Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_39_2519 - Patient-Reported Outcome Measures of Long-Term Swallowing Function after Oropharyngeal Radiation Therapy: A Cross-Sectional Methods Comparison

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Patient-Reported Outcome Measures of Long-Term Swallowing Function after Oropharyngeal Radiation Therapy: A Cross-Sectional Methods Comparison
S. R. Grant1, M. Kamal2, A. S. Mohamed1, J. Zaveri1, M. P. Barrow1, G. B. Gunn1, S. Lai1, J. S. Lewin3, D. I. Rosenthal1, X. S. Wang4, C. D. Fuller5, and K. A. Hutcheson1; 1The University of Texas MD Anderson Cancer Center, Houston, TX, 2Clinical Oncology and Nuclear Medicine Department, Ain Shams University, Cairo, Egypt, 3Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 4Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, 5University of Texas Graduate School of Biomedical Sciences, Houston, TX

Purpose/Objective(s): Definitive radiation therapy (RT) plays an important role in the curative treatment of many patients with oropharyngeal cancer (OPC), but carries a risk of long-term toxicity including the development of severe dysphagia. Here we characterize the relationship of patient-reported outcomes (PRO) of swallowing to quality of life (QOL) and radiation dose in long-term OPC survivors following definitive RT.

Materials/Methods: Patients with non-metastatic OPC treated with definitive RT at a single institution between January 2000 and April 2014 were examined. All patients completed the MD Anderson Symptom Inventory—Head and Neck (MDASI-HN), the MD Anderson Dysphagia Inventory (MDADI), and the EuroQol five dimension questionnaire (EQ-5D VAS) 12 months or more following end of RT in a cross-sectional survivorship survey. A single dysphagia question from MDASI-HN (designated MDASI-HN-S) was used. An MDASI-HN-S score ≥6 and composite MDADI score <60 were considered representative of moderate-severe swallowing dysfunction. The Bayesian information criteria (BIC) were used to test the predictive power of MDASI-HN-S and composite MDADI with QOL as measured by EQ-5D VAS. The modified Breiman recursive partitioning analysis (RPA) was used to identify an MDASI-HN-S cut off score for poor QOL. To assess validity of PRO cutpoints, the mean dose to candidate regions of interest (ROI) were compared in patients with and without moderate/severe dysphagia symptoms.

Results: A total of 714 patients met criteria for inclusion, with 91.9% treated with intensity modulated radiotherapy (IMRT) and a mean time from treatment of 6.7 years. Moderate/severe dysphagia was reported by 17% and 16% of respondents by MDASI-HN-S and composite MDADI, respectively. QOL as measured by EQ-5D VAS was lower in those with moderate/severe dysphagia per both MDASI-HN-S (63.4 vs 83.5, p<0.001) and composite MDADI scores (64.5 vs 83.2, p< 0.001). Although both inventories were predictive of QOL, the model including MDASI-HN-S was slightly more parsimonious for discrimination of EQ-5D VAS scores compared to composite MDADI (BIC of 6062 vs 6076). Recursive partitioning analysis showed that an MDASI-HN-S cutoff score of ≥6 correlated best with EQ-5D VAS decline (LogWorth 2.7, p<0.001). Among 320 patients with available DICOM-RT plans, a higher mean dose to the contralateral anterior digastric muscle, intrinsic tongue muscles, and larynx was associated with moderate-severe dysphagia by both MDASI-HN-S and composite MDADI (all p <0.05).

Conclusion: In long-term survivors of OPC following definitive RT, the single item dysphagia MDASI-HN-S question performed as well as the 20-item MDADI for discrimination of patient-reported dysphagia and QOL. Dose-response relationships to candidate ROIs were similar for the two questionnaires.

Author Disclosure: S.R. Grant: None. M. Kamal: None. A.S. Mohamed: Research Grant; National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research (1R01DE025248-01/R56DE025248-01) and NIH/NCI Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program (1R01CA218148-01). J. Zaveri: None. M.P. Barrow: None. G.B. Gunn: Associate Medical Director; MD Anderson Cancer Center - Proton Therapy. S. Lai: Research Grant; National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research (1R01DE025248-01/R56DE025248-01) and NIH/NCI Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program (1R01CA218148-01). D.I. Rosenthal: None. X. Wang: None. C.D. Fuller: Research Grant; National Institutes of Health, National Science Foundation, Elekta AB. Grant funding; Elekta AB. Honoraria; Nederlandse Organisatie voor Wetenschappelijk Onde. Consultant; Elekta AB, Nederlandse Organisatie voor Wetenschappelijk Onde. Travel Expenses; Elekta AB, Nederlandse Organisatie voor Wetenschappelijk Onde. Reviewer; Radiological Society of North America. Associate Editor; Radiographics. Data Management Task Force Committee Member; MR-LinAc Consortium. Member; National Cancer Institute. Task Group Member; American Association of Physicists in Medicine. K.A. Hutcheson: Research Grant; National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research (1R01DE025248-01/R56DE025248-01) and NIH/NCI Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program (1R01CA218148-01), This work is directly supported by the Andrew Sabin Family Foundation and the Charles and Daneen Steifel Oropharynx Fund.

Stephen Grant, MD

Disclosure:
Employment
MD Anderson Cancer Center: Professor: Employee

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