Changing functional status within 6 months posttreatment is prognostic of overall survival in patients with head and neck cancer: NRG Oncology Study

• Type of Material: Article
• Authors: Ronald Eldridge, Emory University; Stephanie L. Pugh, NRG Oncology Statistics and Data Management Center; Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute; Kenneth Hu, NYU Langone; Sharon Spencer, University of Alabama Birmingham; Sue Yom, UCSF Medical Center at Mount Zion; David Rosenthal, University of Texas MD Anderson Cancer Center; Nancy Read, London Regional Cancer Program; Anand Desai, Akron City Hospital; Elizabeth Gore, Zablocki VA Medical Center; George Shenouda, McGill University; Mark V. Mishra, University of Maryland; Deborah Bruner, Emory University; Canhua Xiao, Emory University
• Language: English
• Date: 2019-08-22
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 John Wiley & Sons, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1002/hed.25922
• Title of Journal or Parent Work: Head & Neck: Journal of the Sciences and Specialties of the Head and Neck
• Volume: 41
• Issue: 11
• Start Page: 3924
• End Page: 3932
• Grant/Funding Information: This project was supported by grants UG1CA189867 (NCORP), U10CA180868 (NRG Oncology Operations), U10CA180822 (NRG Oncology SDMC) from the National Cancer Institute (NCI).
• Keywords: Therapy; Radiation; longitudinal change; Science & Technology; Performance status; posttreatment; Otorhinolaryngology; head and neck cancer survival; quality of life; Human-papillomavirus; functional status; Locally advanced head; Life Sciences & Biomedicine; Toxicity; Impact; Surgery
• Research Categories: Health Sciences, Radiology; Health Sciences, Oncology; Health Sciences, Rehabilitation and Therapy; Health Sciences, Medicine and Surgery

Abstract

Background: Is post-treatment functional status prognostic of overall survival in head and neck cancer (HNC) patients. Methods: In an HNC clinical trial, 495 patients had two post-treatment functional assessments measuring diet, public eating, and speech within 6 months. Patients were grouped by impairment (highly, moderately, modestly, or not impaired) and determined if they improved, declined, or did not change from the first assessment to the second. Multivariable Cox models estimated overall mortality. Results: Across all three scales, the change in post-treatment patient function strongly predicted overall survival. In diet, patients who declined to highly impaired had three times the mortality of patients who were not impaired at both assessments (hazard ratio=3.60; 95% confidence interval: 2.02, 6.42). For patients improving from highly impaired, mortality was statistically similar to patients with no impairment (HR=1.38, 95% CI: 0.82, 2.31). Conclusions: Post-treatment functional status is a strong prognostic marker of survival in HNC patients.