2822 - Impact of Mental Health on Long-Term Patient-Reported Outcomes and Quality of Life after Head and Neck Radiation

A. Kassardjian, C. J. Ladbury, A. Amini, and S. Sampath; Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA

Purpose/Objective(s): Baseline anxiety or depression (AD) in patients receiving head and neck (H&N) radiation (RT) may negatively impact quality of life (QoL), yet the relationship between baseline mental health and long-term patient-reported outcomes is not well understood. This study aims to characterize long-term toxicity in patients with and without baseline AD who underwent H&N RT. Materials/

Methods: In patients treated with H&N RT between 2010 and 2021, symptoms were captured using the Vanderbilt Head and Neck Symptom Survey (VHNSS) version 2.0. VHNSS data were prospectively collected at baseline prior to RT and at follow-up visits after RT. Responses were classified into symptom clusters for characterization of side effects and scored from 0 (asymptomatic) to 10 (severe symptoms). Participants were stratified by their baseline mental health scores regarding the questions “I feel sad or depressed” and “I feel anxious” with AD corresponding to scores >1 and no significant anxiety or depression symptoms (NAD) corresponding to scores =1. Surveys collected at 1 year and 2 years (± 3 months) upon completion of RT were analyzed. Survey response distributions are reported as median and interquartile ranges (IQR). Comparisons between groups were made using the Mann-Whitney U-test.
Results: A total of 75 and 47 patients had survey responses at 1 and 2 years, respectively. At 1 year, median age was 58 [49-65] and 61 (81.3%) were male. At 2 years, median age was 59 [50.5-64] and 37 (78.7%) were male. AD patients reported significantly worse fatigue, nutrition, and mental health symptoms compared to NAD patients at 1 year and 2 years (Table 1). AD patients also experienced more general pain, mucous, sleep issues, and difficulty swallowing solids than NAD patients at 1 year, but not 2 years.
Conclusion: Baseline mental health can impact long-term QoL based on results from the VNHSS. Symptoms of anxiety and depression may increase the burden of long-term toxicity from H&N RT. These results can guide design for supportive intervention-based clinical trials to address patients at highest risk for QoL deterioration during survivorship.

Abstract 2822 – Table 1. Median score and IQR of VNHSS responses in AD and NAD patients

VNHSS Cluster	AD 1-year Median [IQR]	NAD 1-year Median [IQR; p-value]	AD 2-year Median [IQR]	NAD 2-year Median [IQR; p-value]
Fatigue	2.0 [0.0-4.2]	0.0 [0.0-1.0; p=0.0074]	2.0 [1.0-4.0]	0.0 [0.0-2.0; p=0.012]
General Pain	1.0 [0.0-3.3]	0.0 [0.0-1.0; p=0.017]	0.7 [0.0-2.3]	0.0 [0.0-0.7; p=0.37]
Mental Health	2.0 [1.0-4.2]	0.0 [0.0-0.5; p<0.00001]	2.0 [0.0-5.0]	0.0 [0.0-1.5; p=0.034]
Mucous	1.5 [0.0-4.0]	0.2 [0.0-1.0; p=0.037]	0.2 [0.0-1.7]	0.0 [0.0-1.0; p=0.65]
Nutrition	0.6 [0.0-2.9]	0.0 [0.0-1.0; p=0.032]	0.5 [0.0-4.0]	0.0 [0.0-0.0; p=0.014]
Sleep	1.8 [0.9-4.4]	0.5 [0.0-2.5; p=0.04]	2.0 [0.5-5.0]	1.0 [0.0-3.5; p=0.24]
Swallow Solids	1.6 [0.7-4.9]	0.8 [0.1-1.9; p=0.028]	1.6 [0.6-4.5]	1.0 [0.4-2.4; p=0.45]