ECOG-ACRIN 2399: analysis of patient related outcomes after Chemoradiation for locally advanced head and neck Cancer

Anthony Cmelak,Arlene Forastiere,Sheila Ridner,Shuli Li,David Cella,Barbara A Burtness,Mary S Dietrich,Barbara A Murphy

doi:10.1186/s41199-020-00059-1

Abstract

BackgroundWe conducted a correlative study for E2399, a function preservation trial for resectable locally advanced oropharynx and larynx cancer, to prospectively assess effects of chemoradiation (CCR) on quality of life (QOL), swallowing and voice. We correlated the results of swallow assessments done via questionnaires and objective assessments by modified barium swallow (MBS).MethodsThe Functional Assessment of Cancer-HN (FACT-HN), the Performance Status Scale – Head and Neck (PSS-HN), swallow assessments (including modified barium swallow studies), and voice assessments: Voice Handicap Index (VHI), the Voice Disability Assessment (VDA), and American Speech-Language Hearing Association’s Functional Communication Measure (FCM) were conducted at baseline and periodically post-treatment for 2 years.ResultsBaseline QOL and swallowing function predicted overall survival. Patients experienced a marked decrease in QOL, swallowing, and speech post CCR although the decrease in vocal function was modest. Function and QOL returned towards baseline in the majority of patients by 12 months post treatment. Less than 10% of patients had severe dysphagia and were PEG dependent at 12 months post treatment. There was a high degree of correlation between the FACT-HN and PSS-HN swallow items. Statistically significant correlations were found between subjective and objective measures of swallow function.ConclusionsPatients experience marked loss in swallowing function post CCR which returned to baseline in the majority of patients. The correlations between the FCM and self-report swallow items on the PSS and FACT-HN appear to be sufficiently strong to justify their use as a surrogate marker for swallowing disability in large therapeutic trials.

Highlights

An increasing number of patients with resectable cancer of the oropharynx or larynx are undergoing concomitant chemotherapy and radiation (CCR) in an effort to maximize survival and preserve function during and subsequent to cancer treatment [1]
Patient characteristics One hundred eleven patients with squamous cell carcinoma of the OP or L were accrued from March 16, 2001 until May 11, 2004
Less than 10% of patients had severe dysphagia at 12 months as scored using either the Functional Communication Measure (FCM) or the Dysphagia Outcome Severity Scale (DOSS), and very few patients were gastrostomy-tube dependent at 12 months

Summary

Introduction

An increasing number of patients with resectable cancer of the oropharynx or larynx are undergoing concomitant chemotherapy and radiation (CCR) in an effort to maximize survival and preserve function during and subsequent to cancer treatment [1]. CCR results in improved oncologic treatment outcomes relative to radiation alone; effects on swallowing and speech function are incompletely characterized and may adversely impact long-term quality of life (QOL) [2, 3]. Several symptom questionnaires, including the FACT-HN subscale and the EORTC H&N 35 [4, 5] have questions or subscales which address speech and swallowing function. These self-report measures had not been validated against objective measures of function. We conducted a correlative study for E2399, a function preservation trial for resectable locally advanced oropharynx and larynx cancer, to prospectively assess effects of chemoradiation (CCR) on quality of life (QOL), swallowing and voice. We correlated the results of swallow assessments done via questionnaires and objective assessments by modified barium swallow (MBS)

Methods

Results

Discussion

Conclusion