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Author Notes:

Corresponding author: Canhua Xiao, PhD, School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA 30322-4207, Tel: 404 712 9823; Fax: 404 727 9382, cxiao2@emory.edu.

The authors thank the contributions from Dr.’s Sarah H. Kagan and Andrea M. Barsevick for consultation on the study design.

This manuscript’s contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

Conflict of interest: None.

Subjects:

Research Funding:

This project was supported by RTOG grant U10 CA21661, CCOP grant U10 CA37422, Stat grant U10 CA32115 from the National Cancer Institute (NCI), and American Nursing Foundation (ANF).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • head and neck neoplasms
  • chemoradiation
  • symptom clusters
  • risk factors
  • BREAST-CANCER
  • CONCURRENT CHEMORADIOTHERAPY
  • POSTOPERATIVE NAUSEA
  • NICOTINE PATCH
  • ORAL MUCOSITIS
  • ONCOLOGY
  • WOMEN
  • RADIOTHERAPY
  • OUTCOMES
  • HYPERFRACTIONATION

Risk Factors for Clinician-Reported Symptom Clusters in Patients With Advanced Head and Neck Cancer in a Phase 3 Randomized Clinical Trial: RTOG 0129

Tools:

Journal Title:

Cancer

Volume:

Volume 120, Number 6

Publisher:

, Pages 848-854

Type of Work:

Article | Post-print: After Peer Review

Abstract:

BACKGROUND Chemoradiotherapy has become the standard of care for head and neck squamous cell carcinoma; however, those patients often experience multiple treatment-related symptoms or symptom clusters. Two symptom clusters have been identified for this population. Little is known about the risk factors of these symptom clusters. METHODS Subjects comprised 684 patients who were treated with concurrent chemoradiotherapy in a phase 3 randomized clinical trial. This trial compared standard fractionation radiotherapy to accelerated fractionation radiotherapy. Symptom clusters were evaluated at the end of the first and the second cycle of chemotherapy, and 3 months after the start of radiotherapy. Mixed-effect modeling was used to observe risk factors for symptom clusters. RESULTS Race and education were independent predictors for the head and neck cluster, whereas sex and history of tobacco use were independent predictors for the gastrointestinal cluster. Primary cancer site was only significant for the head and neck cluster when other factors were not controlled: patients with oropharyngeal cancer had more severe symptoms in the head and neck clusters than did patients with laryngeal cancer. In addition, patients receiving accelerated fractionation radiotherapy experienced more symptoms of radiomucositis, pain, and nausea at 3 months after the start of radiotherapy than those receiving standard fractionation radiotherapy. CONCLUSIONS Demographic characteristics were more predictive to symptom clusters, whereas clinical characteristics, such as cancer site and treatment arms, were more significant for individual symptoms. Knowing the risk factors will enhance the capability of clinicians to evaluate patients' risk of severe symptom clusters and to personalize management strategies. Cancer 2014;120:848-854. © 2013 American Cancer Society. This is a report from a phase 3 randomized clinical trial: Radiation Therapy Oncology Group (RTOG) 0129. Demographic characteristics, including race, education, sex, and smoking history were significant risk factors for symptom clusters, whereas clinical characteristics, such as primary cancer site and treatment arms, were only significant for individual symptoms rather than symptom clusters. Knowing the risk factors may enhance the ability of clinicians to evaluate patients' risk of severe symptom clusters and to personalize management strategies.

Copyright information:

© 2013 American Cancer Society.

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