• 9/25/2005
  • Virginia, USA
  • staff
  • myDNA (www.mydna.com)

Upper aerodigestive tract cancer patients used to have few treatment options. Fortunately, radiation therapy (RT) has proven to be an effective treatment – either on its own or in combination with surgery. But, despite the benefits, RT can also be associated with several long-term side effects, including depression.

Many cross-sectional and longitudinal studies have looked at the impact that this treatment modality can have on the long-term quality of life of head and neck cancer survivors. On the other hand, few studies have assessed the effect of acute toxicities of radiation therapy on the quality of life during the treatment process. These acute toxicities can be more severe when chemotherapeutic agents that have a synergistic effect on the cancerous and normal tissues are used concomitantly.

The quality of life of head and neck cancer patients during radiation has not been explored before. British researchers planned a prospective study to assess the impact that radiation therapy has on the quality of life during the treatment process. They speculated that the health related quality of life would decrease over the period of radiation therapy and that patients would be increasingly depressed as the treatment progressed caused by the side effects of the treatment.

The authors of “Deterioration in Quality of Life and Depressive Symptoms during Radiation Therapy for Head and Neck Cancer,” are Mr. Vinidh Paleri FRCS, Carol Downes, and Charles Kelly FRCR, all from the Freeman Hospital, University of Newcastle upon Tyne, United Kingdom. Their findings are to be presented at the 109th Annual Meeting and OTO EXPO of the American Academy of Otolaryngology – Head and Neck Surgery Foundation, being held September 25-28, 2005, at the Los Angeles Convention Center, Los Angeles, CA.

All patients who were to receive radiation or chemoradiation as part of the treatment for head and neck cancer were selected for the study. The primary sites included squamous cell carcinomas of the upper aerodigestive tract mucosa including the nasopharynx.

The University of Washington QoL (UW-QOL) version 3 was the instrument chosen to assess quality of life. The self-administered questionnaire consists of ten domains that describe important areas of daily living that may be affected by treatment of head and neck cancer. These domains are pain, appearance, activity, recreation/entertainment, employment, chewing, swallowing, speech and shoulder disability.

The Hospital Anxiety and Depression Scale (HADS) was developed to detect anxiety and depression in a non-psychiatric hospital setting, but since its inception the questionnaire has been used and validated in other, non-hospital settings, including in oncologic work. The UW-QOL and the HADS questionnaire were administered before treatment, at the mid-treatment point and after treatment. Subsequently, all two-year survivors were sent a further questionnaire.

Between August 2001 and February 2003 some 202 patients consented to the study. The mid-treatment data and end of study data was available for 113 and 68 subjects respectively. Datasets at all three time points were available for 63 patients, while 68 patients completed a questionnaire at the beginning and at the end of the study. Eighty-four patients filled out only one questionnaire at the beginning of the study and subsequently dropped out of the study.

The distribution of primaries in the cohort is as follows: paranasal sinus (2.25 percent), oral cavity (19.66 percent), oropharynx (20.22 percent), hypopharynx (10.67 percent), larynx (41.01 percent), nasal cavity (1.1.2 percent), nasopharynx (3.37 percent) and unknown primary (1.69 percent).

The composite score, and domain scores for pain, appearance, recreation, swallowing, chewing, taste and saliva show a steady decrease in time over the radiation period. This difference was statistically significant. The Friedman test was used to assess within subject change of quality of life scores over this period; this showed a significant deterioration in total quality of life scores over the treatment period for the three groups. Attrition of patients led to data being not available at all time points. Comparison of the within subject scores during the first two time points (n=113) showed a significant deterioration even by the mid-point of the treatment period.

There was also a significant increase in depression scores on the HADS scale over the three treatment periods but not in anxiety levels. To assess if poor QoL and depression at the beginning of treatment was related to the attrition, we compared response rates at the second time point between patients who scored above and below the median score prior to start of treatment. There was marginally significant difference in the response rates between the groups with respect to the initial composite scores, but patients with higher depression scores on the HADS scale prior to start of treatment were more likely to drop out.

Conclusions: The researchers found:

1. The primary reasons for patients not completing the questionnaires were the side effects, especially when this was significant enough for treatment interruption due to reactions or admission to ward.

2. This study also validates the anxiety domain of the UWQOL and also shows that depressed patients are likely to drop out of the study, but not those with poor quality of life.

3. Approximately 24.2 percent of patients are depressed prior to start of treatment and this underlines the need for good psychological support in this population. This figure increases with time and given that depressed patients are less likely to respond to questionnaires, the problem is being underestimated as well.