Long-Term Quality of Life Following Head and Neck Radiation: A Study Using the Vanderbilt Head and Neck Symptom Survey

Abstract

Head and neck (H&N) radiation (RT) is characterized by significant acute toxicity, but long-term quality of life (QoL) following H&N RT is not well defined. This study sought to prospectively characterize, by subsite, long-term QoL in patients who underwent H&N RT using the Vanderbilt Head and Neck Symptom Survey (VHNSS) version 2.0. In patients treated with H&N RT between 2010 and 2021, the VHNSS was prospectively collected prior to beginning RT and at follow-up visits after completion of RT. Responses were broken down into symptom clusters for characterization of specific side effects and scored from 0 (asymptomatic) to 10 (severe symptoms). Patients were stratified by disease site and type of RT, with three main subgroups of interest: p16+ oropharynx (OPX) treated with definitive RT, nasopharynx (NPX) treated with definitive RT, and oral cavity (OC) treated with postoperative RT (PORT). To characterize long-term QoL, surveys collected 2 years (±3 months) after completion of RT were analyzed. Survey response distributions are reported as median and interquartile ranges. Comparisons between groups were made using the Mann-Whitney U test. A total of 65 patients (33 OPX [50.8%], 19 NPX [29.2%], 13 OC [20.0%]) had survey responses at 2 years. Median age was 56 (range 20-86). 48 (73.8%) patients were male. Concurrent chemotherapy was administered to 52 patients (80.0%). At 2 years, among OPX patients, trouble hearing (1.5 [0-5]) represented the greatest symptom burden, though this was still less than NPX (4.0 [2.0-7.5]; p = 0.099) patients but greater than OC (0.0 [0.0-1.5]; p = 0.16) patients. OPX patients had significantly less difficulty swallowing solids (0.8 [0.1-2.0]) compared to NPX (2.5 [1.1-5.1]; p = 0.018) and OC (3.5 [1.9-5.1]; p = 0.002) patients. OPX patients also experienced less dry mouth (1.0 [0.2-3.3]) than NPX (3.2 [1.5-6.6]; p = 0.012) and OC (2.4 [1.8-5.4]; p = 0.056) patients. OPX patients reported less trismus (0.0 [0.0-0.2]) than NPX (4.0 [0.0-7.0]; p<0.001) and OC (1.0 [0.5-3]; p = 0.002) patients. OPX patients had less neck tightness (0.0 [0.0-2.0]) than NPX (2.0 [0.0-3.0]; p = 0.022) patients and less voice dysfunction (0.0 [0.0-0.7]) than OC (3.0 [1.2-3.5]; p = 0.011) patients. Lastly, OPX patients had better mental health (0.0 [0.0-1.2]) than NPX (2.0 [0.0-5.0]; p = 0.019) and OC (2.0 [0.0-3.2]; p = 0.086) patients. There was no difference in taste/smell among OPX (0.9 [0.0-2.7]), NPX (2.3 [0.7-5.1]; p = 0.100), and OC (1.5 [1.1-3.4]; p = 0.230) patients. The VHNSS was able to characterize long-term QoL in patients treated with H&N RT. In general, patients with OPX treated with definitive RT have improved long-term QoL relative to patients with NPX or OC cancers, though at least a quarter of patients still report significant dry mouth, taste/smell, and hearing difficulties. Additional work should seek to identify, and, where possible through timely rehabilitation, proactively mitigate late symptoms in patients following H&N RT.