Quality of Life for Patients with Favorable Risk HPV-Associated Oropharyngeal Cancer After De-Intensified Chemoradiotherapy.

BACKGROUND: Human Papillomavirus (HPV)-associated oropharynx cancers have a favorable prognosis, but current treatment approaches carry significant long-term morbidity. Strategies to de-intensify treatment in this population are under investigation, but the impact of these approaches on quality of life is not well-understood. We present patient-reported outcomes from two prospective studies examining de-intensified chemoradiotherapy METHODS: This study included patients enrolled on two prospective phase II trials of de-intensified chemoradiotherapy in HPV-associated oropharynx cancer patients who had at least one year of follow-up. Treatment included concurrent radiotherapy (60 Gy) and chemotherapy (weekly cisplatin 30mg/m2 ). Patients reported quality of life and symptoms using EORTC QLQ-C30, EORTC H&N-35, and Eating Assessment Tool (EAT-10) instruments prior to treatment and at regular intervals thereafter. Changes in quality of life and individual symptoms were examined over time, and multivariate analysis was used to identify clinical factors associated with recovery to baseline symptom levels.

RESULTS: Of the 154 patients enrolled, 126 patients had at least one year of follow-up and were included in this study (median follow-up 25 months). Global quality of life, functional indices, and most individual symptoms returned to baseline 3-6 months after treatment. Swallowing (EAT-10 score) returned to baseline function by two years, but, dry mouth, sticky saliva, and taste/senses did not return to baseline. However, from one to two years, there was continued improvement in dry mouth (55 vs 48), sticky saliva (35 vs 27), and senses (24 vs 20). On multivariate analysis, unilateral radiotherapy was associated with returning to baseline level of swallowing and sticky saliva.

CONCLUSIONS: The use of de-intensified chemoradiotherapy in HPV-associated oropharynx cancer led to favorable patient-reported outcomes, with early recovery of quality of life and continued improvement of xerostomia and dysphagia beyond 1-year post-treatment.