Prospective Patient-Reported Quality of Life Outcomes For Human Papillomavirus Associated Oropharynx Cancer Treated with Transoral Robotic Surgery and Neck Dissection Alone

Presentation: A110
Topic: Oropharynx / HPV Related Disease
Type: Poster
Authors: Sagar Kansara, MD1; Karolina Plonowska-Hirschfeld, MD1; Arushi Gulati1; Mary Xu, MD2; Aaron Zebolsky1; Edgar Ochoa, MD1; Patrick Ha, MD1; Chase Heaton, MD1; Yue Ma, MD1; William R Ryan, MD1
Institution(s): 1UCSF; 2University of Pennsylvania


: Prospective patient reported quality of life (QOL) outcomes are needed for human papillomavirus-related oropharynx squamous cell carcinoma (HPV+OPSCC) treated with transoral robotic surgery (TORS) and neck dissection (ND).

Design: Prospective repeated-measures study

Setting: Tertiary center

Participants: Treatment naïve patients with American Joint Committee on Cancer (AJCC) 8th edition classification T0-T2 and N0-N1 HPV+OPSCC.

Exposures: Definitive surgery alone with TORS and ND.

Main Outcomes/Measures: Patients completed the following patient-reported outcome measures pre-treatment, 3-months (38/38, 100%), and 1-year (25/38, 66%) postoperatively: University of Washington Quality of Life Questionnaire version 4 (UW-QOL), which includes 16 functions, scored 0-100; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Head and Neck Module (EORTC QLQ-HN35), which include 65 symptoms/functions, scored in various ways; and Neck Dissection Impairment Index (NDII) which consists of 10 functions scored 0-5 (total score of 0-50).  Comparisons were analyzed using t-tests at p<0.05.  Mean score changes (Δ) were compared with published minimally clinically important differences (MCID) available for the UW-QOL and EORTC (but not NDII).

Results: Thirty-eight HPV+OPSCC patients underwent TORS for: base of tongue (17 (44.7%)), palatine tonsil (16 (42.1%)), glossotonsillar sulcus (1 (2.6%)), and true unknown (4 (10.5%)) primaries with ipsilateral ND in 25 (65.8%) patients and bilateral ND in 13 (34.2%) patients for these classifications: pT1 (19/38, 50%), pT2 (15/38, 39.5%), pT0 (4/38, 10.5%), pN0 (2/38, 5.3%), and pN1 (36/38, 94.7%).  

Using the UW-QOL, at 3-months, patients reported statistically significant and clinically meaningful (Δ scores exceed MCID) worse mean functional scores for appearance (pre: 91.5, post: 80.9 post, Δ-10.6), shoulder function (97.4, 78.7, Δ-18.7), and taste (98.4, 75.0, Δ-23.4) while at 1-year, patients reported mean scores that were no different than pre-treatment in all domains. 

Using the EORTC, at 3-months, patients reported statistically significant and clinically meaningful (Δ scores exceed MCID) worse mean scores for pain (8.1, 18.0, Δ+9.9), swallowing (4.3, 12.7, Δ+8.4), and social eating (2.5, 16, Δ+13.5), while at 1-year, patients reported mean scores that were no worse than pre-treatment in all domains.  At 1-year, patients reported significant clinical and statistical improvement of mean scores for mood (pre: 75, 1-year: 90, Δ+15) and anxiety (58.4, 86.8, Δ+28.4). There were no statistically significant or clinically meaningful changes in the pre- and post- treatment global health status/QOL mean scores at either 3-months or 1-year.

Using the NDII, at 3-months, patients reported statistically significant worse mean scores for total score (48.5, 44.5, Δ-4.0), neck stiffness (4.6, 4.2, Δ-0.4), lifting (4.9, 4.2, Δ-0.7), reaching above head (4.9, 4.4, Δ-0.5), overall activity level (4.9, 4.5, Δ-0.4), and recreational activity (4.9, 4.6, Δ-0.3) while at 1-year, patients reported no statistically significant differences in mean scores any of the NDII domains.

Conclusions and Relevance: After TORS and ND for HPV+OPSCC, patients may experience mild pain, mild impacts on appearance, taste, swallowing, and social eating, and mild shoulder dysfunction at 3-months with likely resolution of all such symptoms and dysfunction, including improvements in pre-treatment mood and anxiety, by 1-year.