Page 25 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

Swallowing function after treatment for early-stage OPC
INTRODUCTION
The incidence of oropharyngeal cancer (OPC) has risen over recent decades, mainly due to the increase in human papilloma virus (HPV) associated cases (1, 2). In some people with early stage OPC, single-modality treatment with surgery or radiotherapy (RT) can be a curative treatment with a high probability of disease-free survival. Because of these excellent survival outcomes, survivors are expected to live with the long-term effects of treatment.
When in the past open surgery was the usual surgical treatment for early-stage OPC, complication rates and morbidity favoured RT (3). However, since the introduction of transoral surgery, the two treatment modalities became more comparable in terms of adverse effects. Several meta- analyses of observational studies showed similar results for survival but differences in severity and timing of short- and long-term morbidity (4-10). Only one study has compared differences in self-reported functional outcomes in a randomized comparative study. Results of this ORATOR-trial (NCT01590355), including 68 patients, showed no clinically meaningful difference in swallowing related quality of life one year after treatment, despite statistically significantly better results in the RT arm (11). Other ongoing (randomized) comparative studies, such as the EORTC-1420-HNCG-ROG trial (NCT02984410) and the ORATOR2 trial (NCT03210103), are also comparing surgery and RT, and will increase the body of evidence and hopefully provide more definitive conclusions on optimal patient selection (12, 13). In the meantime, further observational analyses with self-reported functional outcomes are informative.
Given the comparable disease-free survival, clinicians and patients need information on toxicity profiles to make informed treatment decisions. OPC and its treatment often affect swallowing function (14, 15). Impaired swallowing has proven to be an important problem in people with OPC having significant impact on their quality of life (15, 16). Information on swallowing and oral function would be potentially important for clinicians and patients when making treatment decisions.
The objective of this study is to compare self-reported swallowing function in people planned for single-modality treatment with surgery or RT for early T classification OPC, regardless of received treatment, in order to inform patients prior to treatment on likely outcome of their intended treatment. Data from an existing large UK-wide multicentre study HN5000 were used, resulting in a large cohort, but detailed data on treatment were not included in this study.
2
23