Treatment, Patient and Tumor Characteristics Impact Quality of Life (QOL) in Patients with Locally Advanced Head and Neck Cancer: Report of the Radiation Therapy Oncology Group (RTOG) Trial 90-03

Heather Jones, MD
University of Pennsylvania Cancer Center
Last Modified: November 7, 2001

Presenter: J. Fisher
Presenter's Affiliation: Bon Secours Cottage Health Services, Grosse Pointe Farms, MI
Type of Session: Scientific

Background
The RTOG 90-03 was a four-arm trial that enrolled patients with locally advanced head and neck cancer. This study evaluated the factors that could potentially affect the QOL for patients randomized to standard fractionation radiotherapy (SFX), hyperfractionation (HFX), Accelerated Fractionation with Split (AFX-S) and Accelerated Fractionation with Concomitant Boost (AFX-C).

Materials and Methods

The RTOG 90-03 used the Head and Neck Performance Status Scale (HNPSS) and the Functional Assessment of Cancer Therapy (FACT-H&N), version 2 to assess QOL.

The HNPSS has three components: Normalcy of Diet, Eating in Public, and Understandability of Speech.

The FACT-H&N has two components: a global QOL questionnaire (FACT-G) consisting of 4 domains; Physical Well Being (PWB), Social Well Being (SWB), Emotional Well Being (EWB), Functional Well Being (FWB), and an additional H&N specific questionnaire (AC).

Patients completed the HNPSS & FACT-H&N pretreatment, 4 weeks post-RT, then every 3 months for 1 year.

Results

774 patients completed a pretreatment FACT-H&N.

Before the start of radiotherapy (RT) 48% of patients had normal diets, 64% had normal public eating, and 77% had normal speech.

During the acute toxicity phase diet, eating, and speech were related to the intensity of RT (HFX or AFX-C), marital status (single), tumor site (oral cavity), use of oral nutrient supplements, and feeding tube.

At one-year of follow-up oral cavity tumors, AFX-C, oral nutrient supplements, feeding tube, and single patients had worse diet, eating, and speech.

Author's Conclusions
A pretreatment patient and tumor characteristic such as marital status, the need for oral supplements or feeding tube affects QOL before the initiation of therapy. Intensification of radiotherapy, marital status, tumor site, and nutritional support all effect QOL during the first year post therapy.

Clinical/Scientific Implications
The concept of quality of life continues to create struggles for clinicians and researchers, in that it is difficult to acquire a consensus concerning its definition, as well as techniques with which to measure it. One major advantage to this RTOG analysis is the repeat measurements of quality of life over time. This enabled providers to examine this concept within a short-term timeframes. Consequently, recall biases are avoided and the effect of personality traits can be ascertained. These data suggest that interventions (such as before the start of therapy) may improve QOL in long-term survivors.

Oncolink's ASTRO Coverage made possible by an unrestricted Educational Grant from Bristol-Myers Squibb Oncology and Pharmacia Oncology.