Quality of life, physical, and psychologic functioning in patients affected by end-stage head and neck cancer.

Abstract

5537 Background: Primary head and neck squamous cell carcinomas (HNSCC) and their recurrences can heavily affect patient’s quality of life (QoL). Aim of our study was the evaluation of the impact of treatment on QoL, physical and psychological functioning of patients affected by recurrent end-stage HNSCC. Methods: The sample was composed by 34 patients affected by recurrent HNSCC. Primary tumour treatment was as follows: exclusive RT (radiotherapy) 18%, S+RT 55%, RT + chemotherapy (CT) 27%.In order to evaluate the late effects of RT we used the RTOG – EORTC late radiation morbidity score plus the DISCHE morbidity recording scheme. Psycho-oncological assessment included: HADS, MADRS, MINI MAC, EORTC QoL HN 35. Results: Among this population, 55% of pts relapsed on T, 15% on N, 21% on T+N and 9% on M. Recurrences were treated with S+CT 6%, RT+CT 21% and CT alone 73%. The late toxicity evaluation demonstrates that skin alterations, salivary glands impairment, subcutaneous fibrosis and mucous membrane alterations were the most relevant and severe damages. After a median follow-up of 60 ± 26 months, analysing RTOG-EORTC scale, high scores of skin and mucous membrane alterations are related (p<0.05) with higher levels of anxiety and depression, negative coping styles (reduction of fighting spirit, anxiety and depression) are increased by salivary and mucous membrane dysfunctions (p<0.05), moreover lower levels of QoL, in particular physical and social functioning, are correlated with higher levels of mucous membrane damages (p<0.05); all the mentioned above symptoms increase negative thoughts (p<0.05). DISCHE findings are superimpose able. Conclusions: In end stage HNSCC previous mucous, skin and salivary damages have a strong influence on QoL and coping styles. End stage treatments should evaluate previous toxicity and psychological profile. Treatment tailoring considering these parameters should be discussed with the patient. A negative impact of end stage therapies on mucosal and salivary functioning can deeply compromise QoL and depression profile.