Analysis of quality-of-life outcomes in patients with head and neck squamous cell carcinoma.

Abstract

e23208 Background: Patients with head and neck squamous cell carcinoma (HNSCC) are known to experience decline in quality of life due to the side effects of treatments. In recent years, there has been a shift towards preserving organ functionality with the goal of improving quality of life for patients. However, it is unknown if these novel treatment paradigms exert a meaningful difference in quality-of-life (QOL) measures. Methods: A total of 594 patients with HNSCC were included in this retrospective study. Demographic, clinicopathologic characteristics, and wellness scores (including GAD-7, PHQ-9, PROMIS, and patient reported quality of life scores) were analyzed. Descriptive statistics and independent-samples t-tests were used to analyze differences in wellness and QOL outcomes amongst patients who received different treatment paradigms including chemotherapy, radiation and surgery (organ sparing vs non-organ sparing). Results: In our sample, 40% underwent chemotherapy while 60% did not undergo chemotherapy. Patients who underwent chemotherapy had significantly higher mean GAD-7 scores (10 vs 2, p = 0.044) and PHQ-9 scores (11 vs 2, p = 0.004) compared to those who did not receive chemotherapy. However, there was no significant difference in patients’ self-reported measures of fatigue, pain, or physical function. In regard to radiation therapy, 66% of the sample received radiation while 33% did not. Patients who underwent radiation has higher levels of pain (p = 0.09) as well as worse physical function scores (p = 0.138). Of the patients included in the study, 40.9% underwent organ-sparing surgery ,19.4% underwent non-organ sparing surgery and 39.7% did not undergo any surgery. When comparing patients who underwent organ sparing vs non-organ sparing surgery, it was found that patients who underwent organ-sparing procedures did not have a significant difference in GAD-7 and PHQ-9 scores. When comparing PROMIS scores which assess patient reported outcomes that impact quality of life, a few trends were noted. First, patients who underwent organ-sparing treatment had a significantly lower fatigue scores (50 vs 54, p = 0.031). Furthermore, patients who underwent organ-sparing treatment had lower self-reported pain scores (53 vs 56, p = 0.07). Conclusions: Patients who undergo chemotherapy have significantly higher levels of anxiety and depression. However, patients undergoing radiation did not demonstrate a similar pattern. Instead, patients reported higher levels of pain and worse physical functioning. Patients who underwent organ sparing surgery reported significantly lower levels of fatigue; however, there was no significant difference in anxiety and depression levels. This analysis was limited by sample size. However, these findings warrant further investigations to assess the true impact of these novel treatment strategies and their impact on QOL.