PURPOSE: Radiotherapy is an effective but burdensome treatment for head and neck cancer (HNC). We aimed to characterize the severity and time pattern of patient-reported symptoms and quality of life in a large cohort of HNC patients treated with definitive radiotherapy, with or without systemic treatment.
MATERIAL AND METHODS: 859 HNC patients treated between 2007 and 2017 prospectively completed the EORTC QLQ-HN35 and QLQ-C30 questionnaires at regular intervals during and after treatment for up to 5 years. Patients were classified into three subgroups: early larynx, infra-hyoideal, and supra-hyoideal. Outcome scales of both questionnaires were quantified per subgroup and time point by means of average scores and frequency distribution of categorized (none, mild, moderate, severe) severity. Time patterns and symptom severities were characterized. Toxicity profiles were compared using linear mixed model analysis. Additional toxicity profiles based on age, HPV-status, treatment modality, smoking status, tumor site and treatment period were characterized as well.
RESULTS: The study population consisted of 157 early larynx, 304 infra-hyoideal, and 398 supra-hyoideal patients. The overall compliance rate was 83%. Generally, the EORTC QLQ-HN35 symptoms showed a clear time pattern, with increasing scores during treatment, followed by a gradual recovery in the first 2 years. Distinct toxicity profiles were seen across subgroups (p<0.001), with generally less severe symptom scores in the early larynx subgroup. The EORTC QLQ-C30 functioning, quality of life and general symptoms showed a less evident time pattern and less pronounced differences in average scores between subgroups, although differences were still significant (p<0.001). Differences in average scores were most pronounced for role functioning, appetite loss, fatigue, and pain.
CONCLUSION: We established patient-reported toxicity and quality of life profiles that showed different patterns for three subgroups of HNC patients. These profiles provide detailed information on the severity and persistency of various symptoms as experienced by patients during and after definitive radiotherapy. These profiles can be used to inform future patients and may serve as a benchmark for future studies.
|Tijdschrift||International Journal of Radiation Oncology, Biology, Physics|
|Status||E-pub ahead of print - 2021|