Abstract
PurposeWe compared work outcomes in patients with oropharyngeal cancer (OPC), randomized to intensity-modulated proton (IMPT) versus intensity-modulated photon therapy (IMRT) for chemoradiation therapy (CRT).Patients and MethodsIn 147 patients with stage II-IVB squamous cell OPC participating in patient-reported outcomes assessments, a prespecified secondary aim of a randomized phase II/III trial of IMPT (n = 69) versus IMRT (n = 78), we compared absenteeism, presenteeism (i.e., the extent to which an employee is not fully functional at work), and work productivity losses. We used the work productivity and activity impairment questionnaire at baseline (pre-CRT), at the end of CRT, and at 6 months, 1 year, and 2 years. A one-sided Cochran-Armitage test was used to analyze within-arm temporal trends, and a χ2 test was used to compare between-arm differences. Among working patients, at each follow-up point, a 1-sided Wilcoxon rank-sum test was used to compare work-productivity scores.ResultsPatient characteristics in IMPT versus IMRT arms were similar. In the IMPT arm, within-arm analysis demonstrated that an increasing proportion of patients resumed working after IMPT, from 60% (40 of 67) pre-CRT and 71% (30 of 42) at 1 year to 78% (18 of 23) at 2 years (P = 0.025). In the IMRT arm, the proportion remained stable, with 57% (43 of 76) pre-CRT, 54% (21 of 39) at 1 year, and 52% (13 of 25) working at 2 years (P = 0.47). By 2 years after CRT, the between-arm difference between patients who had IMPT and those who had IMRT trended toward significance (P = 0.06). Regardless of treatment arm, among working patients, the most severe work impairments occurred from treatment initiation to the end of CRT, with significant recovery from absenteeism, presenteeism, and productivity impairments by the 2-year follow-up (P < 0.001 for all). Higher magnitudes of recovery from absenteeism (at 1 year, P = 0.05; and at 2 years, P = 0.04) and composite work impairment scores (at 1 year, P = 0.04; and at 2 years, P = 0.04) were seen in patients treated with IMPT versus those treated with IMRT.ConclusionIn patients with OPC receiving curative CRT, patients randomized to IMPT demonstrated increasing work and productivity recovery trends. Studies are needed to identify mechanisms underlying head and neck CRT treatment causing work disability and impairment.
Highlights
Rising costs of cancer care have prompted a pressing need for ‘‘value’’ in cancer treatment decisions [1,2,3,4]
Higher magnitudes of recovery from absenteeism and composite work impairment scores were seen in patients treated with intensity-modulated proton therapy (IMPT) versus those treated with intensity-modulated photon therapy (IMRT)
In the within-arm analysis, patients treated with IMPT, a significantly increased proportion resumed working over time, from 60% (40 of 67) pre-chemoradiation therapy (CRT) and 71% (25 of 35) at 1 year to 78% (18 of 23) at 2 years (1-sided Cochran-Armitage test for a trend of P 1⁄4 0.025)
Summary
Rising costs of cancer care have prompted a pressing need for ‘‘value’’ in cancer treatment decisions [1,2,3,4]. The current standard for curative therapy in OPC requires 6 to 7 weeks of radiation directly targeting the soft tissues and lymph nodes of the head and neck, concurrent with chemotherapy. Because of this intensive, multimodality treatment approach for head and neck cancer, conventional treatment is associated with toxicities that can be symptomatically severe and impair a patient’s daily function: acutely, mucositis, thick secretions, dehydration, poor nutrition, and requirement of narcotic pain medications, and, in the long term, xerostomia, dysphagia, dysgeusia, lymphedema, trismus, esophageal stricture, and dependency on a feeding tube [6,7,8,9,10]. A recent single-center study [17] found that about one third of patients with head and neck cancer had moderate to catastrophic financial toxicity with radiation treatment
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