Mona Kamal1, David I Rosenthal2, Stefania Volpe3, Ryan P Goepfert4, Adam S Garden2, Katherine A Hutcheson4, Karine A Al Feghali5, Mohamed Ahmed Mohamed Meheissen6, Salman A Eraj7, Amy E Dursteler7, Bowman Williams2, Joshua B Smith7, Jeremy M Aymard8, Joel Berends9, Aubrey L White7, Steven J Frank2, William H Morrison2, Richard Cardoso4, Mark S Chambers4, Erich M Sturgis10, Tito R Mendoza11, Charles Lu11, Abdallah S R Mohamed12, Clifton D Fuller13, G Brandon Gunn14. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; University of Milan, Department of Oncology and Hemato-Oncology, Milano, Italy. 4. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA. 5. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center, Lebanon. 6. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt. 7. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, USA. 8. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Abilene Christian University, USA. 9. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; University of Texas Health Science Center at San Antono, USA. 10. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, USA. 11. Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA. 12. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt; MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, USA. 13. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, USA. 14. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: gbgunn@mdanderson.org.
Abstract
PURPOSE: To identify a clinically meaningful cut-point for the single item dry mouth question of the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). METHODS: Head and neck cancer survivors who had received radiation therapy (RT) completed the MDASI-HN, the University of Michigan Hospital Xerostomia Questionnaire (XQ), and the health visual analog scale (VAS) of the EuroQol Five Dimension Questionnaire (EQ-5D). The Bayesian information criteria (BIC) were used to test the prediction power of each tool for EQ-5D VAS. The modified Breiman recursive partitioning analysis (RPA) was used to identify a cut point of the MDASI-HN dry mouth score (MDASI-HN-DM) with EQ-5D VAS, using a ROC-based approach; regression analysis was used to confirm the threshold effect size. RESULTS: Two-hundred seven respondents formed the cohort. Median follow-up from the end of RT to questionnaire completion was 88 months. The single item MDASI-HN-DM score showed a linear relationship with the XQ composite score (ρ = 0.80, p < 0.001). The MDASI-HN-DM displayed improved model performance for association with EQ-5D VAS as compared to XQ (BIC of 1803.7 vs. 2016.9, respectively). RPA showed that an MDASI-HN-DM score of ≥6 correlated with EQ-5D VAS decline (LogWorth 5.5). CONCLUSION: The single item MDASI-HN-DM correlated with the multi-item XQ and performed favorably in the prediction of QOL. A MDASI-HN-DM cut point of ≥6 correlated with decline in QOL.
PURPOSE: To identify a clinically meaningful cut-point for the single item dry mouth question of the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). METHODS:Head and neck cancer survivors who had received radiation therapy (RT) completed the MDASI-HN, the University of Michigan Hospital Xerostomia Questionnaire (XQ), and the health visual analog scale (VAS) of the EuroQol Five Dimension Questionnaire (EQ-5D). The Bayesian information criteria (BIC) were used to test the prediction power of each tool for EQ-5D VAS. The modified Breiman recursive partitioning analysis (RPA) was used to identify a cut point of the MDASI-HN dry mouth score (MDASI-HN-DM) with EQ-5D VAS, using a ROC-based approach; regression analysis was used to confirm the threshold effect size. RESULTS: Two-hundred seven respondents formed the cohort. Median follow-up from the end of RT to questionnaire completion was 88 months. The single item MDASI-HN-DM score showed a linear relationship with the XQ composite score (ρ = 0.80, p < 0.001). The MDASI-HN-DM displayed improved model performance for association with EQ-5D VAS as compared to XQ (BIC of 1803.7 vs. 2016.9, respectively). RPA showed that an MDASI-HN-DM score of ≥6 correlated with EQ-5D VAS decline (LogWorth 5.5). CONCLUSION: The single item MDASI-HN-DM correlated with the multi-item XQ and performed favorably in the prediction of QOL. A MDASI-HN-DM cut point of ≥6 correlated with decline in QOL.
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