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Chapter 2
comparisons were carried out in this study increasing the risk of reporting false positive results. For this reason, our presented p values should be interpreted with caution.
The study did have a number of strengths. Firstly, this was a multi-institution nationwide prospective study. Secondly, all institutes were eligible to take part so those with different views on management of early-stage OPC were included. Thirdly, this is, to our knowledge, the first study to report on swallowing and oral function (a high priority in people with OPC) after surgery or RT for early-stage OPC within a study that recruited both groups at the same time.
CONCLUSION
In this study we compared a key self-report functional outcome (swallowing) in people with early-stage OPC offered surgery or RT alone. Survival was similar between groups but swallowing was worse with RT, although not statistically significant in multivariable analysis, which did not result in differences of feeding tube use. Trials are required to confirm these observational differences are not a result of residual confounding. In the meantime, these results are helpful in informing treatment decisions by clinicians and patients. Over half of people offered surgery alone received surgery plus adjuvant therapy. More effort should be made to define the indications for postoperative RT and select the patients who will not go on to need adjuvant therapy.
ACKNOWLEDGEMENTS
This publication presents data from the HN5000 study which was a component of independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10034). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Human papillomavirus (HPV) serology was supported by a Cancer Research UK Programme Grant, the Integrative Cancer Epidemiology Programme (grant number: C18281/ A19169). The department of Head and Neck Oncology and Surgery of the Netherlands Cancer Institute receives a research grant from ATOS Medical to support this type of research. We thank Vanessa Marshall, Katrina Hurley and Tom Stu for their contribution to the project.
