The impact of palliative radiotherapy on health-related quality of life in patients with head and neck cancer - Results of a multicenter prospective cohort study

Marie-Luise Weiss; Justus Domschikowski; David Krug; Mathias Sonnhoff; Mirko Nitsche; Wolfgang Hoffmann; Martina Becker-Schiebe; Felix Bock; Markus Hoffmann; Claudia Schmalz; Jürgen Dunst; Alexander Fabian

doi:10.1016/j.ctro.2023.100633

The impact of palliative radiotherapy on health-related quality of life in patients with head and neck cancer - Results of a multicenter prospective cohort study

Clin Transl Radiat Oncol. 2023 Apr 26:41:100633. doi: 10.1016/j.ctro.2023.100633. eCollection 2023 Jul.

Affiliations

¹ Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany.
² Center for Radiotherapy and Radiation Oncology, 28239 Bremen, Germany.
³ Radiotherapy & Radiation Oncology, Hospital Braunschweig, 38114 Braunschweig, Germany.
⁴ Department of Radiotherapy, University of Rostock, 18059 Rostock, Germany.
⁵ Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein Campus Kiel, Germany.

Abstract

Purpose: Palliative radiotherapy for patients with head and neck cancer can be used to alleviate symptoms. Only a few studies have investigated its impact on patient-reported outcomes (PRO). Therefore, we conducted a prospective multicenter observational study. The primary objective was to assess changes in health-related quality of life (HrQoL) per PRO.

Methods: Eligibility criteria included i.) head and neck cancer and ii.) palliative radiotherapy indicated (EQD_2Gy < 60 Gy). The primary follow-up date was eight weeks after radiotherapy (t_8w). PRO measures included the EORTC QLQ-C30 and EORTC QLQ-H&N43 and pain per Numeric Rating Scale (NRS). Per protocol, five PRO domains were to be reported in detail as well as PRO domains corresponding to a primary and secondary symptom as determined by the individual patient. We defined a minimal important difference (MID) of 10 points.

Results: From 06/2020 to 06/2022, 61 patients were screened and 21 patients were included. Due to death or decline in health-status, HrQoL data was available for 18 patients at the first fraction and for eight patients at t_8w. The MID was not met for the predefined domains in terms of mean values as compared from first fraction to t_8w. Individually in those patients with available HrQoL data at t_8w, 71% (5/7) improved in their primary and 40% (2/5) in their secondary symptom domain reaching the MID from first fraction to t_8w, respectively. There was a significant improvement in pain per NRS in those patients with available data at t_8w per Wilcoxon signed rank test (p = 0.041). Acute mucositis of grade ≥3 per CTCAE v5.0 occurred in 44% (8/18) of the patients. The median overall survival was 11 months.

Conclusion: Despite low patient numbers and risk of selection bias, our study shows some evidence of a benefit from palliative radiotherapy for head and neck cancer as measured by PRO.German Clinical Trial Registry identifier: DRKS00021197.

Keywords: Head and neck neoplasms; Palliative care; Patient reported outcome measure; Quality of life; Radiotherapy; Signs and symptoms.