Head and Neck Symptom Severity (HNSS) and Health-Related Quality of Life (HRQL) Trajectories during and after Chemoradiotherapy (CRT) for HPV-Associated Oropharyngeal Cancer (HPVOPC): A TROG 12.01 Secondary Analysis.

This secondary analysis aimed to identify HNSS and HRQL trajectories during and following CRT for HPVOPC. All 182 evaluable TROG 12.01 patients were included. HNSS was assessed with the MDASI-HN (range 0-10) at baseline (BL), weekly during CRT (weeks (w) 1-7) and then 1, 3, 5, 9 and 13w and 6, 12 and 24 months (m) post CRT. HRQL was assessed using the FACT-G (range 0-108) at BL, and 7w, 6m, 12m and 24m post CRT. Latent class growth mixture modelling (LCMM) was performed to identify trajectories. Mean estimates and 95% confidence intervals (CI) were calculated at each time point. The HNSS model identified 4 trajectory classes (HNSS1-4) distinguished by differences in HNSS at BL, during the peak of treatment symptoms (w7 CRT/1w post CRT) and during early (1w to 9w post CRT) and intermediate recovery (9w to 12m post CRT). The trajectories of all 4 classes were stable beyond 12m. The reference trajectory (HNSS4, n=74) score was 0.1 (CI 0.1-0.2) at BL, peaking at 4.6 (CI 4.2-5.0), with rapid early recovery (1.1, CI 0.8-2.2) and gradual improvement to 12m (0.6, CI 0.5-0.8). HNSS2 ("high BL", n=30) reported higher BL scores (1.4, CI 0.8-2.0) but was otherwise similar, HNSS3 ("low acute", n=53) reported reduced acute symptoms (2.5, CI 2.2-2.9) with stable scores beyond 9w post CRT (1.1, CI 0.9-1.4). HNSS1 ("slow recovery", n=25) had slower recovery from an acute peak of 4.9 (CI 4.3-5.6) to 0.9 (CI 0.6-1.3) at 12m. Compared to HNSS4, the high BL group were younger (mean 53.6 vs 57.4), with fewer ECOG0 (87 vs 99%) or with higher degree (38 vs 69%), and higher baseline anxiety (HADS, mean 6.8 vs 4.4). The low acute group were older (mean 60.1), had fewer ECOG0 patients (87%) and were more likely to have received cetuximab (68% vs 43%). The slow recovery group had fewer with a higher degree (52%). The HRQL model included 2 trajectory classes. The reference trajectory (HRQL2, n=156) scores were 90 (CI 88-92) at BL, similar 7w post CRT (88, CI 85-90) with slow but clinically meaningful improvement to 12m (98, CI 96-100). HRQL1 (n=26) had lower BL mean scores (80, CI 74-86), with a significant decline at 7w post CRT (57, CI 50-63) and a slower recovery to BL scores over 12m (83, CI 72-94). Both trajectories were flat beyond 12m. The slow recovery group were older (mean 61.1 vs 56.8), with worse BL anxiety (mean 6.5 vs 4.4) and depression (mean 4.5 vs 2.1). In addition, LCMM identified 4 trajectories for head and neck symptom interference, 3 for anxiety and 4 for depression, which will be presented. LCMM identified distinct trajectories of HNSS and HRQL during and after CRT. These and their associations with variations in HPVOPC patients' characteristics and treatment factors provide clinically relevant insights into identifying patients who may require increased support during and after CRT. [ABSTRACT FROM AUTHOR]