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TU_37_2957 - Functional Burden Associated with Late Lower Cranial Neuropathy in Long-Term Oropharyngeal Cancer Survivors Treated With Definitive Radiation Therapy

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Functional Burden Associated with Late Lower Cranial Neuropathy in Long-Term Oropharyngeal Cancer Survivors Treated With Definitive Radiation Therapy
P. Aggarwal, J. Zaveri, R. P. Goepfert, G. B. Gunn, S. Lai, C. D. Fuller, E. Y. Hanna, D. I. Rosenthal, J. S. Lewin, and K. A. Hutcheson; The University of Texas MD Anderson Cancer Center, Houston, TX

Purpose/Objective(s): Lower cranial neuropathy (LCNP) is a rare potentially disabling late toxicity induced by damage due to radiotherapy (RT) and other cancer therapies. The objective of this paper was to examine the impact of late LCNP on functional burden and swallowing related QOL. We hypothesized that OPC survivors with late LCNP would report significantly worse swallowing-related QOL scores.

Materials/Methods: 882 OPC survivors (median survival time: 7 years) who received definitive RT at an institution between January, 2000 – December, 2013 completed a cross-sectional survey (56% response rate) that included the MD Anderson Dysphagia Inventory (MDADI). The 19-item composite MDADI score representing overall swallowing-related QOL was the primary outcome and composite emotional, physical and functional subscale scores were secondary outcomes. Late LCNP events defined by onset >3-months after cancer therapy were abstracted from medical records. Multivariate models regressed MDADI scores on late LCNP status adjusting for clinical covariates.

Results: 3.9% (n=34) of respondents (median survival time: 11.5 years) developed late LCNP. Among them, 50% were treated with RT and concurrent chemotherapy and 32%with RT only. They were treated with a higher total mean RT dose (LCNP: 69.5 vs. 68.2 Gy, p<0.001), 64% received IMRT-SF and 26% received 3D Conformal RT. Patients with late LCNP reported significantly worse mean composites scores (LCNP: 67.6 vs. no LCNP: 79.8, p<0.001). Late LCNP was independently associated with worse mean composite scores (β= -7.6, p=0.007, 95%CI: -13.1, -2.0) adjusting for age, survival time, sex, education, treatment modality, T-stage, subsite, RT type, solid food at baseline and smoking. Subscale scores that were most severe, in rank order of means, included physical (LCNP: 62.0 vs. no LCNP: 75.5, p<0.001), global (LCNP: 64.1 vs. no LCNP: 80.8, p<0.001), emotional (LCNP: 69.9 vs. no LCNP: 80.6, p<0.001) and functional scores (LCNP: 73.8 vs. no LCNP: 85.5, p<0.001). Late LCNP was independently associated with worse physical (β = - 8.8, p=0.008, 95%CI: - 15.23, -2.29), global (β = -10.6, p=0.01, 95%CI: -18.6, - 2.5), emotional (β = -6.1, p=0.035, 95%CI: -11.7, -4.2) and functional scores (β = -7.5, p=0.009, 95%CI: -13.0, -1.9) adjusting for age, survival time, sex, education, treatment modality, T-stage, subsite, RT type, solid food at baseline and smoking.

Conclusion: In our large survey study, OPC survivors with late LCNP reported significantly poor swallowing related QOL and higher levels of functional impairment. Late LCNP may lead to profound deficits in swallowing, extended placement of feeding tubes, tracheostomy tubes and refractory aspiration that can lead to pneumonia and diminished QOL. Further efforts are necessary to alleviate the functional burden associated with this disabling late effect of cancer treatment experienced by OPC survivors.

Author Disclosure: P. Aggarwal: None. J. Zaveri: None. R.P. Goepfert: None. G.B. Gunn: Associate Medical Director; MD Anderson Cancer Center - Proton Therapy. S. Lai: None. C.D. Fuller: Research Grant; National Institutes of Health, Elekta AB, National Science Foundation. 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. E.Y. Hanna: None. D.I. Rosenthal: None. K.A. Hutcheson: Research Grant; Patient-Centered Outcomes Research Institute (PRO-ACTIVE), the MD Anderson Institutional Research Grant Program Survivorship Seed Monies Award, National Institutes of Health(NIH)/National Cancer Institute, National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research.

Katherine Hutcheson, PhD

Disclosure:
Employment
The University of Texas MD Anderson Cancer Center: Associate Professor: Employee

Compensation
National Institutes of Health (NIH)/National Cancer Institute (NCI): Research Grants; National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research: Research Grants; Patient-Centered Outcomes Research Institute (PRO-ACTIVE): Research Grants; The MD Anderson Institutional Research Grant Program Suvivorship Seed Monies Award: Research Grants

Biography:
Dr. Kate Hutcheson is an Associate Professor and the Deputy Director of HNS Clinical Research in the Department of Head and Neck Surgery at The University of Texas MD Anderson Cancer Center. She is also the Associate Director of Research in the Section of Speech Pathology and Audiology. Dr. Hutcheson is a certified speech-language pathologist, a Board Certified Specialist in Swallowing and Swallowing Disorders (BCS-S), and holds a Doctorate Degree in Epidemiology. She has authored over 95 journal articles with funding support from the Patient-Centered Outcomes Research Institute, the NIH/NIDCR, the MD Anderson Institutional Research Grant Award program, and the CPRIT UT Health Innovation Training Program. She is an accomplished clinician and educator who lectures nationally and internationally on radiation-associated dysphagia and head and neck cancer rehabilitation. Her research mission is to optimize functional outcomes and quality of life in head and neck cancer survivorship.

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