                JAMA Otolaryngol Head Neck Surg
                American Medical Association (AMA)
                2168-6181
                November 01 2018
                November 01 2018
                : 144
                : 11
                : 1066
                Affiliations
                [1 ]Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
                [2 ]Division of Epidemiology & Disease Control, School of Public Health, The University of Texas, Houston
                [3 ]Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston
                [4 ]Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
                Article
                10.1001/jamaoto.2018.1791
                6248190
                30193299
                9c310736-88a4-4ceb-bf23-c37ebdcb6175
                © 2018
                History

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