Catherine O Allen-Ayodabo1, Antoine Eskander2, Laura E Davis3, Haoyu Zhao4, Alyson L Mahar5, Irene Karam6, Simron Singh7, Vaibhav Gupta8, Lev D Bubis9, Lesley Moody10, Lisa Barbera11, Natalie G Coburn12. 1. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Canada; Institute for Clinical Evaluative Sciences (IC/ES), Canada. 2. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Canada; Institute for Clinical Evaluative Sciences (IC/ES), Canada; Odette Cancer Centre, Surgical Oncology, Sunnybrook Health Sciences Centre, Canada; Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada. 3. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Canada. 4. Institute for Clinical Evaluative Sciences (IC/ES), Canada. 5. Department of Community Health Sciences, University of Manitoba, Canada. 6. Department of Radiation Oncology, University of Toronto, Canada. 7. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Canada; Institute for Clinical Evaluative Sciences (IC/ES), Canada; Odette Cancer Centre, Medical Oncology, Sunnybrook Health Sciences Centre, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Cancer Care Ontario, Toronto, Canada. 8. Division of General Surgery, Department of Surgery, University of Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada. 9. Division of General Surgery, Department of Surgery, University of Toronto, Canada. 10. Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Cancer Care Ontario, Toronto, Canada. 11. Institute for Clinical Evaluative Sciences (IC/ES), Canada; Department of Radiation Oncology, University of Toronto, Canada; Division of Radiation Oncology, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Canada. 12. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Canada; Institute for Clinical Evaluative Sciences (IC/ES), Canada; Odette Cancer Centre, Surgical Oncology, Sunnybrook Health Sciences Centre, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Cancer Care Ontario, Toronto, Canada. Electronic address: natalie.coburn@sunnybrook.ca.
Abstract
PURPOSE: Head and neck cancer (HNC) and its treatment affects quality of life, with significant symptom burden. The main objectives of this study were to examine symptom trajectories of HNC patients by treatment and to identify factors associated with high ESAS scores. METHODS AND MATERIALS: We conducted a retrospective cohort study in patients diagnosed with HNC in Ontario, Canada from 2007 to 2015 using linked health administrative databases. The primary outcome was a monthly patient self-reported moderate-to-severe (≥4) symptom score in the year following diagnosis. Multivariable Modified Poisson regression analyses with robust variance were used to investigate factors associated with moderate-to-severe scores. RESULTS: Of 13,827 HNC patients identified, 4793 had ≥1 ESAS assessment within 12 months of cancer diagnosis. Overall, 60% (n = 2708) and 65% (n = 2903) of patients reported moderate-to-severe pain and poor appetite, respectively. The proportion of patients reporting a score ≥4 increased significantly during treatment and was most pronounced for those who received chemoradiation (CRT). On multivariable analysis, patients who were female (Relative Risk (RR) 1.15, 95% CI 1.08-1.23, received CRT, had a higher comorbidity burden (RR 1.31, 1.23-1.39), and had a diagnosis of oropharyngeal (1.10, 1.02-1.19), or oral cavity cancer (1.31, 1.19-1.45), were at an increased risk of reporting severe pain scores (p < 0.01 for all). CONCLUSION: The majority of HNC patients report high pain scores, with symptom burden highest during the treatment phase, and especially for patients who received radiation or chemoradiation. This large study highlights the need for proactive symptom management during the HNC patients' cancer journey.
PURPOSE: Head and neck cancer (HNC) and its treatment affects quality of life, with significant symptom burden. The main objectives of this study were to examine symptom trajectories of HNC patients by treatment and to identify factors associated with high ESAS scores. METHODS AND MATERIALS: We conducted a retrospective cohort study in patients diagnosed with HNC in Ontario, Canada from 2007 to 2015 using linked health administrative databases. The primary outcome was a monthly patient self-reported moderate-to-severe (≥4) symptom score in the year following diagnosis. Multivariable Modified Poisson regression analyses with robust variance were used to investigate factors associated with moderate-to-severe scores. RESULTS: Of 13,827 HNC patients identified, 4793 had ≥1 ESAS assessment within 12 months of cancer diagnosis. Overall, 60% (n = 2708) and 65% (n = 2903) of patients reported moderate-to-severe pain and poor appetite, respectively. The proportion of patients reporting a score ≥4 increased significantly during treatment and was most pronounced for those who received chemoradiation (CRT). On multivariable analysis, patients who were female (Relative Risk (RR) 1.15, 95% CI 1.08-1.23, received CRT, had a higher comorbidity burden (RR 1.31, 1.23-1.39), and had a diagnosis of oropharyngeal (1.10, 1.02-1.19), or oral cavity cancer (1.31, 1.19-1.45), were at an increased risk of reporting severe pain scores (p < 0.01 for all). CONCLUSION: The majority of HNC patients report high pain scores, with symptom burden highest during the treatment phase, and especially for patients who received radiation or chemoradiation. This large study highlights the need for proactive symptom management during the HNC patients' cancer journey.
Authors: Christopher W Noel; Rinku Sutradhar; Lesley Gotlib Conn; David Forner; Wing C Chan; Rui Fu; Julie Hallet; Natalie G Coburn; Antoine Eskander Journal: JAMA Otolaryngol Head Neck Surg Date: 2022-08-01 Impact factor: 8.961
Authors: Julie Hallet; Jesse Zuckerman; Matthew P Guttman; Tyler R Chesney; Barbara Haas; Alyson Mahar; Antoine Eskander; Wing C Chan; Amy Hsu; Victoria Barabash; Natalie Coburn Journal: Ann Surg Oncol Date: 2022-09-06 Impact factor: 4.339
Authors: Christopher W Noel; Yue Jennifer Du; Elif Baran; David Forner; Zain Husain; Kevin M Higgins; Irene Karam; Kelvin K W Chan; Julie Hallet; Frances Wright; Natalie G Coburn; Antoine Eskander; Lesley Gotlib Conn Journal: JAMA Otolaryngol Head Neck Surg Date: 2022-04-01 Impact factor: 8.961
Authors: K Naik; M N Janal; J Chen; D Bandary; B Brar; S Zhang; J C Dolan; B L Schmidt; D G Albertson; A Bhattacharya Journal: J Dent Res Date: 2020-10-08 Impact factor: 6.116