Supportive care services (SCS) during curative-intent treatment with chemoradiation for patients with locally advanced head and neck cancer (HNC).

Abstract

e18041 Background: SCS assist in managing symptoms and outcomes for patients in palliative care settings. But impact of services in curative intent settings is not well defined. Here we evaluate this for head and neck cancer patients. Methods: Following IRB approval, we retrospectively reviewed charts of patients with HNC treated from 2014-2017 at the University of Illinois Hospital. Of 260 patient charts reviewed, 67 patients fit the study criteria, which included completing treatment with curative intent at University of Illinois Hospitals, not living at a skilled nursing facility, and follow-up of at least 3 months. Demographic data and treatment course data were collected. SCS included opioid use, tracheostomy use, G-tube use, prophylaxis for mucositis, speech and swallow f/u, nutritionist visits, social worker visits, and anti-emetic prophylaxis. Outcomes included number of hydration visits, number of ER visits, and number of days in the hospital. We tested the significance of correlations between continuous variables using Pearson correlation and the significance of difference in a continuous variable between two groups using the Wilcoxon ranked sum test. We used Cox proportional hazards model for analyses of overall survival (OS). Analyses were univariable. Results: 20 patients had oropharyngeal cancer. 47 had non-oropharyngeal disease. 57 patients received cisplatin and 10 patients received cetuximab, concurrently with radiation therapy. Median weight loss was 6.0kg during treatment. Highest potency opioid at end of treatment was not associated with outcomes. Among the full cohort, having a G-tube was associated with increased number of ER visits (median 1.5 vs. 0.0, p < 0.01), hospitalizations (median 2.0 vs. 0.0, p < 0.01), and number of days in the hospital (median 7.0 vs. 0.0, p < 0.01). Increased hydration appointments, meanwhile, did not predict outcomes. In subgroup analysis of patients who received G-tubes, ER visits before or after G-tube placement did not predict OS (HR 0.64, p = 0.56 for ER visits before G-tube placement, HR 1.06, p = 0.75 for ER visits after G-tube placement). Number of hydration visits after starting treatment for cetuximab vs cisplatin was significant (median 8 for cisplatin and 2 for cetuximab, p = 0.02). Conclusions: G-tube placement, even after placement, was associated with medical care needs during treatment, suggesting an unmet need for this patient population. Further studies are needed to determine how to best provide support for this vulnerable patient population.