Sub-Acute Post-Treatment Dysphagia and Shortness of Breath Symptoms Associate With Worse Survival in Oropharyngeal Cancer

PURPOSE/OBJECTIVE(S) Post-treatment symptoms are a focal point of follow-up visits for head and neck cancer patients. While symptoms such as dysphagia and shortness of breath may empirically guide earlier detection of disease recurrence, their association with patient outcomes is less well studied, especially for HPV-positive disease. This study aimed to investigate the association between patient reported dysphagia and shortness of breath at 3-to-6 months following radiotherapy (RT) and overall survival (OS). MATERIALS/METHODS Data were collected from oropharyngeal cancer patients that received RT with curative intent from 2015-2019. Included patients had self-reported scores for shortness of breath, choking/coughing ("choke"), and difficulty swallowing/chewing ("swallow"), which were surveyed via the MD Anderson Symptom Inventory-Head and Neck Module (MDASI-HN) questionnaire at 3-to-6 months after RT. Symptom severity was scored from 0-10. Significant predictors of OS were analyzed via Cox regression. Symptom scores were also discretized for Kaplan-Meier (KM) analysis, with more severe symptoms being 6+ for "swallow" and "choke" and 2+ for shortness of breath. RESULTS Symptom scores were collected at 3-to-6 months from 470 patients. The majority (91.3%) were HPV-positive. Median follow-up time was 31.7 months (IQR: 21.9-42.1). Univariable Cox regression (Table 1) showed significant associations between OS and MDASI scores for shortness of breath, "choke," and "swallow." Furthermore, a composite variable integrating scores of all three symptoms had the best predictive value for OS (c-index = 0.748). Symptom severity stratified patients based on OS for all three symptoms, with more severe symptoms predicting worse OS on KM analysis (P < 0.001 for all symptoms). On subset analysis more severe symptoms remained significantly associated with worse OS among HPV-positive patients (P < 0.01 for all symptoms). CONCLUSION Quantitative early patient-reported measures of dysphagia and shortness of breath are significant predictors of OS in head and neck cancer, in particular for HPV-positive disease. Integrating quantitative symptom surveys into post-treatment surveillance may be beneficial for individualizing follow-up strategies.