S. Kacker1, D. Midthune2, V. Kipnis2, C. Kut3, and H. Quon3; 1Johns Hopkins University School of Medicine, Baltimore, MD, United States, 2Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, National Institute of Health, Bethesda, MD, 3Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
Purpose/Objective(s): To improve our temporal understanding of the effects of standard CRT in HNCs through analysis of a rich longitudinal database of validated multi-dimensional PROs among HNC patients receiving CRT. Materials/
Methods: All patients receiving CRT for HNCs beginning 12/29/2014 to current were asked to complete a palette of validated PROs before, during and at each follow-up (FU) visit on a secure tablet writing directly to our database (approved by institutional IRB). At baseline and during FU visits, the Sydney Swallow Questionnaire (SSQ), the MD Anderson Dysphagia (MDADI), the FACT-HN QoL and the University of Michigan Xerostomia Questionnaire (XQ) were administered. During CRT, the SSQ, XQ and the Skindex questionnaire were administered weekly. Patient demographics and performance status, HN sub-site, HPV status, use of induction and/or concurrent chemotherapy, and absolute lymphocyte count (ALC) were also collected. Analysis was restricted to treatment start dates between 12/29/2014 and 12/26/2019 due to institutional data safety requirements. We limit this presentation to the SSQ, which reflects patient perceived swallow effectiveness (normal range 0-250), and the XQ (normalized range 0 to 100) to understand the post-CRT burden of swallow and xerostomia toxicities. Statistical analyses were conducted in STATA version 18. Results: Longitudinal SSQ and XQ data were available for 420 of 432 patients (97.2% response), yielding a total of 4248 observations with a median duration of 22.2 months (0 to 84 months) from the start of treatment. Peak XQ and SSQ scores were 42 and 624, with the peak values reported an average of 13 months and 6.5 months after treatment initiation, respectively. XQ nadir (14) and SSQ nadir (173) were reported after an average of 14.6 and 8.8 months, respectively. In multivariate linear regression, greater peak SSQ scores were associated with HPV-negative pathology, African American race, and decreasing absolute lymphocyte count. A 1-point decrease in absolute lymphocyte count (ALC) was associated with a 252 point increase in peak SSQ (p<0.05). Additional analysis by HN sub-site and time trends will be reported. Conclusion: Self-reported SSQ and XQ in HNC patients demonstrated swallow dysfunction and xerostomia to be low with normal swallow possible within 12 months. The relationship between decreased ALC due to treatment and SSQ warrants further investigation.
