<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.
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<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?
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<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.
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<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.
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<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.
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<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.
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<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.
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<h5 class="section-title" id="d4994581e466">Exposures</h5>
<p id="d4994581e468">Late LCNP defined by onset 3 months or more after cancer therapy.</p>
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<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.
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<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).
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<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.
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