Reporter: Abigail T Berman
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 4, 2013
Presenter: Michele Yvette Halyard
Presenter's Affiliation: Mayo Clinic, Scottsdale, Arizona
For patients with head and neck cancers, radiation therapy is key part of the treatment strategy. Radiation therapy – which involves giving high doses of radiation accurately to the tumor while avoiding as much normal tissue as possible – can be administered upfront or after surgery. Furthermore, radiation can be administered with or without chemotherapy.
Each of these treatment approaches is associated with treatment-related toxicities (side effects). For radiation therapy, these can include symptoms such as dry mouth (xerostomia), skin irritation (dermatitis), swallowing difficulty or pain (dysphagia/odynophagia), and others. In addition to the physical side effects of treatment, patients also experience psychosocial challenges. Specifically, patients can experience sadness, fear, anxiety and/or depression, which may not be immediately obvious to the patient care team.
It is important for physicians to be able to track these physical and psychosocial effects of treatment in their patients. Studies have shown that electronic methods of tracking these patient-reported outcomes (PROs) increases patient – provider communication.
Researchers from the Mayo Clinic in Scottsdale, Arizona, led by Dr. Michele Halyard, reported the feasibility and impact of using a real-time electronic PRO tool in patients with head and neck cancers. In the study, patients with a variety of cancers, including head and neck cancers, completed a web-based patient reported outcome tool before and during radiation treatment. The tool required patients to answer 12 questions related to their physical and emotional well being on a scale of 0-9.
In patients with head and neck cancers, the authors found that quality of life (QOL) decreased during treatment with respect to physical well being, mental well being, social activity, pain and fatigue. Most of these patients had locally advanced head and neck cancers, mostly arising from the oral cavity and oropharynx. The majority of patients also received chemotherapy. Those patients that had both chemotherapy and radiation fared worse than those who received radiation alone. The authors also reported that "75% of patients felt that participation in the study was worthwhile and 94% would participate again."
The main conclusion the authors drew from their study was that collecting PRO in a real-time manner during radiation therapy is feasible. The vast majority of patients felt they would participate in the study again, suggesting that participation was not burdensome for the patient. And finally, the significant decreases in QOL they observed in patients with head and neck cancers undergoing radiation therapy included symptoms that are not often evaluated – such as mental and social well being.
In the future, doctors may ask their patients to complete these quality of life tools as they go through treatment. Furthermore, doctors and patients both may need to be more vigilant for signs of changes in psychosocial health.