The neurotoxicity rating scale: A novel patient-reported outcome (PRO) measure for neuro-psycho-behavioral late effects in head and neck cancer (HNC) survivors.

Abstract

12115 Background: Chronic fatigue, mood disorders and cognitive dysfunction are well recognized but understudied late toxicities experienced by HNC survivors. In addition to these well recognized central symptoms, patients also experience an array of less well recognized psycho-behavioral complaints (see table below). These symptoms may profoundly affect a patient’s ability to function within society. The neurotoxicity rating scale (NRS) was developed to assess the breadth of neuro-psycho-behavioral symptoms in cancer patients treated with interferon. We conducted a prospective cohort study in HNC survivors to assess the psychometric properties of this tool. Methods: Eligible patients included HNC survivors without evidence of disease ≥6 months after completion of therapy. The NRS was administered as part of a battery of patient reported outcome measures to assess pain and central symptoms. The NRS is a patient reported outcome measure which includes 36 items ranked from 0-4 (0 = no symptoms, 4 = severe). Hierarchical clustering was applied. Results: 243 patients were included with an average age of 72 years. Patients experienced clinically significant levels of neuro-psycho-behavioral symptoms; prevalence for selected items are shown in the table below. Preliminary analysis results in a group of six of clusters. The six-cluster solution was chosen as the most appropriate fit based on expert opinion. Clusters included: pain (α=0.89), sleep (α=0.83), general systemic symptoms (α=0.67), neuromotor-autonomic (α=0.73), cognitive (α=0.82), and psycho-behavioral (α=0.94). Conclusions: The NRS is a unique tool that comprehensively captures neuro-psycho-behavioral symptoms not assessed by existing instruments. The preliminary analysis amongst HNC survivors confirms the high prevalence of neuro-psycho-behavioral symptoms in this population. We identified six distinct symptom clusters: all demonstrated good internal constancy. This instrument allows for systematic study of neurotoxicity patterns, identification of high-risk patients, and evaluation of targeted interventions. Future directions include longitudinal validation and correlation with objective neuropsychiatric testing. Selected items from the NRS with prevalence. Item Prevalence (%) Tiredness/Fatigue 68% Difficulty staying asleep 58% Loss of interest in sex 41% Restlessness 44% Distractibility 41% Word-finding difficulty 41% No interest in activities 35% Memory problems 50% Decreased motivation 43%