Electronic patient-reported outcomes and toxicities during radiotherapy for head-and-neck cancer

Joshua R. Niska, Michele Y. Halyard, Angelina D. Tan, Pamela J. Atherton, Samir H. Patel, Jeff A Sloan

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: To characterize quality of life (QOL) using real-time, electronic patient-reported outcomes (ePROs) and to evaluate adverse events (AEs) and supportive care during head-and-neck radiotherapy (RT) and concurrent chemoradiotherapy (CCRT). Methods: Sixty-five patients undergoing head-and-neck RT completed electronic, real-time, 12-item linear analog self-assessments (LASA) at baseline, before biweekly appointments, and at the last week of RT. Changes in QOL domains between time points were calculated. Clinical data were collected from the institutional medical record. AEs were recorded at the same time points as the LASA and graded. Results: During head-and-neck RT, most patients had clinically meaningful decreases in all QOL domains except level of support, financial concerns, and legal concerns. QOL domains with the most prevalent, clinically meaningful decreases were fatigue (75.4% of patients; 95% CI, 62.9–84.9%), social activity (70.8%; 95% CI, 58.0–81.1%), and overall QOL (70.8%; 95% CI, 58.0–81.1%). All patients had grade 2 AEs; 35.4% had grade 3 (50.0%, CCRT; 12.0%, RT; P = .002). Weight loss averaged 5.5 kg (6.9 kg, CCRT; 2.8 kg, RT; P < .001). Intravenous hydration was needed in 52.3% (77.5%, CCRT; 12.0%, RT; P < .001); feeding tube placement 40.0% (57.5%, CCRT; 12.0%, RT; P = .001); emergency department visits without hospitalization, 10.8%; and emergent hospitalization, 27.7% (37.5%, CCRT; 12.0%, RT; P = .04). Conclusions: Head-and-neck RT, particularly CCRT, negatively impacts patients’ overall QOL, social activity, and fatigue, with frequent grade 3 AEs, weight loss, intravenous hydration, feeding tube placement, ED visits, and hospitalization. Real-time ePROs allow providers to monitor QOL at multiple time points during RT, potentially allowing early intervention to improve QOL and mitigate AEs.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalQuality of Life Research
DOIs
StateAccepted/In press - Feb 28 2017

Fingerprint

Head and Neck Neoplasms
Radiotherapy
Chemoradiotherapy
Quality of Life
Neck
Head
Hospitalization
Fatigue
Weight Loss
Patient Reported Outcome Measures
Financial Support
Parenteral Nutrition
Enteral Nutrition
Medical Records
Hospital Emergency Service
Appointments and Schedules

Keywords

  • Adverse events
  • Head-and-neck cancer
  • Patient-reported outcomes
  • Quality of life
  • Radiation
  • Toxicity

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Electronic patient-reported outcomes and toxicities during radiotherapy for head-and-neck cancer. / Niska, Joshua R.; Halyard, Michele Y.; Tan, Angelina D.; Atherton, Pamela J.; Patel, Samir H.; Sloan, Jeff A.

In: Quality of Life Research, 28.02.2017, p. 1-11.

Research output: Contribution to journalArticle

Niska, Joshua R. ; Halyard, Michele Y. ; Tan, Angelina D. ; Atherton, Pamela J. ; Patel, Samir H. ; Sloan, Jeff A. / Electronic patient-reported outcomes and toxicities during radiotherapy for head-and-neck cancer. In: Quality of Life Research. 2017 ; pp. 1-11.
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AU - Halyard, Michele Y.

AU - Tan, Angelina D.

AU - Atherton, Pamela J.

AU - Patel, Samir H.

AU - Sloan, Jeff A

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N2 - Purpose: To characterize quality of life (QOL) using real-time, electronic patient-reported outcomes (ePROs) and to evaluate adverse events (AEs) and supportive care during head-and-neck radiotherapy (RT) and concurrent chemoradiotherapy (CCRT). Methods: Sixty-five patients undergoing head-and-neck RT completed electronic, real-time, 12-item linear analog self-assessments (LASA) at baseline, before biweekly appointments, and at the last week of RT. Changes in QOL domains between time points were calculated. Clinical data were collected from the institutional medical record. AEs were recorded at the same time points as the LASA and graded. Results: During head-and-neck RT, most patients had clinically meaningful decreases in all QOL domains except level of support, financial concerns, and legal concerns. QOL domains with the most prevalent, clinically meaningful decreases were fatigue (75.4% of patients; 95% CI, 62.9–84.9%), social activity (70.8%; 95% CI, 58.0–81.1%), and overall QOL (70.8%; 95% CI, 58.0–81.1%). All patients had grade 2 AEs; 35.4% had grade 3 (50.0%, CCRT; 12.0%, RT; P = .002). Weight loss averaged 5.5 kg (6.9 kg, CCRT; 2.8 kg, RT; P < .001). Intravenous hydration was needed in 52.3% (77.5%, CCRT; 12.0%, RT; P < .001); feeding tube placement 40.0% (57.5%, CCRT; 12.0%, RT; P = .001); emergency department visits without hospitalization, 10.8%; and emergent hospitalization, 27.7% (37.5%, CCRT; 12.0%, RT; P = .04). Conclusions: Head-and-neck RT, particularly CCRT, negatively impacts patients’ overall QOL, social activity, and fatigue, with frequent grade 3 AEs, weight loss, intravenous hydration, feeding tube placement, ED visits, and hospitalization. Real-time ePROs allow providers to monitor QOL at multiple time points during RT, potentially allowing early intervention to improve QOL and mitigate AEs.

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KW - Head-and-neck cancer

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KW - Quality of life

KW - Radiation

KW - Toxicity

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