. 2017 Sep 9;12(1):150.

doi: 10.1186/s13014-017-0878-9.

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; Salman A Eraj^{1

2}, Mona K Jomaa¹, Crosby D Rock^{1

3}, Abdallah S R Mohamed^{1

4}, Blaine D Smith^{1

2}, Joshua B Smith^{1

2}, Theodora Browne¹, Luke C Cooksey^{1

5}, Bowman Williams¹, Brandi Temple^{1

5}, Kathryn E Preston^{1

5}, Jeremy M Aymard^{1

5}, Neil D Gross⁶, Randal S Weber⁶, Amy C Hessel⁶, Renata Ferrarotto⁷, Jack Phan¹, Erich M Sturgis^{6

8}, Ehab Y Hanna^{6

9}, Steven J Frank¹, William H Morrison¹, Ryan P Goepfert⁶, Stephen Y Lai⁶, David I Rosenthal¹, Tito R Mendoza¹⁰, Charles S Cleeland¹⁰, Kate A Hutcheson⁶, Clifton D Fuller^{1

11}, Adam S Garden¹, G Brandon Gunn^{12

13}

Affiliations

¹ Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
² School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, Houston, TX, USA.
³ School of Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA.
⁴ Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
⁵ Abilene Christian University, Abilene, TX, USA.
⁶ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁷ Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁸ Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁹ Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁰ 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.
¹² Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA. gbgunn@mdanderson.org.
¹³ Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. gbgunn@mdanderson.org.

PMID: 28888224
PMCID: PMC5591495
DOI: 10.1186/s13014-017-0878-9

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 et al. Radiat Oncol. 2017.

. 2017 Sep 9;12(1):150.

doi: 10.1186/s13014-017-0878-9.

Authors

Affiliations

¹ Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
² School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, Houston, TX, USA.
³ School of Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA.
⁴ Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
⁵ Abilene Christian University, Abilene, TX, USA.
⁶ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁷ Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁸ Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁹ Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁰ 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.
¹² Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA. gbgunn@mdanderson.org.
¹³ Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. gbgunn@mdanderson.org.

PMID: 28888224
PMCID: PMC5591495
DOI: 10.1186/s13014-017-0878-9

Erratum in

Correction to: 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; Eraj SA, Jomaa MK, Rock CD, Mohamed ASR, Smith BD, Smith JB, Browne T, Cooksey LC, Williams B, Temple B, Preston KE, Aymard JM, Gross ND, Weber RS, Hessel AC, Ferrarotto R, Phan J, Sturgis EM, Hanna EY, Frank SJ, Morrison WH, Goepfert RP, Lai SY, Rosenthal DI, Mendoza TR, Cleeland CS, Hutcheson KA, Fuller CD, Garden AS, Brandon Gunn G. MD Anderson Head and Neck Cancer Symptom Working Group, et al. Radiat Oncol. 2017 Nov 23;12(1):186. doi: 10.1186/s13014-017-0921-x. Radiat Oncol. 2017. PMID: 29169353 Free PMC article.

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.

Keywords: Oropharynx; Patient reported outcomes; Symptoms.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

MDACC Protocol ID #: DR09–0891.

Protocol Title: Prospective Data Collection of Symptom Burden in Patients Previously Treated for Head and Neck Cancer.

Official IRB Approval Date: 04/23/2010.

Official Activation Date: 07/15/2010.

It was noted that the protocol, informed consent documents (ICDs) and/or the Waivers of ICD and Authorization are satisfactory and in compliance with federal and institutional guidelines. It was also noted that risks to human subjects are minimal and that confidentiality of records will be maintained.

Consent for publication

Not applicable.

Competing interests

Dr. Fuller has received direct industry grant funding and speaker travel from Elekta AB for unrelated technical projects.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
Heat map depicting the proportion of patients experiencing each level of symptom severity (0–10) for the 22 individual MDASI-HN symptom items for the entire study cohort (n = 79)

**Fig. 2**
Heat map depicting the proportion of patients experiencing each level of symptom severity (0–10) for the 22 individual MDASI-HN symptom items for those with base of tongue versus tonsil primaries (panel a), those who had T1/2 versus T3/4 disease, and those who received CCRT versus those who did not (panel c). Figure legend adjacent to panel c applies to panels a-c

**Fig. 3**
Heat map of the severity ratings for the 22 individual MDASI-HN symptom items, for each individual patient (numbered 1–79), and grouped by hierarchal cluster analysis of patients with accompanying dendrogram (far right of the figure). Three patient clusters were identified (labelled A, B, and C). The dendrogram shows how similarly individual patients reported symptom severity across all 22 items. The lines that join further to the left side of the dendrogram suggest these patients reported similar symptom pattern and severity ratings

See this image and copyright information in PMC

References

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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

Affiliations

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

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical