Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Head and neck symptom severity (HNSS) and symptom interference (HNSI), health-related quality of life (HRQL) and emotional distress trajectories during and after chemoradiotherapy (CRT) for HPV-associated oropharyngeal cancer (HPVOPC): a TROG 12.01 secondary analysis (#414)

Lachlan McDowell 1 2 , Mathias Bressel 3 , Madeleine T King 4 , June Corry 5 6 , Liz Kenny 7 8 , Sandro Porceddu 8 9 , Christopher Wratten 10 , Andrew Macann 11 , James E. Jackson 12 , Danny Rischin 2 13
  1. Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  2. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
  3. Centre for Biostatistics and Clinical Trials , Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  4. School of Psychology, University of Sydney, Sydney, New South Wales, Australia
  5. Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
  6. GenesisCare St Vincent's Hospital, Melbourne, Victoria, Austalia
  7. Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  8. Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
  9. Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  10. Department of Radiation Oncology, Calvary Mater Hospital and University of Newcastle, Newcastle, New South Wales, Australia
  11. Department of Radiation Oncology, Auckland City Hospital and University of Auckland, Auckland, New Zealand
  12. Icon Cancer Centres, Gold Coast, Queensland, Australia
  13. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Aims

This secondary analysis of a multicentre HPVOPC study aimed to identify patient-reported trajectories during and following CRT. 

Methods

All 182 TROG12.01 patients were included.  HNSS and HNSI (MDASI-HN), HRQL (FACT-G) and emotional distress (HADS) were assessed before, during and after CRT.  Latent class growth mixture modelling (LCMM) was performed to identify trajectories. 

Results

The HNSS model identified 4 trajectory classes (HNSS1-4) distinguished by differences at baseline, at the peak of treatment symptoms and during early (to 9w post CRT) and intermediate recovery (9w to 12m post CRT).   All trajectories were stable beyond 12m.  The reference trajectory (HNSS4, n=74) score was 0.1 (CI 0.1-0.2) at baseline, peaking at 4.6 (CI 4.2-5.0), with rapid early recovery (1.1, CI 0.8-2.2) and improvement to 12m (0.6, CI 0.5-0.8). HNSS2 (“high baseline", n=30) reported higher baseline scores (1.4, CI 0.8-2.0) but was otherwise similar, HNSS3 (“low acute”, n=53) reported reduced acute symptoms (2.5, CI 2.2-2.9) with stable scores beyond 9w post CRT (1.1, CI 0.9-1.4).  HNSS1 (“slow recovery”, n=25) had slower recovery from an acute peak of 4.9 (CI 4.3-5.6) to 0.9 (CI 0.6-1.3) at 12m.  Compared to HNSS4, the high baseline group were younger (mean 53.6 vs 57.4), with fewer ECOG0 (87 vs 99%) or with higher degree (38 vs 69%), with higher baseline anxiety (HADS, mean 6.8 vs 4.4).  The low acute group were older (mean 60.1), had fewer ECOG0 patients (87%) and were more likely to have received cetuximab (68% vs 43%).  The slow recovery group had fewer with a higher degree (52%).

LCMM also identified 4 HNSI, 2 HRQL, 3 anxiety and 4 depression trajectories, which will be presented.

Conclusion

LCMM identified 4 distinct HNSS trajectories which in combination with variations in patient characteristics may be clinically useful in identifying patients requiring increased support during and after CRT.