Original ArticleBaseline MD Anderson Symptom Inventory Score is Strongly Associated With Patient-reported Acute and Late Toxicity Following (Chemo) Radiotherapy for Head and Neck Cancers
Introduction
The effects of head and neck cancer (HNC) can be diverse depending on subsite and stage at diagnosis. Many patients present with marked symptoms of pain and swallowing dysfunction due to local tumour growth [1,2]. Radiotherapy, with or without concurrent chemotherapy, is commonly part of curative treatment but is known to be particularly detrimental to salivary function, taste and the muscles of mastication and swallowing. The combination of these disease and treatment factors can negatively impact on long-term symptom burden [[3], [4], [5], [6]] and quality of life [[7], [8], [9]].
Increasingly, patient-reported outcome measures (PROMs) are mandated in randomised head and neck radiotherapy trials and may be used as primary end points [10,11]. Despite this, PROMs may lack sensitivity, with only a small minority of phase III trials demonstrating a clinically significant change in PROM scores between treatment arms [12]. This is probably, in part, due to patient-reported symptoms being a consequence of a number of factors in addition to treatment received. The ability to better control for these factors may improve the sensitivity of PROMs to detect symptom benefit from treatment modifications. It is known that baseline symptom burden is associated with overall survival [13], but its association with acute and late patient-reported symptoms following modern radiotherapy for HNC is not reported. We hypothesise that baseline symptom score is associated with PROMs evolution following treatment and may be an effective stratification factor for assessing treatment effects.
This study assessed the association of baseline PROMs score with acute and late PROM scores following (chemo)radiotherapy for HNC and compared this with other factors previously reported to be associated with PROMs score evolution.
Section snippets
Materials and Methods
All data analysis was carried out following institutional board approval and was compliant with UK research governance (ref. 17/NW/0060). Patients under the care of two clinical oncology consultants and undergoing definitive or adjuvant treatment for HNC with (chemo)radiotherapy (±surgery) were invited as part of their standard of care treatment to complete a PROM at baseline and at subsequent appointments following treatment. Time periods after treatment were measured from the last day of
Patient Characteristics
For the period 2016–2019, a total of 247 eligible patients completed baseline and at least one follow-up MDASI questionnaire and remained disease free at the time of analysis. Patient characteristics are summarised in Table 1. A small number of patients did not complete each single symptom or interference severity scale (either at baseline or on their follow-up forms). The number of patients included for each item analysis is indicated in the relevant figures.
In total, 206 (83%) patients had 30
Conclusion
This analysis found that in patients treated with (chemo)radiotherapy for HNC, baseline reported symptom and interference severity score is the factor most strongly associated with change in PROMs score up to 1 year post-treatment. On average, for patients who present with a moderate or high symptom score at baseline, an early and durable benefit to reported symptoms following (chemo)radiotherapy is experienced. This finding is of value for pre-treatment discussions with patients and has
Conflicts of interest
The authors declare no conflict of interest.
Author contributions
CB was responsible for literature research, experimental studies/data analysis, manuscript preparation and manuscript editing. GP was responsible for experimental studies/data analysis, statistical analysis, manuscript preparation and manuscript editing. LL was responsible for clinical studies and manuscript editing. AMcP is the guarantor of integrity of the entire study and was responsible for clinical studies, study concepts and design, manuscript preparation and manuscript editing.
Acknowledgements
Gareth Price was supported by Cancer Research UK via funding to the Cancer Research Manchester Centre [C147/A25254] and RadNet Manchester [C1994/A28701].
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