Pre-treatment Class Attendance and Outcomes in Head & Neck Cancer Patients Undergoing Radiation

Abstract

The pre-treatment (“Prehab”) class at our center is a psychoeducational group intervention offered to all patients starting radiotherapy for head & neck cancers (HNC). It focuses on symptom management, psychosocial support, swallowing, and nutrition during treatment. The purpose of this study is to investigate any relationship of class attendance with treatment outcomes. In this retrospective cohort study, records of patients with HNC receiving radiotherapy (RT) as part of curative intent treatment from September 2013 to December 2017 were retrieved from our prospective quality assurance tool, the Anthology of Outcomes, and cross referenced with class attendance. Overall survival (OS), locoregional recurrence free survival (LRFS), and locoregional recurrence (LRR) were compared between prehab attendees (PA) and non-attendees (PNA). There were 864 PA and 1128 PNA. For PA and PNA, OS was 88% vs 80% (p<0.001), LRFS was 84% vs 75% (p<0.001) and LRR was 11.7% vs 16% (p=0.016) respectively at 2 years. At baseline, PA were less frequently ECOG performance status ≥2 (3% vs 5%, p = 0.002), current smokers (29% vs 40%, p <0.001), heavy drinkers (14% vs 18%, p = 0.035), P16 negative oropharynx cancers (17 vs 25%, p = 0.003), T3/T4 (41% vs 48%, p=0.001), and N2/3 (51% vs 55%, p<0.001). On univariable analysis, baseline characteristics significantly associated with worse OS were (HR, 95%CI): ECOG ≥2 (6.34, 4.25 – 9.46), current smoking (1.96, 1.56 – 2.47), heavy drinking (1.67, 1.26 – 2.21), PNA (1.59, 1.26 – 2.03), age≥62 (1.67, 1.33 – 2.11), and RT alone (2.04,1.5-2.77). On multivariable analysis (MVA), OS and LRFS were independently and unfavorably associated with PNA, as were current smoking, ECOG ≥2, T3/4, and N2/3. Treatment other than concurrent chemoRT was also associated with worse OS, LRFS, and LRR on MVA. Patients with poor performance status, current smokers, heavy drinkers, and those with more advanced cancers were less likely to attend Prehab. However, class attendance remains independently associated with better cancer outcomes. Whether the class itself influences outcomes or serves as a marker of favorable prognosis patients cannot be determined from this study design, but merits future study.Abstract 2867; Table 1MVA Results: HR and 95% CIOSLRFSLRRPNA1.41 (1.09 – 1.82)1.37 (1.11 – 1.70)Nonsignificant(NS)Current smoking1.48 (1.15 – 1.91)1.44 (1.15 – 1.79)NSECOG ≥24.65 (3.02 – 7.16)3.56 (2.40 – 5.28)1.84 (1.08 – 3.12)T3/T42.22 (1.7 – 2.89)2.39 (1.91 – 3.0)1.94 (1.48 – 2.54)N2/N32.52 (1.82 – 3.48)1.7 (1.31 – 2.21)NSTreatment*RT alone2.35 (1.64 – 3.36)2.49 (1.82 – 3.41)1.72 (1.18 – 2.49)Surgery+chemoRT3.87 (2.27 – 6.59)4.05 (2.56 – 6.41)2.72 (1.49 – 4.94)Surgery+ RT2.43 (1.54 – 3.85)2.38 (1.62 – 3.5)1.66 (1.05 – 2.64)*relative to concurrent chemoRT Open table in a new tab