Patient and clinician expert perspectives on the impactful symptoms of head and neck squamous cell carcinoma and its treatment.

Abstract

e18001 Background: Head and neck squamous cell carcinoma(HNSCC) and its treatments affect health-related quality of life. This study aimed to describe patient and clinician views on the most impactful disease- and treatment-related symptoms. Methods: In this qualitative study, patients (aged ≥18 years with pathologically-confirmed recurrent and/or metastatic HNSCC) and experts (clinicians identified based on their experience treating patients with HNSCC) participated in a one-hour semi-structured interview. Interviews focused on identifying and assessing the importance of disease- and treatment-related symptom and impact concepts through an open-ended discussion of the disease and treatment experience. Concepts that were identified by patients and experts as unique characteristics of HNSCC were organized and presented as separate conceptual models. Results: Thirteen patients (mean age [standard deviation], 56.4 [11.5] years; male, 69.2% [9/13]) were interviewed. At the time of the interviews, 69.2% (9/13) of patients were receiving first-line chemo-, immune-, and/or targeted therapy after relapse or progression and 30.8% (4/13) of patients were receiving second-line therapy. A total of 16 disease-related signs and symptoms were reported. The most common were difficulty swallowing (53.8% [7/13]), throat, neck or mouth lumps (53.8% [7/13]), mouth pain (46.2% [6/13]) and voice changes (46.2% [6/13]), with mouth pain reported as most bothersome (38.5% [5/13]). Overall, 40 treatment-related concepts were reported across treatments (radiation, chemotherapy, surgery, and immunotherapy); skin burns (84.6% [11/13]), nausea (76.9% [10/13]), fatigue (69.2% [9/13]), difficulty swallowing (61.5% [8/13]) and pain (53.8% [7/13]) were most common. Patients named 30 disease- and treatment-related concepts as important to improve. Impaired speaking ability (38.5% [5/13]), fatigue and swelling (30.8% [4/13] each) were most important to improve. Four clinician experts were interviewed: two HN surgeons, one physician’s assistant in medical oncology, and one medical oncologist. Their experience ranged from 7.5–>30 years. Experts identified 15 disease-related sign and symptom concepts; all identified difficulty swallowing, throat, neck or mouth lumps, mouth/throat pain, weight loss, and voice changes. Difficulty swallowing was identified as the most important to improve (75.0% [3/4]). All experts identified burns, difficulty swallowing, dry mouth, fatigue and pain from 28 treatment-related concepts. Conclusions: This qualitative study highlights the heavy symptom burden associated with HNSCC and/or its treatment. Difficulty swallowing and throat, neck or mouth lumps were the most impactful disease-related symptoms reported by patients and clinicians. This study highlights symptoms of interest that should be carefully considered by new treatment options.