Impact on Health-Related Quality of Life of Induction Chemotherapy Compared With Concurrent Cisplatin and Radiation Therapy in Patients With Head and Neck Cancer

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) Vol. 31; no. 9; pp. e123 - e131
• Main Authors: Adkins, D., Ley, J., Oppelt, P., Gay, H.A., Daly, M., Paniello, R.C., Jackson, R., Pipkorn, P., Rich, J., Zevallos, J., Trinkaus, K., Thorstad, W.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2019
• Subjects: Adult; Aged; Antineoplastic Agents - pharmacology; Antineoplastic Agents - therapeutic use; Chemoradiotherapy - methods; Cisplatin - pharmacology; Cisplatin - therapeutic use; Female; Head and neck; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - radiotherapy; Humans; induction; Induction Chemotherapy - methods; Male; Middle Aged; quality of life; Quality of Life - psychology; Survival Analysis; Head and neck; quality of life; induction
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2019.05.007

Organ preservation, an important goal in the treatment of head and neck squamous cell carcinoma (HNSCC), may include induction chemotherapy and cisplatin with radiation therapy (CRT). To our knowledge, no reports have directly compared the impact of induction chemotherapy with that of CRT on health-related quality of life (HRQOL). In a phase II trial, we assessed the HRQOL of patients treated with induction chemotherapy followed by CRT. Eligible patients had stage III–IV HNSCC. HRQOL questionnaires were administered at baseline, the end of induction (EOI), the end of CRT (EOCRT) and after CRT. Functional Assessment of Cancer Therapy (FACT version 4) assessed HRQOL. We carried out a comparison of changes in HRQOL from baseline to EOI and from EOI to EOCRT. This trial is registered with ClinicalTrials.gov (NCT01566435). Thirty patients were enrolled in the study. Most HRQOL questionnaires were completed (88%). The mean total FACT scores did not differ from baseline to EOI (general: 83.8 versus 79.1, P = 0.08; head and neck: 109.7 versus 105.8, P = 0.33; Total Outcome Index: 69.7 versus 62.3, P = 0.03; respectively, using P ≤ 0.01 to adjust for multiple simultaneous tests of differences). However, total FACT scores significantly worsened from EOI to EOCRT (79.1 versus 62.3, P = 0.01; 105.8 versus 74.2, P < 0.01; 62.3 versus 34.2, P = 0.01; respectively). Within domains, the head and neck cancer subscale score did not differ from baseline to EOI (median 28.5 versus 27.0, P = 0.69), but significantly worsened from EOI to EOCRT (27.0 versus 9.5, P < 0.01). Swallowing, oral pain and voice quality improved from baseline to EOI, but worsened from EOI to EOCRT. Physical and functional scores worsened from baseline to EOI and from EOI to EOCRT. The emotional well-being score improved from baseline to EOI but worsened from EOI to EOCRT. Overall, HRQOL did not significantly change from baseline to EOI but dramatically worsened from EOI to EOCRT. •Quality of life may be impaired by head and neck cancer and its treatment.•Organ preservation may include induction chemotherapy and cisplatin + radiation.•Overall, quality of life was not significantly impaired by induction chemotherapy.•Swallowing, oral pain and voice quality improved after induction therapy.•Overall, quality of life was dramatically worsened by cisplatin + radiation therapy.