Comparative impact of metronomic therapy (methotrexate and celecoxib) and cisplatin-based radiochemotherapy on health-related quality of life in tracheostomized head and neck cancer patients: A comparative analysis.

Abstract

e18002 Background: Tracheostomy is a common intervention for managing airway obstruction in advanced head and neck squamous cell carcinoma (H&N SCC), which can significantly affect health-related quality of life (HRQoL). This study evaluates and compares HRQoL outcomes in Tracheostomized H&N SCC patients receiving metronomic therapy (methotrexate and Celecoxib) versus cisplatin-based Radiochemotherapy. Methods: This comparative study included Tracheostomized patients aged 18 years or older, diagnosed with metastatic, or advanced head and neck squamous cell carcinoma (H&N SCC). Eligibility criteria required a Karnofsky Performance Score of at least 70. Participants were randomly assigned to receive either metronomic therapy (methotrexate and Celecoxib) or cisplatin-based Radiochemotherapy. HRQoL assessments were conducted using validated EORTC QLQ-C30 and QLQ-H&N35 questionnaires. Data were collected at baseline and subsequently every three weeks over a six-week period. The analysis focused on key domains, including pain, swallowing, speech, fatigue, and emotional well-being, to evaluate the treatment impact on patients' quality of life. Analysis was done using SPSS V. 26 and P-value 0.05 was considered significant. Results: A total of 50 patients were enrolled (metronomic: 25; cisplatin: 25). Both groups showed improvements in HRQoL over time, with metronomic therapy yielding better results in specific domains. Pain scores improved by 18% in the metronomic group compared to 12% in the cisplatin group at week 6 (p = 0.031). Swallowing difficulties decreased by 15% in the metronomic group versus 8% in the cisplatin group (p = 0.042), while speech-related challenges showed a 10% improvement in the metronomic group compared to 6% in the cisplatin group (p = 0.049). Fatigue scores improved by 13% in the metronomic group versus 9% in the cisplatin group (p = 0.038). Emotional well-being also increased significantly, with a 14% improvement in the metronomic group compared to 10% in the cisplatin group (p = 0.045). While overall HRQoL scores at the study’s end were comparable between groups, metronomic therapy showed superior symptom control and fewer adverse effects, enhancing its tolerability. Conclusions: Metronomic therapy (methotrexate and Celecoxib) demonstrated significant advantages over cisplatin-based Radiochemotherapy in improving HRQoL domains like pain, swallowing, and speech in Tracheostomized H&N SCC patients. These findings underline the importance of HRQoL-focused treatment planning for advanced cancer patients.