Patient-reported quality-of-life outcomes after de-escalated chemoradiation for human papillomavirus-positive oropharyngeal carcinoma: Findings from a phase 2 trial

John V. Hegde, Narek Shaverdian, Megan E Daly, Carol Felix, Deborah L. Wong, Michael H. Rosove, Jordan H. Garst, Pin Chieh Wang, Darlene Veruttipong, Shyam Rao, Ruben C Fragoso, Jonathan Riess, Michael L. Steinberg, Allen M. Chen

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND: The current study represents a subset analysis of quality-of-life (QOL) outcomes among patients treated on a phase 2 trial of de-escalated chemoradiation for human papillomavirus (HPV)-associated oropharyngeal cancer. METHODS: Eligibility included newly diagnosed, (American Joint Committee on Cancer, 7th edition) stage III or IV oropharyngeal squamous cell carcinoma, p16 positivity, age≥18 years, and a Zubrod performance status of 0 to 1. Treatment was induction paclitaxel at a dose of 175mg/m2 and carboplatin at an area under the curve of 6 for 2 cycles followed by response-adapted, dose-reduced radiation of 54 Gy or 60 Gy with weekly concurrent paclitaxel at a dose of 30mg/m2. The University of Washington Quality of Life (UW-QOL) and the Functional Assessment of Cancer Therapy-Head and Neck questionnaires were used to assess patient-reported QOL as a secondary endpoint. RESULTS: A total of 45 patients were registered, 40 of whom completed QOL surveys and were evaluable. Nadirs for overall UW-QOL and Functional Assessment of Cancer Therapy-Head and Neck scores were reached at 4 weeks after treatment but returned to baseline at 3 months. Nearly all functional indices returned to baseline levels by 6 to 9 months. The mean overall UW-QOL score was 71.6 at baseline compared with 70.8, 73.0, 83.3, and 81.1, respectively, at 3 months, 6 months, 1 year, and 2 years after therapy. The percentage of patients rating their overall QOL as "very good" or "outstanding" at 6 months, 1 year, and 2 years using the UW-QOL was 50%, 77%, and 84%, respectively. CONCLUSIONS: This de-escalation regimen achieved QOL outcomes that were favorable compared with historical controls. These results serve as powerful evidence that ongoing de-escalation efforts lead to tangible gains in function and QOL.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - 2017

Fingerprint

Quality of Life
Carcinoma
Head and Neck Neoplasms
Paclitaxel
Oropharyngeal Neoplasms
Therapeutics
Radiation Dosage
Carboplatin
Area Under Curve
Squamous Cell Carcinoma
Neoplasms

Keywords

  • Chemoradiation
  • De-escalation
  • Head and neck
  • Human papillomavirus (HPV)
  • Oropharyngeal
  • Quality of life (QOL)

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Patient-reported quality-of-life outcomes after de-escalated chemoradiation for human papillomavirus-positive oropharyngeal carcinoma : Findings from a phase 2 trial. / Hegde, John V.; Shaverdian, Narek; Daly, Megan E; Felix, Carol; Wong, Deborah L.; Rosove, Michael H.; Garst, Jordan H.; Wang, Pin Chieh; Veruttipong, Darlene; Rao, Shyam; Fragoso, Ruben C; Riess, Jonathan; Steinberg, Michael L.; Chen, Allen M.

In: Cancer, 2017.

Research output: Contribution to journalArticle

Hegde, John V. ; Shaverdian, Narek ; Daly, Megan E ; Felix, Carol ; Wong, Deborah L. ; Rosove, Michael H. ; Garst, Jordan H. ; Wang, Pin Chieh ; Veruttipong, Darlene ; Rao, Shyam ; Fragoso, Ruben C ; Riess, Jonathan ; Steinberg, Michael L. ; Chen, Allen M. / Patient-reported quality-of-life outcomes after de-escalated chemoradiation for human papillomavirus-positive oropharyngeal carcinoma : Findings from a phase 2 trial. In: Cancer. 2017.
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abstract = "BACKGROUND: The current study represents a subset analysis of quality-of-life (QOL) outcomes among patients treated on a phase 2 trial of de-escalated chemoradiation for human papillomavirus (HPV)-associated oropharyngeal cancer. METHODS: Eligibility included newly diagnosed, (American Joint Committee on Cancer, 7th edition) stage III or IV oropharyngeal squamous cell carcinoma, p16 positivity, age≥18 years, and a Zubrod performance status of 0 to 1. Treatment was induction paclitaxel at a dose of 175mg/m2 and carboplatin at an area under the curve of 6 for 2 cycles followed by response-adapted, dose-reduced radiation of 54 Gy or 60 Gy with weekly concurrent paclitaxel at a dose of 30mg/m2. The University of Washington Quality of Life (UW-QOL) and the Functional Assessment of Cancer Therapy-Head and Neck questionnaires were used to assess patient-reported QOL as a secondary endpoint. RESULTS: A total of 45 patients were registered, 40 of whom completed QOL surveys and were evaluable. Nadirs for overall UW-QOL and Functional Assessment of Cancer Therapy-Head and Neck scores were reached at 4 weeks after treatment but returned to baseline at 3 months. Nearly all functional indices returned to baseline levels by 6 to 9 months. The mean overall UW-QOL score was 71.6 at baseline compared with 70.8, 73.0, 83.3, and 81.1, respectively, at 3 months, 6 months, 1 year, and 2 years after therapy. The percentage of patients rating their overall QOL as {"}very good{"} or {"}outstanding{"} at 6 months, 1 year, and 2 years using the UW-QOL was 50{\%}, 77{\%}, and 84{\%}, respectively. CONCLUSIONS: This de-escalation regimen achieved QOL outcomes that were favorable compared with historical controls. These results serve as powerful evidence that ongoing de-escalation efforts lead to tangible gains in function and QOL.",
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author = "Hegde, {John V.} and Narek Shaverdian and Daly, {Megan E} and Carol Felix and Wong, {Deborah L.} and Rosove, {Michael H.} and Garst, {Jordan H.} and Wang, {Pin Chieh} and Darlene Veruttipong and Shyam Rao and Fragoso, {Ruben C} and Jonathan Riess and Steinberg, {Michael L.} and Chen, {Allen M.}",
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T1 - Patient-reported quality-of-life outcomes after de-escalated chemoradiation for human papillomavirus-positive oropharyngeal carcinoma

T2 - Findings from a phase 2 trial

AU - Hegde, John V.

AU - Shaverdian, Narek

AU - Daly, Megan E

AU - Felix, Carol

AU - Wong, Deborah L.

AU - Rosove, Michael H.

AU - Garst, Jordan H.

AU - Wang, Pin Chieh

AU - Veruttipong, Darlene

AU - Rao, Shyam

AU - Fragoso, Ruben C

AU - Riess, Jonathan

AU - Steinberg, Michael L.

AU - Chen, Allen M.

PY - 2017

Y1 - 2017

N2 - BACKGROUND: The current study represents a subset analysis of quality-of-life (QOL) outcomes among patients treated on a phase 2 trial of de-escalated chemoradiation for human papillomavirus (HPV)-associated oropharyngeal cancer. METHODS: Eligibility included newly diagnosed, (American Joint Committee on Cancer, 7th edition) stage III or IV oropharyngeal squamous cell carcinoma, p16 positivity, age≥18 years, and a Zubrod performance status of 0 to 1. Treatment was induction paclitaxel at a dose of 175mg/m2 and carboplatin at an area under the curve of 6 for 2 cycles followed by response-adapted, dose-reduced radiation of 54 Gy or 60 Gy with weekly concurrent paclitaxel at a dose of 30mg/m2. The University of Washington Quality of Life (UW-QOL) and the Functional Assessment of Cancer Therapy-Head and Neck questionnaires were used to assess patient-reported QOL as a secondary endpoint. RESULTS: A total of 45 patients were registered, 40 of whom completed QOL surveys and were evaluable. Nadirs for overall UW-QOL and Functional Assessment of Cancer Therapy-Head and Neck scores were reached at 4 weeks after treatment but returned to baseline at 3 months. Nearly all functional indices returned to baseline levels by 6 to 9 months. The mean overall UW-QOL score was 71.6 at baseline compared with 70.8, 73.0, 83.3, and 81.1, respectively, at 3 months, 6 months, 1 year, and 2 years after therapy. The percentage of patients rating their overall QOL as "very good" or "outstanding" at 6 months, 1 year, and 2 years using the UW-QOL was 50%, 77%, and 84%, respectively. CONCLUSIONS: This de-escalation regimen achieved QOL outcomes that were favorable compared with historical controls. These results serve as powerful evidence that ongoing de-escalation efforts lead to tangible gains in function and QOL.

AB - BACKGROUND: The current study represents a subset analysis of quality-of-life (QOL) outcomes among patients treated on a phase 2 trial of de-escalated chemoradiation for human papillomavirus (HPV)-associated oropharyngeal cancer. METHODS: Eligibility included newly diagnosed, (American Joint Committee on Cancer, 7th edition) stage III or IV oropharyngeal squamous cell carcinoma, p16 positivity, age≥18 years, and a Zubrod performance status of 0 to 1. Treatment was induction paclitaxel at a dose of 175mg/m2 and carboplatin at an area under the curve of 6 for 2 cycles followed by response-adapted, dose-reduced radiation of 54 Gy or 60 Gy with weekly concurrent paclitaxel at a dose of 30mg/m2. The University of Washington Quality of Life (UW-QOL) and the Functional Assessment of Cancer Therapy-Head and Neck questionnaires were used to assess patient-reported QOL as a secondary endpoint. RESULTS: A total of 45 patients were registered, 40 of whom completed QOL surveys and were evaluable. Nadirs for overall UW-QOL and Functional Assessment of Cancer Therapy-Head and Neck scores were reached at 4 weeks after treatment but returned to baseline at 3 months. Nearly all functional indices returned to baseline levels by 6 to 9 months. The mean overall UW-QOL score was 71.6 at baseline compared with 70.8, 73.0, 83.3, and 81.1, respectively, at 3 months, 6 months, 1 year, and 2 years after therapy. The percentage of patients rating their overall QOL as "very good" or "outstanding" at 6 months, 1 year, and 2 years using the UW-QOL was 50%, 77%, and 84%, respectively. CONCLUSIONS: This de-escalation regimen achieved QOL outcomes that were favorable compared with historical controls. These results serve as powerful evidence that ongoing de-escalation efforts lead to tangible gains in function and QOL.

KW - Chemoradiation

KW - De-escalation

KW - Head and neck

KW - Human papillomavirus (HPV)

KW - Oropharyngeal

KW - Quality of life (QOL)

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