Patient perspectives and treatment regret after de-escalated chemoradiotherapy for HPV-positive head and neck cancer: Findings from a phase II trial.

Abstract

212 Background: We present the first data evaluating overall treatment priorities, priorities specific to de-escalated therapy, treatment regret, and original expectations versus actual experiences among patients treated with de-escalated chemoradiation for human papillomavirus (HPV)-positive head and neck cancer (HNSCC). Methods: Participants were treated on a prospective phase II trial of induction chemotherapy followed by attenuated chemoradiotherapy for HPV-positive HNSCC. Eligible patients presented with stage III or IV squamous cell carcinoma of the oropharynx, p16-positivity, age ≥ 18 years, and Zubrod score 0-1. A total tumor dose of 60 Gy or 54 Gy was delivered depending on the response to induction chemotherapy. Participants were surveyed with validated measures evaluating their treatment experience. Results: Twenty-four out of 26 (92%) study patients participated with a median post-treatment follow-up of 20 months. 96% (n = 23) of participants selected ‘being cured’ or ‘living as long as possible’ to be their top priority. The highest-ranked priority with respect to treatment de-escalation was ‘to be able to swallow all foods and drinks’. No patient professed to any regret about the decision to enroll and be treated on a de-escalation protocol. 67% (n = 16) of participants reported long-term swallowing function to be either better than or as originally expected. 71% (n = 17) found long-term salivary function to be worse than expected. Overall, 63% (n = 15) of respondents found the severity of short-term side effects to be greater than expected, however, 63% (n = 15) of respondents found overall long-term toxicities to be less than originally expected. Conclusions: Among HPV-positive patients with HNSCC who had completed de-escalated therapy on a phase II protocol, cancer cure was the top overall priority, and preserving swallowing function was the highest priority for de-escalated therapy. No patient endorsed treatment regret, and the majority of patients found long-term swallowing outcomes to be better than or as originally expected. These data support ongoing studies aiming to establish the role of de-escalated therapies for HPV-positive HNSCC.