Impact of tobacco and alcohol use on HRQOL in patients with advanced head and neck cancer: Results from a community oncology database.

Abstract

e17512 Background:Tobacco and heavy alcohol use are important risk factors for head and neck (H&N) cancer. H&N cancer may affect activities of daily life (eg, eating, drinking, swallowing), and can be debilitating to health-related quality of life (HRQOL). This study reports HRQOL findings for patients (pts) with advanced H&N cancer eligible for systemic treatment in multimodality or palliative care. Methods:Medical records from pts diagnosed 1/1/2007–10/1/2015 with stage III–IVc H&N cancer and ≥1 disease progression were retrospectively collected from 10 US community oncology practices. We evaluated specific items and composite measures (physical symptoms, treatment effects, distress, despair, ambulation, and performance) with the Patient Care Monitor (PCM), an 86-item pt-recorded outcomes survey. Linear mixed models (LMM) assessed prespecified effects (eg smoking, alcohol use) and change over time across 2 lines of therapy. Results: The study included 462 pts (median age, 61 y; range, 26–99 y). Of these, 81% were male, 77% white, and 21% African American. The most common tumor locations were hypopharynx/larynx (31.1%) and oropharynx (30.9%). Overall, 41.8% of pts were current tobacco users and 22.3% were current or past alcohol abusers/excessive users. No significant difference was observed for receipt of surgery or radiation therapy in the first or second line for either alcohol or tobacco use. Approximately 1240 PCM surveys were collected from 146 pts. LMM showed effects for past tobacco use vs never/undocumented use for sore throat (1.31), dry mouth (1.46), and changes in taste (1.57); P< 0.05. Effects were seen for alcohol use for increased trouble swallowing (1.87; P= 0.01) among current or past abusers/excessive vs never/undocumented users. LMM showed no impacts of tumor location. Models of composite scores showed that after progression, worsening was seen over time for despair (0.57; P= 0.03), impaired ambulation (0.81; P= 0.05) and performance (0.66; P= 0.05). Conclusions: The study showed smoking and alcohol use were associated with worsening clinical symptoms in pts with advanced H&N cancer. Certain composite scores for symptom burden also worsened with progression.