Baseline symptom burden predicts patient reported well-being following curative (chemo)radiotherapy
Barker, Claire L Price, G. Garcez, Kate Lee, Lip W Sykes, Andrew J Thomson, David J McPartlin, Andrew J
Barker, Claire L
Price, G.
Garcez, Kate
Lee, Lip W
Sykes, Andrew J
Thomson, David J
McPartlin, Andrew J
Citations
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Abstract
Purpose or Objective
Patients (pts) with Head and Neck SCC (HNSCC) may
present with marked symptoms of pain and swallowing
dysfunction. Few patient-reported outcome measures
(PROMS) are available to quantify the effects of
(chemo)radiotherapy ((CT)RT) on baseline symptoms,
despite this being an important part of discussion
during consent for therapy.
The aim of this study was to determine the acute and late
effects of (CT)RT on baseline symptoms in pts with HNSCC
in clinical practice.
Material and Methods
All pts who completed a MD Anderson Symptom Inventory
Head and Neck (MDASI-HN) questionnaire prior to (CT)RT
for HNSCC, plus at least one post treatment time point (6-
9 weeks (wks), 10-19 wks, 20-39 wks and 40-78 wks after
RT) from 2016-19 were considered. Any with subsequent
disease relapse were excluded.
Pts were considered symptomatic at baseline if a score was
>/= 5 (moderate symptom burden) and dichotomised
accordingly for that subscale. Clinically relevant MDASI-HN
questions were considered: symptom subscales of pain,
dry mouth, difficulty swallowing/chewing and difficulty
with voice/speech and interference subscales of mood and
enjoyment of life. The difference in PROM score evolution
between patients with high and low initial symptom
burden was assessed via likelihood ratio test of a linear
mixed model containing baseline score as a fixed effect to
one without. Patient identity was included as a random
effect to account for individual differences.
Results
320 patients were analysed (Table 1).
A significant difference in overall score evolution after RT
for all subscales (p<0.001) was shown (Figure 1). Those pts
with moderate or severe symptoms at baseline in pain,
difficulty swallowing/chewing, difficulty with
voice/speech subscales experienced a reduction in scores
by 6 wks post RT. Decreases persisted throughout followup (FU), with the latter continuing to improve. Similar
trends are seen in both interference subscales. Dry mouth
scores in pts with moderate or severe symptoms at
baseline do not significantly change after RT.
In contrast those with low symptoms at baseline described
a worsening of symptoms acutely post RT. In pain and
difficulty with voice/speech subscales these return to
baseline, while scores in dry mouth and difficulty with
swallowing/chewing remain elevated throughout FU.
For all subscales pts who were symptomatic pre-treatment
continued to rate their symptoms more highly throughout
FU. Although a smaller variation at 40-78 wks is seen, there
is still a significant difference between groups in all
subscales (p<0.05) except pain (p=0.058).
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Barker C, Price G, Garcez K, Lee L, Sykes A, Thomson D, et al. PD-0054: Baseline symptom burden predicts patient reported well-being following curative (chemo)radiotherapy. Radiotherapy and Oncology . 2020 Nov;152:S21–2.