Correlation of symptoms, quality of life, and functional status in head and neck cancer patients receiving radiation therapy ± chemotherapy

Abstract

20671 Background: Oral mucositis is a major side effect of radiation therapy (RT) to the head and neck. Few studies have reported the correlations of prevalent symptoms, quality of life (QOL), and functional status in this population. The purpose of this study is to increase our understanding of these issues. Methods: In this clinical trial testing an innovative mouthwash, symptoms (Symptom Checklists), functional status (Karnofsky Functional Status [KPS]), quality of life (QOL-CA), and the Oral Mucositis Assessment Scale (OMAS) subjective pain score were measured at four times (beginning of RT [T1], onset of mucositis [T2], end of RT [T3], and healing of mucositis [T4]) over an approximate 10-12 week period. Results: Forty-three head and neck cancer patients were enrolled at T1: 78% male, 62% white, 67% married; 15.3 mean education years; 44% employed full time; 58% squamous cell carcinoma; 98% received IMRT, 6463.9 cGY mean total radiation dose, 56% received concurrent CTX. Mean days to onset of mucositis were 15 (SD 6.6), and mean days to healing of mucositis were 60 days after T2 (SD 48.8). Mucositis pain scores (possible range 0–10) were moderate at T2 (x=3.5 SD 2.2) and T3 (x=4.4, SD 2.9). Overall QOL ranged from 6.9 to 7.4 (possible range 0–10); and KPS ranged from 76 to 86 (possible range 0–100). Patients reported 10 co-existing symptoms at T1, and 16 co-existing symptoms at other time points. Notably, > 50% of patients had three symptoms: ‘thirst’, ‘sleep problems’, and ‘fatigue’ at all time points. At T4, ‘dry mouth’, ‘thirst’, and ‘taste changes’ were the most prevalent (> 90% patients) followed by ‘fatigue’ and ‘lack of appetite’. Negative correlations existed between QOL and the number of symptoms at all four time points (r=-0.47 to -0.66, p<0.05), and between QOL and KPS (r=-0.37 to -0.62, p<0.05). The OMAS subjective pain score was significantly negatively correlated only with QOL, and only at T4 (r=-0.65, p<0.01). Conclusions: HNC patients experience multiple symptoms both during and after RT, these multiple symptoms are significantly and negatively associated with QOL and KPS. Therefore, it is important to provide supportive care during and beyond RT. No significant financial relationships to disclose.