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      Long-term patient reported outcomes following radiation therapy for oropharyngeal cancer: cross-sectional assessment of a prospective symptom survey in patients ≥65 years old

      MD Anderson Head and Neck Cancer Symptom Working Group, 1 , 2 , 1 , 1 , 3 , 1 , 4 , 1 , 2 , 1 , 2 , 1 , 1 , 5 , 1 , 1 , 5 , 1 , 5 , 1 , 5 , 6 , 6 , 6 , 7 , 1 , 6 , 8 , 6 , 9 , 1 , 1 , 6 , 6 , 1 , 10 , 10 , 6 , 1 , 11 , 1 , , 1 , 9

      Radiation Oncology (London, England)

      BioMed Central

      Oropharynx, Symptoms, Patient reported outcomes

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Given the potential for older patients to experience exaggerated toxicity and symptoms, this study was performed to characterize patient reported outcomes in older patients following definitive radiation therapy (RT) for oropharyngeal cancer (OPC).

          Methods

          Cancer-free head and neck cancer survivors (>6 months since treatment completion) were eligible for participation in a questionnaire-based study. Participants completed the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). Those patients ≥65 years old at treatment for OPC with definitive RT were included. Individual and overall symptom severity and clinical variables were analyzed.

          Results

          Of the 79 participants analyzed, 82% were male, 95% white, 41% T3/4 disease, 39% RT alone, 27% induction chemotherapy, 52% concurrent, and 18% both, and 96% IMRT. Median age at RT was 71 yrs. (range: 65–85); median time from RT to MDASI-HN was 46 mos. (2/3 > 24 mos.). The top 5 MDASI-HN items rated most severe in terms of mean (±SD) ratings (0–10 scale) were dry mouth (3.48 ± 2.95), taste (2.81 ± 3.29), swallowing (2.59 ± 2.96), mucus in mouth/throat (2.04 ± 2.68), and choking (1.30 ± 2.38) reported at moderate-severe levels (≥5) by 35, 29, 29, 18, and 13%, respectively. Thirty-nine % reported none (0) or no more than mild (1–4) symptoms across all 22 MDASI-HN symptoms items, and 38% had at least one item rated as severe (≥7). Hierarchical cluster analysis resulted in 3 patient groups: 1) ~65% with ranging from none to moderate symptom burden, 2) ~35% with moderate-severe ratings for a subset of classically RT-related symptoms (e.g. dry mouth, mucus, swallowing) and 3) 2 pts. with severe ratings of most items.

          Conclusions

          The overall long-term symptom burden seen in this older OPC cohort treated with modern standard therapy was largely favorable, yet a higher symptom group (~35%) with a distinct pattern of mostly local and classically RT-related symptoms was identified.

          Electronic supplementary material

          The online version of this article doi: (10.1186/s13014-017-0878-9) contains supplementary material, which is available to authorized users.

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          Most cited references 23

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          The Performance Status Scale for Head and Neck Cancer Patients and the Functional Assessment of Cancer Therapy-Head and Neck Scale. A study of utility and validity.

          The goal of this investigation was to examine the relationship between, and application of, two disease specific quality of life (QL) measures currently being employed for head and neck cancer patients: the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT-H&N) and the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN). The FACT-H&N and PSS-HN were administered to 151 head and neck cancer patients with a range of disease sites, treatment status (on vs. off treatment), and treatment modalities (surgery, radiation, and chemotherapy). FACT-H&N subscale and total scores and PSS-HN subscale scores proved sensitive to patients groups (showed significant and clinically meaningful differences) on the basis of treatment status (on vs. off treatment) and global performance status (Karnofsky scores). The pattern of correlations between FACT-H&N and PSS-HN subscales supported the scales' construct (convergent vs. divergent) validity. The strongest and most significant associations were observed between PSS-HN Normalcy of Diet and Eating in Public, and the head and neck subscale (HNS) of FACT-H&N, both of which were designed to measure the unique problems of head and neck cancer patients. More modest associations were observed between subscales measuring physical and functional areas of performance, social functioning, and emotional well-being. The FACT-HNS was found to be reliable and valid when applied to head and neck cancer patients. It clearly adds information to that collected by the parent (core) instrument. The PSS-HN also provides unique information, independent of that provided by the Karnofsky or the FACT-H&N. This study supported the multidimensional nature of QL for head and neck cancer patients, and thus the importance of assessing disease specific concerns in addition to general health status when assessing functional and QL outcome.
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            Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer.

            By using the age-adjusted Charlson comorbidity index (ACCI), the authors characterized the impact of age and comorbidity on disease progression and overall survival after radical cystectomy (RC) for transitional cell carcinoma of the bladder. Also evaluated was whether ACCI was associated with clinicopathologic and treatment characteristics. The authors evaluated 1121 patients treated by RC for transitional cell carcinoma of the bladder at a single institution (1990-2004). Logistic regression was used to determine the relation between ACCI and clinical features. They evaluated the association between ACCI and overall and progression-free survival by using multivariate survival-time models with pathologic stage and nodal status as covariates. ACCI scores increased during the study period (P = .009). Extravesical disease was present in 43% of patients with ACCI 5 (P = .051). Despite their higher prevalence of extravesical disease, patients with higher ACCI were less likely to have lymph-node dissection (odds ratio, 0.55 and 0.35, respectively, for ACCI 3-5 and >5 vs 5 vs
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              Toxicities affecting quality of life after chemo-IMRT of oropharyngeal cancer: prospective study of patient-reported, observer-rated, and objective outcomes.

              To test the hypothesis that intensity modulated radiation therapy (IMRT) aiming to spare the salivary glands and swallowing structures would reduce or eliminate the effects of xerostomia and dysphagia on quality of life (QOL). In this prospective, longitudinal study, 72 patients with stage III-IV oropharyngeal cancer were treated uniformly with definitive chemo-IMRT sparing the salivary glands and swallowing structures. Overall QOL was assessed by summary scores of the Head Neck QOL (HNQOL) and University of Washington QOL (UWQOL) questionnaires, as well as the HNQOL "Overall Bother" question. Quality of life, observer-rated toxicities (Common Toxicity Criteria Adverse Effects scale, version 2), and objective evaluations (videofluoroscopy assessing dysphagia and saliva flow rates assessing xerostomia) were recorded from before therapy through 2 years after therapy. Correlations between toxicities/objective evaluations and overall QOL were assessed using longitudinal repeated measures of analysis and Pearson correlations. All observer-rated toxicities and QOL scores worsened 1-3 months after therapy and improved through 12 months, with minor further improvements through 24 months. At 12 months, dysphagia grades 0-1, 2, and 3, were observed in 95%, 4%, and 1% of patients, respectively. Using all posttherapy observations, observer-rated dysphagia was highly correlated with all overall QOL measures (P<.0001), whereas xerostomia and mucosal and voice toxicities were significantly correlated with some, but not all, overall QOL measures, with lower correlation coefficients than dysphagia. Late overall QOL (≥6 or ≥12 months after therapy) was primarily associated with observer-rated dysphagia, and to a lesser extent with xerostomia. Videofluoroscopy scores, but not salivary flows, were significantly correlated with some of the overall QOL measures. After chemo-IMRT, although late dysphagia was on average mild, it was still the major correlate of QOL. Further efforts to reduce swallowing dysfunction are likely to yield additional gains in QOL. Copyright © 2013 Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                salman.a.eraj@uth.tmc.edu
                MKJomaa@mdanderson.org
                CDRock@mdanderson.org
                ASMohamed@mdanderson.org
                Blaine.D.Smith@uth.tmc.edu
                Joshua.B.Smith@uth.tmc.edu
                theob077@gmail.com
                lcc12a@acu.edu
                BWilliams4@mdanderson.org
                btemple@xula.edu
                kep11c@acu.edu
                jma12a@acu.edu
                NGross@mdanderson.org
                rsweber@mdanderson.org
                ahessel@mdanderson.org
                RFerrarotto@mdanderson.org
                jphan@mdanderson.org
                esturgis@mdanderson.org
                EYHanna@mdanderson.org
                sjfrank@mdanderson.org
                whmorrison@mdanderson.org
                RGoepfert@mdanderson.org
                SYLai@mdanderson.org
                dirosenthal@mdanderson.org
                tmendoza@mdanderson.org
                ccleeland@mdanderson.org
                KArnold@mdanderson.org
                CDFuller@mdanderson.org
                agarden@mdanderson.org
                (713) 563-2300 , gbgunn@mdanderson.org
                Journal
                Radiat Oncol
                Radiat Oncol
                Radiation Oncology (London, England)
                BioMed Central (London )
                1748-717X
                9 September 2017
                9 September 2017
                2017
                : 12
                Affiliations
                [1 ]ISNI 0000 0001 2291 4776, GRID grid.240145.6, Department of Radiation Oncology, Unit 97, , The University of Texas MD Anderson Cancer Center, ; 1515 Holcombe Boulevard, Houston, TX 77030 USA
                [2 ]ISNI 0000 0000 9206 2401, GRID grid.267308.8, School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, ; Houston, TX USA
                [3 ]GRID grid.449768.0, School of Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, ; El Paso, TX USA
                [4 ]ISNI 0000 0001 2260 6941, GRID grid.7155.6, Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, , University of Alexandria, ; Alexandria, Egypt
                [5 ]ISNI 0000 0000 9819 8422, GRID grid.251705.4, Abilene Christian University, ; Abilene, TX USA
                [6 ]ISNI 0000 0001 2291 4776, GRID grid.240145.6, Department of Head and Neck Surgery, , The University of Texas MD Anderson Cancer Center, ; Houston, TX USA
                [7 ]ISNI 0000 0001 2291 4776, GRID grid.240145.6, Department of Medical Oncology, , The University of Texas MD Anderson Cancer Center, ; Houston, TX USA
                [8 ]ISNI 0000 0001 2291 4776, GRID grid.240145.6, Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, , The University of Texas MD Anderson Cancer Center, ; Houston, TX USA
                [9 ]ISNI 0000 0001 2291 4776, GRID grid.240145.6, Department of Neurosurgery, Division of Surgery, , The University of Texas MD Anderson Cancer Center, ; Houston, TX USA
                [10 ]ISNI 0000 0001 2291 4776, GRID grid.240145.6, Department of Symptom Research, Division of Internal Medicine, , The University of Texas MD Anderson Cancer Center, ; Houston, TX USA
                [11 ]Medical Physics Program, The University of Texas Graduate School of Biomedical Sciences, Houston, TX USA
                Article
                878
                10.1186/s13014-017-0878-9
                5591495
                28888224
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: Stiefel Oropharyngeal Research Fund of the University of Texas MD Anderson Cancer Center Charles and Daneen Stiefel Center for Head and Neck Cancer
                Funded by: Family of Paul W. Beach
                Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;
                Award ID: 1R01DE025248-01
                Award ID: 1R01DE025248-01
                Award ID: 1R01DE025248-01
                Award ID: R03 CA188162
                Award Recipient :
                Funded by: National Institutes of Health (US)
                Award ID: 1R01DE025248-01
                Award Recipient :
                Funded by: National Science Foundation (US)
                Award ID: NSF 1557679
                Award Recipient :
                Funded by: National Cancer Institute (US)
                Award ID: R01CA214825-01
                Award Recipient :
                Funded by: Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program
                Award ID: P50CA097007-10
                Award Recipient :
                Funded by: Paul Calabresi Clinical Oncology Program Awards
                Award ID: K12 CA088084-06
                Award Recipient :
                Categories
                Research
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                © The Author(s) 2017

                Oncology & Radiotherapy

                oropharynx, symptoms, patient reported outcomes

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