Integrating Quality of Life Metrics into Head and Neck Cancer Treatment Planning: Evidence and Implications

Improved Quality of Life (QOL) Outcomes in Patients With Head-and-Neck Squamous Cell Carcinoma (HNSCC) Treated With Intensity Modulated Radiation Therapy (IMRT) Compared to 3-dimensional Conformal Radiation Therapy (3D-CRT): Evidence From a Prospective Randomized Study

Impact of Radiation-Induced Xerostomia on Quality of Life After Primary Radiotherapy Among Patients With Head and Neck Cancer

Dynamic Change in Patient Reported Quality of Life is a Predictor for Survival in Localized Prostate Cancer: Exploratory Analysis from a Phase III Randomized Controlled Trial

e18615 Background: Multidisciplinary tumor boards are widely accepted as vehicles for improving patient outcomes in Head and Neck Cancer (HNC). Little work describes their structure and practices. The purpose of this study is to better understand the international practice patterns of multidisciplinary HNC tumor boards. Methods: A cross-sectional survey on head and neck cancer multidisciplinary tumor board practice patterns was developed by a panel of six experts and distributed internationally to HNC providers. The survey interrogated the attendance, participation, operation, and perceptions of multidisciplinary tumor conferences, through a mix of Likert-based, tick box and open-ended questions. Results: One hundred and twenty-three responses (55%) were received from 88 surgical oncologists, 17 radiation oncologists, and 18 medical oncologists from nine different countries. Overall, most HNC tumor boards are led by a surgeon (77%), and most commonly 5-10 minutes (61%) was spent on each case. In 60% of responses, all HNC patients were discussed at their tumor boards, while select cases were presented in 40% of responses. Pathology was routinely reviewed in 75% of sites and imaging reviewed in 95% of sites. In 75% of responses, sufficient time was felt to be spent on each case. Majority (75%) of tumor boards documented their recommendation, with 92% reporting that inability to reach a consensus recommendation was rare. When this occurred, the most common recourse was involving patient decision making (53%), followed by offline discussion until an agreement is reached (38%). Most respondents felt that tumor boards rarely altered the treatment plan (68%), while 37% felt the treatment plan was sometimes altered. Involvement of radiation and medical oncology prior to surgery varied, with 53% sending patients routinely, 32% sometimes, and 15% deferring referral. Logistics was cited as a primary barrier. Surgeons and radiation oncologists agree that the top three reasons tumor boards assist in cancer care are: receiving additional opinion and perspective, coordinating care, and communication. Medical oncologist also found tumor boards enhance clinical trial enrollment. Conclusions: While there are variations in the structure and process of multidisciplinary tumor boards, the majority of management is agreed upon by the treatment team. Areas of improvement include verification of cancer stage, identifying logistics that prevent timely and documentation of recommendations. Identifying the variations from most-common practice should provide a mechanism for improvement.

Osteoradionecrosis (ORN) is an aggressive sequela of head and neck cancer, the treatment of which focuses on functional restoration and quality of life (QoL). In this study, the authors aimed to identify risks for poor QoL in ORN reconstruction and build a chronologic, longitudinal framework for QoL. A prospective database of reconstructions performed by the senior author (F.C.W.) was reviewed from 2015 to 2023. QoL metrics (University of Washington QoL, version 4) were administered prospectively before surgery, 1 year postoperatively, and at each yearly follow-up. The study included 56 ORN patients with an average age of 58.2 years and mean radiation dose of 6412 Gy. Reconstruction was achieved most often with the fibula (55.4%) and anterolateral thigh flaps (37.5%). The total complication rate was 23.2% at a median period of 10.7 months postoperatively. Both health-related QoL in comparison with before the cancer diagnosis (62.5 versus 43.5; P = 0.030) and overall QoL during the past 7 days (50.5 versus 41.7; P = 0.029) were higher after ORN reconstruction than before. Physical QoL was rated higher before cancer reconstruction (79.0) than before ORN reconstruction (50.6; P < 0.001) and following reconstruction (52.5; P = 0.001). Social-emotional function was rated higher after ORN reconstruction compared with before reconstruction (68.7 versus 59.6; P = 0.010). Multivariate analysis showed that both postoperative social-emotional and physical function were affected by betel nut use ( P = 0.038; P = 0.025). Poor improvement in QoL from before to after ORN reconstruction was affected by maxilla involvement ( P = 0 .048) and fistula ( P = 0.004) and hardware issues ( P = 0.001). The authors' longitudinal experience trended toward a decline in QoL at ORN diagnosis, with gradual improvement following reconstruction and eventual significant improvement in social-emotional, pain, anxiety, chewing, and global QoL following surgery. Betel nut use was a risk factor for poor postoperative QoL. Maxillary involvement and postoperative fistula and hardware issues were risks for nonimprovement in QoL. Risk, III.

Comprehensive Geriatric Assessment as a Predictor of Quality of Life and Toxicity in Older Patients Receiving Radiation

Do Clinical Outcomes and Quality of Life Differ by the Number of Antianginals for Stable Ischemic Heart Disease? Insights from the BARI 2D Trial

This study evaluated the utility of self-reported quality of life (QOL) metrics in predicting mortality among all-comers with renal cell carcinoma (RCC) and externally tested the findings in a registry of patients with small renal masses. The Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) captured QOL metrics composed of mental component summary (MCS) and physical component summary (PCS) scores. Regression models assessed associations of MCS and PCS with all-cause, RCC-specific, and non-RCC-specific mortality. Harrell's concordance statistic (the C-index) and the Akaike information criterion (AIC) determined predictive accuracy and parsimony, respectively. Findings were tested in the prospective Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry. In SEER-MHOS, 1494 patients had a median age of 73.4 years and a median follow-up time of 5.6 years. Each additional MCS and PCS point reduced the hazard of all-cause mortality by 1.3% (95% CI, 0.981-0.993; P < .001) and 2.3% (95% CI, 0.971-0.984; P < .001), respectively. Models with QOL metrics demonstrated higher predictive accuracy (C-index, 72.3% vs 70.1%) and parsimony (AIC, 9376.5 vs 9454.5) than models without QOL metrics. QOL metrics exerted a greater effect on non-RCC-specific mortality than RCC-specific mortality. External testing in the DISSRM registry confirmed these findings with similar results for all-cause mortality. Models with self-reported QOL metrics predicted all-cause mortality in patients with RCC with higher accuracy and parsimony than those without QOL metrics. Physical health was a stronger predictor of mortality than mental health. The findings support the incorporation of QOL metrics into prognostic models and patient counseling for RCC.

Besides morbidity and mortality, quality of life (QoL) is a key outcome of cancer treatments. Trials on the basis of clinical outcomes have expectations that QoL outcomes can be either tolerated or improved. Simultaneously considering QoL and clinical outcomes is challenging with lack of suitable metrics allowing incorporation of QoL as coprimary end points in clinical trial design and utilization of hierarchical hypothesis testing. We propose combining time to achieving a minimal clinically important difference (MCID) and probabilities of a MCID occurring in each QoL domain to provide QoL metrics analogous to those used for clinical end points. For QoL domains of interest, these yield QoL profiles, time to MCID, and number needed to treat. Incorporation of QoL as coprimary end points in clinical trial designs through hierarchical hypothesis testing can easily be achieved. The noninferiority designed Laparoscopic Approach to Carcinoma of the Endometrium trial, evaluating laparoscopic versus open abdominal surgery for endometrial cancer with Functional Assessment of Cancer Therapy-General QoL domains, is used to illustrate the usefulness of these metrics. This analysis revealed that laparoscopic surgery had a significant shorter time to MCID for physical and functional well-being QoL domains (physical mean: 1.5 months, 95% CI, 0.5 to 2.6; P = .002; and functional mean: 1.4 months; 95% CI, 0.4 to 2.4; P = .003) than abdominal surgery, but little difference between the two approaches for psychologic social and emotion well-being. Probability profile plots show a consistent > 2-fold higher chance of attaining a MCID for physical and functional well-being over time for laparoscopic compared with abdominal surgery. This analysis reinforces the potential value of novel MCID metrics and their usefulness in raising the profile of QoL outcomes to complement clinical end points. The methods will allow health professionals to counsel patients about QoL outcomes and clinical outcomes simultaneously.

Comparison of hospital based and home based exercise on quality of life, and neck and shoulder function in patients with spinal accessary nerve injury after head and neck cancer surgery

This study evaluated post-treatment performance and quality of life (QOL) outcome in head and neck cancer (HNC) patients treated with organ preservation, intensive chemoradiotherapy (FHX). Participants were 47 Stage II-IV HNC patients with no evidence of disease at least one year post-completion of organ preservation, concomitant FHX treatment. Patients were assessed via a semi-structured in-person interview, standardized measures of QOL (FACT-H&N, CES-D), performance (PSS-HN) and patients' perception of residual side effects. Disease, treatment and toxicity data were retrieved from medical charts and protocol records. The most salient performance impairment was inability to eat a normal solid food diet, with 50% of patients able to eat soft foods or take liquids only. This specific functional deficit was not related to global QOL, nor to specific quality of life dimensions. Dry mouth, the most frequent and severe residual effect, was not associated with outcome diet, depression or QOL. Residual pain, seen in only 15% of patients, appeared to influence both functional and QOL parameters as well as being a marker for other troublesome symptoms. Twenty-three per cent of patients were depressed; depression was associated with past problems related to alcohol abuse. Decreased QOL and increased depressive symptomatology were related to total number and severity of residual effects. The data highlight the importance of systematic study of QOL dimensions and caution against making assumptions about patients' experience of particular disease and treatment sequelae.

Long-Term Quality of Life (QOL) After Chemo-IMRT for Locally Advanced Oropharyngeal Cancer (OPC): A Prospective Longitudinal Study

Collective Wisdom and Multidisciplinary Tumor Boards

875O - Quality of Life in a Randomised Double-Blind Phase III Trial of Cediranib (Azd2171) in Relapsed Platinum Sensitive Ovarian Cancer (Icon6)

Quality of life (QoL) is impaired in many cancer patients. The aim of this study was to test whether detriments in QoL were less pronounced in global assessments of QoL compared to more specific components. A total of 2059 cancer patients with mixed diagnoses were examined 6months after discharge from a cancer rehabilitation clinic. QoL was measured with the EORTC QLQ-C30, which contains a global QoL scale, and 14 functioning and symptom scales and symptom items. A sample of the general population (n=4476) served as controls. Regression analyses were performed to calculate expected mean scores for the patients, based on their age and gender distribution. Global QoL in the cancer sample (M=69.3) was nearly equal to that of the general population, while the mean scores of all functioning scales, symptom scales and symptom items showed markedly worse QoL. This general relationship between global and specific QoL was found for seven of eight cancer types. The results indicate that global QoL is not the sum of its parts. This should be considered when treatment effects on QoL are examined. One alternative is to use higher order summarising functioning and symptom scales.