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Program Number: B151
Session Name: Poster Session

Longitudinal analysis of performance status at three phases of oropharyngeal cancer survivorship

Rajas Tipnis¹; Evan Kerr²; Ajaipal Randhawa³; Jason Azzi¹; Andrew Cooke⁴; Ciaran Lane¹; Paul D Kerr¹; ¹Department of Otolaryngology-Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba; ²Max Rady College of Medicine, University of Manitoba; ³Department of Radiology, Max Rady College of Medicine, University of Manitoba; ⁴Section of Radiation Oncology, Department of Radiology, Max Rady College of Medicine, University of Manitoba

Objective: The longitudinal effects of radiation for treatment of oropharyngeal cancer remain poorly delineated. The purpose of this study is to provide a descriptive longitudinal analysis of selected functional outcomes in a population-based series of oropharyngeal cancer patients and to identify factors associated with functional change.

Methods: Secondary analysis of prospectively collected performance data in a cohort of HPV-associated oropharyngeal squamous cell carcinoma from 2008 to 2019, treated curatively with Intensity-modulated radiation therapy (IMRT). Normalcy of diet and understandability of speech were measured with Performance Status Scale (PSS-HN), xerostomia using the modified Edmonton Symptom Assessment Scale (mESAS), and feeding tube dependence using the Royal Brisbane Hospital Outcome Scale (RBHOMS). Data was collected pre-treatment (0 months) and 3, 6, 12, 24, 36 months post-treatment. The following factors were assessed: T-Stage (early vs. advanced), tumour subsite (tongue base vs. tonsil), smoking status, primary tumour planning target volume (70GyPTV), adjuvant planning target volume (59GyPTV), and larynx mean radiation dose. Mean outcomes at each timepoint were compared for each of the above factors using the unpaired student’s T-test with corrections for multiple comparisons (p<0.05). Percentage feeding tube dependence was calculated for each timepoint.

Results: There were 104 patients included in our study. Our data suggests that patients undergo an initial decline in function but begin to recover at 3 months post-treatment. Advanced T-stage was associated with significantly worse normalcy of diet from 0-3 months) and worse speech from 0-6 months. Base of tongue subsite was associated with worse speech at 3 months. Smokers had worse xerostomia at 3 months and worse normalcy of diet from 0-6 months. Higher 70GyPTV was associated with worsen normalcy of diet at 6 & 12 months. High 59GyPTV was associated with worse xerostomia at 24 months. Higher laryngeal dosing was associated with worse xerostomia 12-36 months, worse speech 6 months, and worse normalcy of diet 12&36 months.

Conclusions:  Patients who are treated with radiotherapy suffer a multitude of adverse effects on speech, normalcy of diet, xerostomia, and feeding tube dependence. Primary tumour factors appear to be associated with worse outcomes for diet, feeding tube dependence, and speech during the rehabilitation phase. While radiation dosing to the neck is associated with worse xerostomia, speech, and normalcy of diet at later stages of survivorship. Accounting for tumour factors, patient factors, and treatment factors is critical in determining the functional recovery of patients being treated for HPV-associated oropharyngeal cancer.

Figure  A. Longitudinal results of functional outcomes for a cohort of 107 patients treated for oropharyngeal squamous cell carcinoma.

 

 

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