A comparison between surgery plus radiotherapy and exclusive chemoradiation therapy regimes in oral and oropharyngeal cancer: Long-term functional and psychological impact.

Abstract

5575 Background: Treatment of head and neck tumors negatively affects speech, swallowing, and quality of Life (QoL). Our aim was the evaluation of QoL and psychological functioning comparing surgery + radiotherapy (S+RT) and exclusive chemo-radiation therapy (CH-RT) regimes. Methods: Seventy-two patients, homogeneous for demographic and TNM characteristics were affected by a tumor of oral cavity and oropharynx; 36 underwent S+RT and 36 received exclusive CH-RT. Late effects of treatment and psycho-oncological assessment included: Radiation Therapy Oncology Group (RTOG)-European Organisation for Research and Treatment of Cancer (EORTC) late radiation morbidity scoring system, DISCHE morbidity recording scheme, Hospital Anxiety and Depression Scale (HADS), Montgomery Asberg Depression Rating Scale (MADRS), Mini Mental Adjustment to Cancer (MINI MAC), EORTC QoL Head and Neck35, Karnofky performance status, Visual Analogue Scales for dysphonia, dysphagia, dysmorphism and pain and Goodenough-Harris Draw a Person Test (DAP). Results: After median follow-up of 63 months, moderate-severe DISCHE score in S+RT vs. CT+RT was: taste impairment (64% vs. 89%), salivary function (59% vs. 79%), subcutaneous fibrosis (97% vs. 75%). Long term dysphagia: some discomfort (22% vs. 39%), soft diet required (42% vs. 28%), fluids only and naso-gastric tube feeding (11% vs. 4%); patients with severe dysphagia and taste impairment showed higher levels of anxiety (p<0.05): dysphagia influences the QoL, fatigue and physical-social functioning. Severe salivary function impairment is related only with troubles in social eating and contacts, without effects on QoL. MADRS depression was 56% vs. 46%, HADS anxiety was 22% vs. 21%. Just fair concordance in rate of depression between self-reported and clinician-rated scales was observed, with higher rates relieved in MADRS scale compared to HADS depression subscale (using 8 or 10 cut-off, Cohen's k test=0.401). Conclusions: A different pattern of long term toxicity was observed in S+RTvsCT+RT. Anxiety rate is lower, depression is present in half of patients and is statistically related with dysphagia. No significant financial relationships to disclose.