Abstract
PurposeNeuroinflammation and central sensitization from cancer and its therapy may result in chronic systemic symptoms (CSS) such as fatigue, sleep disturbance, chronic widespread pain, mood disorders, neuropsychiatric symptoms, and temperature dysregulation. We undertook a cross-sectional study of CSS in head and neck cancer (HNC) survivors to determine their frequency, severity, and impact.MethodsHNC patients without evidence of recurrence who were at least 12 months post-treatment completed a one-time battery of self-report measures including the Vanderbilt Head and Neck Symptom survey plus the General Symptom Subscale, the Body Image Quality of Life Inventory, Neurotoxicity Rating Scale, the Profile of Mood States, and a five-item quality of life measure.ResultsOne hundred five patients completed the surveys. Forty-eight point four percent of patients experienced one or more moderate-to-severe systemic symptom. The frequency of individual symptoms was between 20% and 56% with almost half of patients rating symptoms as moderate-to-severe in intensity. Low and high systemic symptom burden populations were identified. Previously undescribed chronic neuropsychiatric symptoms were also found to be frequent and severe. The vigor score on the POMS was low. Body image was not adversely impacted. At least 40% of HNC survivors have diminished quality of life, and up to 15% have a poor quality of life.ConclusionsCSS are common among HNC survivors and are frequently moderate to severe in intensity. Of note, previously underrecognized neuropsychiatric symptoms were endorsed by a significant cohort of patients warranting further study. Quality of life was diminished in a significant cohort.
Highlights
The use of combined modality treatment, including surgery, chemotherapy, and radiation, has resulted in increased disease control in locally-advanced head and neck cancer (HNC) [1], but improved disease control occurs at the expense of increased acute and late effects from therapy
The General Symptom Survey was developed to assess the systemic symptoms associated with head and neck cancer and its therapy through review of the systemic symptom literature, patient interviews, and expert panel review
As the number of HNC survivors increases, there has been growing interest in the quality of their survivorship. This includes a wide array of outcomes ranging from symptom burden and functional deficits to overall quality of life
Summary
The use of combined modality treatment, including surgery, chemotherapy, and radiation, has resulted in increased disease control in locally-advanced head and neck cancer (HNC) [1], but improved disease control occurs at the expense of increased acute and late effects from therapy. In the HNC population, acute tumor and treatment effects have garnered tremendous interest and have been extensively investigated. Support Care Cancer (2019) 27:2893–2902 the rise in HPV-associated oropharyngeal cancers, have resulted in a rapid increase in the number of HNC survivors. This expanding survivor population has generated a surge of interest in the late effects of HNC therapy. Late effects may profoundly affect function and quality of life [4]
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