Assessment of Optimal Time Points for Collection of Patient Reported Outcome Measures for Patients Undergoing Radical Radiotherapy for Head and Neck Cancer

Abstract

<h3>Purpose/Objective(s)</h3> Patient Reported Outcome Measures (PROMs) are validated questionnaires completed by patients to provide their perspective on their current state of health and quality of life (QoL). When used in clinical practice during radiotherapy (RT), PROMs can monitor adverse events allowing the early identification of patients who are struggling. The majority of studies assessing the collection of PROMs for patients with Head and Neck Cancer (HNC) have focused on the follow-up period. There are limited studies reporting collection during RT with limited data on the feasibility and relevance of timing for PROMs collection. We therefore aimed to (1) Assess the feasibility of PROMs collection during RT; (2) Identify appropriate time points for PROMs collection during RT. <h3>Materials/Methods</h3> Patients receiving a 6-week course of curative RT completed University of Washington (UWQOL) and MD Anderson Dysphagia Inventory (MDADI) questionnaires at baseline, weekly during RT (W1-6), weeks 2 and 6 post RT (W2POST, W6POST). PROMs were completed on paper (pPROMs) from July to December 2020, then electronically (ePROMs) until July 2021. Compliance was calculated as the number PROMs completed/number of PROMs distributed. Multivariable logistic regression was performed to assess the effect of age, treatment modality, smoking and employment status on compliance. <h3>Results</h3> 48 patients participated. The overall compliance was 73.8% (298/402); ePROMs 77.0% (188/244) and pPROMs 69.6% (110/158). Patients treated with RT were more likely to be compliant than those with CRT (OR 2.11, p = 0.011). Unemployed patients were less likely to be compliant compared to the employed (OR 0.258, p=0.003). Age and smoking status were not significant. Patients with compliance ≤70% reported more significant issues compared to those with >70% (24% vs 17%). For UWQOL, treatment modality affected the time point at which significant issues differed most compared with baseline: W2POST for CRT (10.7% vs 35.2%) and W6POST for RT (16.2% vs 34.8%). The maximal weekly increase in significant issues occurred between W2 and 3 for both CRT (+41.2%) and RT (+40.8%). At W3, the most frequently reported issue was dysgeusia in 55.0% (11/20) of patients treated with CRT. For RT, the most frequent issues related to swallowing and chewing (38.1% (8/21)). For MDADI mean composite scores, a clinically significant drop of ≥20 points from baseline occurred at W6POST for patients treated with CRT and at both W2POST and W6POST for RT. <h3>Conclusion</h3> The collection of PROMs appears feasible during RT and can be used to detect significant issues. The proportion of significant issues reported increases after W2 of treatment onwards. Therefore, collection of PROMs at baseline, W3 and W6, W2POST and W6POST would facilitate the identification and understanding of patients' needs. Future efforts should focus on the integration of PROMs into the clinical workflow.