Long-Term Patient Reported Outcomes Following Treatment for Locally Advanced Oropharyngeal Carcinoma: Results from a Symptom Assessment Study

Abstract

To describe long-term patient reported symptoms following radiation (±systemic therapy) for locally advanced oropharyngeal carcinoma (OPC). Disease-free head and neck cancer survivors (> 6 mos. since treatment) were eligible for participation in a prospective questionnaire-based study. Participants completed the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). Those who had been treated with definitive RT (±systemic therapy) for T3-4 or N2c-3 OPC were included in this analysis. Individual item and overall symptom reports were analyzed. Of the 147 participants analyzed, 87% were male, 47% were never and 23% current smokers, 61% had base of tongue and 37% tonsil primaries, and 22% had T4 and 42% N2c disease. 7% had received RT alone, 51% concurrent chemoradiotherapy (CCRT), 18% induction chemotherapy followed by radiotherapy, and 25% induction chemotherapy followed by CCRT. IMRT was the chosen modality in 78% of individuals. Mean age at time of RT was 57.6 years. Mean time from treatment end to MDASI-HN completion was 63.3 mos. (82% >24 mos). Of the 48 tumors that had been tested, 83% were HPV or p16 positive. Mean (±SD) ratings (0-10 scale) for all 22 MDASI-HN symptom items was 1.36 (±1.02). Mean (±SD) symptom interference item score (0-10 scale) was 0.79 (±0.18). The top 5 MDASI-HN items rated most severe in terms of mean (±SD) ratings were dry mouth 4.37 (±3.21), chewing/swallowing 3.24 (±3.10), tasting food 2.40 (±3.02), mucus in mouth/throat 2.29 (±2.83), and choking/coughing 2.01 (±2.72), and were reported at moderate to severe levels (≥5) by 48, 33, 22, 23 and 21% respectively. Considering all 22 MDASI-HN symptom items, 5% were symptom free (0 across all items), 29% had no more than mild (≤5), 20% no more than moderate (≤7), and 46% with at least one item rated severe (>7). The long-term symptom profile in this cohort of patients treated for locally advanced OPC showed ∼50% of patients with potentially problematic xerostomia and ∼20-30% with dysphagia-related symptoms. These data provide a reference for patients treated with toxicity reduction strategies or other modalities.