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Head and Neck Cancer
May 20, 2012

Pattern of symptoms in head and neck cancer (HNC) survivors treated with radiation therapy (RT): Association with systemic therapy.

Abstract

5589
Background: We sought, in a large, long-term follow-up cohort, to determine benchmark cross-sectional analysis of HNC patient (pt) symptom profiles as a function of chemotherapy (CT)/RT strategy. Methods: Pts treated with RT with or without CT in remission > 18 mos. were surveyed with the MD Anderson Symptom Inventory–Head and Neck Module (MDASI-HN). Clinical data were extracted. Data were tabulated, and group comparison performed using non-parametric analyses. Results: 250 pts participated; 81% were male. Median age at RT was 54 years. 87% had oropharynx HNC. Most were T1/X (41%), 37% T2 and, 22% T3/4. For N-category, most were N2 (55%), <5% N3, and 40% NX-1. 18% had induction CT, 26% concurrent, 5% both, and 50% had none. At a median follow-up time of 5.9 years (range 2-15), 11% of pts were entirely symptom free, 31% reported ≤mild symptom severity, 20% ≤moderate, and 38% reported ≥1 symptom as severe. 16% of pts receiving RT alone and 11% sequential CT followed by RT were symptom free, vs. 1% of those receiving concurrent CT (chi-square p<0.01), and the symptom distribution profile was distinct (p<0.03). The proportion of pts who received concurrent CT reporting any severe symptom item was 44%, vs. 36% of those not receiving concurrent CT (p=n.s.). No difference was seen in the moderate to severe (M/S) symptom report by treatment group. For all MDASI-HN items, most pts rated “0” or “not present”, except dry mouth and difficulty swallowing items, where mild symptoms were most likely (36% and 33%). The most common symptoms rated M/S were dry mouth, swallowing, choking, fatigue, and mouth and throat mucus reported by 42%, 23%, 18%, 16%, and 16%. MVA demonstrated T-stage and primary site, but not CT cohort correlated with M/S symptom report. Conclusions: Cumulatively, most pts had no more that mild symptom severity, but a substantial group of pts experience M/S levels. The symptom severity profile was highest with concurrent CT, though this effect appears mediated by disease specific factors. The addition of sequential CT to RT did not to appear to alter M/S symptom report substantially; however, concurrent pts were almost never symptom free, in contrast to induction and no CT cohorts.

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Journal of Clinical Oncology
Pages: 5589

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Published online: May 20, 2012
Published in print: May 20, 2012

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David Ira Rosenthal
University of Texas M. D. Anderson Cancer Center, Houston, TX
Gary Brandon Gunn
University of Texas M. D. Anderson Cancer Center, Houston, TX
Adam S. Garden
University of Texas M. D. Anderson Cancer Center, Houston, TX
Charles Lu
University of Texas M. D. Anderson Cancer Center, Houston, TX
Tito R. Mendoza
University of Texas M. D. Anderson Cancer Center, Houston, TX
William H. Morrison
University of Texas M. D. Anderson Cancer Center, Houston, TX
Steven J. Frank
University of Texas M. D. Anderson Cancer Center, Houston, TX
Beth Michelle Beadle
University of Texas M. D. Anderson Cancer Center, Houston, TX
Jack Phan
University of Texas M. D. Anderson Cancer Center, Houston, TX
Clifton David Fuller
University of Texas M. D. Anderson Cancer Center, Houston, TX
Ehab Y. Hanna
University of Texas M. D. Anderson Cancer Center, Houston, TX
K. Kian Ang
University of Texas M. D. Anderson Cancer Center, Houston, TX
Charles S. Cleeland
University of Texas M. D. Anderson Cancer Center, Houston, TX
University of Texas M. D. Anderson Cancer Center, Houston, TX

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David Ira Rosenthal, Gary Brandon Gunn, Adam S. Garden, Charles Lu, Tito R. Mendoza, William H. Morrison, Steven J. Frank, Beth Michelle Beadle, Jack Phan, Clifton David Fuller, Ehab Y. Hanna, K. Kian Ang, Charles S. Cleeland
Journal of Clinical Oncology 2012 30:15_suppl, 5589-5589

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