HRQOL valuable for patients and doctors in head and neck cancer

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Laryngeal and oral cavity cancer and pharyngeal cancer can negatively affect health-related quality of life (HRQOL) because they induce symptoms that may interfere with daily life. In patients with resectable hypopharyngeal and laryngeal cancers, a trend toward worse HRQOL scores was found in patients receiving alternating chemoradiotherapy compared to patients receiving sequential induction chemotherapy and radiotherapy.

In Europe in 2012, an estimated 39,900 new cases of laryngeal cancer and 99,600 new cases of oral cavity and pharyngeal cancers occurred. The estimated number of deaths from laryngeal and oral cavity and pharyngeal cancers were 19,800 and 43,700, respectively.

“Most clinical trials focus on clinical endpoints such as survival or disease-free survival, but not all undertake a detailed evaluation of HRQOL. In addition, there are few randomized controlled trials in the head and neck literature,” said lead author Andrew Bottomley, PhD, assistant director of the European Organization for Research and Treatment of Cancer (EORTC) in Brussels, Belgium. The trial was published in Cancer (2013; doi:10.1002/cncr.28392).

The two treatment schemes (alternating and sequential) were compared in EORTC trial 24954. From July 1996 through May 2004 this prospective phase III EORTC study randomized 450 patients age 35 to 76 years (WHO performance status less than or equal to 2) with untreated, resectable advanced stage squamous cell carcinoma of the larynx (tumor stage T3-T4, lymph node stage N0-N2, distant metastasis stage M0) or hypopharynx (T2-4N0-2M0) into either the sequential or alternating arms. Patients in both arms were assessed for HRQOL at randomization, baseline, Day 42, and at Months 6, 12, 24, 36, and 48.

No differences were observed in the primary end point, fatigue, or a secondary end point, dyspnea. Significant differences were found in the swallowing and speech problems, both of which were secondary end points, at Day 42 in favor of patients in the sequential arm. Explanatory and sensitivity analysis revealed that the primary analysis favored the sequential arm, but most differences in HRQOL did not exist at the end of treatment and returned to baseline levels.

“We saw this as something that needed to be addressed. Quality of life is an important end point, and patients with head and neck cancers could suffer from debilitating problems with swallowing, speech, and hearing. They also have psychological effects from loss of function and changes in their body image. Assessing HRQOL of patients is of great value to both patients and their physicians,” explained J.L. Lefebvre, MD, of the Centre Oscar Lambret in Lille, France, and an EORTC member.

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