Background & Aims
There is significant symptom burden in head and neck patients. The quality of life of patients is frequently significantly impacted by both the diagnosis and the intense treatment with surgery, radiotherapy and chemotherapy a high risk of unmet needs. The primary objective of this study was conducted to assess the symptom burden and quality of life in patients of advanced head and neck cancer receiving palliative care.
secondary objective was to compare changes in quality of life and symptoms burden on follow up at baseline, one and three months.
Methods
After approval from Institute Ethics Committee, patients attending the palliative care department with the diagnosis of Head and Neck malignancy were recruited in the study. Patients were explained about the study protocol and a written informed consent was taken. The patients’ demographic data including the age, gender, educational status, histopathological diagnosis and stages, ECOG (Eastern cooperative oncology group) staging, treatment history, previous admissions, duration of disease, adverse effects of analgesics like constipation, dyspepsia, sedation as well chemotherapy induced side effects like mucositis, vomiting, fever, rashes, neuropathy etc. if any were recorded in a predesigned proforma. Patient were asked in detail about the various complaints which impact the quality of life or the outcome using questionnaire based validated scale of EORTC QLQ C-30 and disease specific EORTC-QLQ H&N-35. Detailed symptom assessment was done by using ESAS scale.
Results
Total 189 patients were recruited in the study . It was found that majority of patients in the study were diagnosed as oral cavity cancer with the mean age being 51.64 years with male predominance. Upon assessment of symptom burden, we found pain as most prevalent ( severe pain in 41.2% patients ) and severe symptom (7.28 +- 1.03) by poor overall well-being, eating difficulty, tiredness, anxiety, lack of appetite and depression. With effective management in terms of physical symptom, social and psychological support, there was significant improvement in the ESAS score (symptom burden) upon follow up at 1 and 3 months.
On EORTC scales we found that the disease specific symptom burden was significantly high in initial visit which improved at one month and three months follow up. Global health status and functional status was poor at baseline which also improved significantly at 1 month and 3 months after palliative care consultation.
Conclusions
It was observed that symptom burden was high and health related quality of life was poor for patients of head and neck cancers at baseline presentation to palliative medicine. Palliative care services are important for these patients for controlling symptom burden and improving quality of life as our study results showed significant reduction in severity of majority of symptoms and improvement in quality of life in terms of global health, functioning, common malignancy related symptoms and disease specific symptoms of head and neck cancer.
References
1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68:394.
2. Lambert R, Sauvaget C, de Camargo Cancela M, Sankaranarayanan R. Epidemiology of cancer from the oral cavity and oropharynx. Eur J GastroenterolHepatol 2011; 23:633.
3. Kulkarni, Manik. (2013). Head and Neck Cancer Burden in India. International Journal of Head and Neck Surgery. 4. 29-35. 10.5005/jp-journals-10001-1132.
4. Wells, M., Cunningham, M., Lang, H., Swartzman, S., Philp, J., Taylor, L. & Thomson, J. (2015) European Journal of Cancer Care24, 748– 760 Distress, concerns and unmet needs in survivors of head and neck cancer: a cross?sectional survey
5. Van der Lan, H.P., Hendrik, P.B., Steenbakkers, R.J.H.M., Van der Shaaf, A., Chouvalova, O., Vemer-van den Hoek, J.G.M., 2015. Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia. Radiotherapy Oncol. 115, 56e62.
6. Velikova G, Stark D, Selby P: Quality of life instruments in oncology. Eur J Cancer 1999;35 :1571–1580
7. Bashir A, Kumar D, Dewan D, Sharma R. Quality of life of head and neck cancer patients before and after cancer-directed treatment – A longitudinal study. J Can Res Ther 2020;16:500-7Nieder C, Kämpe TA. Symptom Burden in Patients With Reduced Performance Status at the Start of Palliative Radiotherapy. In Vivo. 2020;34(2):735-738.
9. do Nascimento Santos Lima, E., Ferreira, I.B., Lajolo, P. et al. Health-related quality of life became worse in short-term during treatment in head and neck cancer patients: a prospective study. Health Qual Life Outcomes 18, 307 (2020).
10.Ostwal, Shrenik P et al. “Correlation between Symptom Burden and Perceived Distress in Advanced Head and Neck Cancer: A Prospective Observational Study.” Indian journal of palliative care vol. 27,3 (2021): 419-425.
11. Bisht M, Bist SS, Dhasmana DC, Saini S. Effect of Palliative Drug Therapy on Quality of life in Advanced Head and Neck Cancer Patients. Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India. 2011 Jul;63(3):220-222.
Presenting Author
Dr Seema Mishra
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Cancer Pain & Palliative Care