Prevailing Symptom Clusters in Advanced Stage, Head and Neck Cancer Survivors

Purpose: Curative treatment involves intense multimodality therapy, which contributes to short and long-term symptoms and treatment-related effects. The majority of patients with HNC still present with advanced disease (i.e., Stage III or IV)^14,15,(1, 2) which is commonly treated with multimodality therapies including surgery, chemotherapy, and/or radiation.¹⁶ Moreover, the intensity of the standard therapies has amplified, resulting in a 500% increase in reported acute toxicity burden (i.e., mucositis and dysphagia) and moderate late treatment-related side effects (i.e., xerostomia and fibrosis).¹⁹ To date, the focus of research on symptom clusters has primarily been with patients receiving treatment.²³ However, delivering high-quality, relevant cancer survivorship care is a growing national priority^24,25, and we need a patient-accessible approach that targets the common physical and functional treatment-related side effects in order to sustain the health and optimize functional capabilities of HNC survivors. The purpose of this presentation is to describe the symptom experienced of head and neck cancer (HNC) survivors and identify symptom clusters experienced by these survivors.

Methods: We conducted a secondary analysis of data collected on advanced stage (Stage III-IV), HNC survivors being seen in a multidisciplinary HNC survivorship clinic. The sample consisted of survivors diagnosed with non-metastatic, squamous cell carcinoma of the oral cavity, oropharynx, and larynx. Patients with metastases and/or second primaries were excluded from this analysis. Primary outcomes were quality of life measured by the University of Washington Quality of Life (UWQOL) questionnaire (version 4). The UWQOL consists of 12 single question domains with response options that are scaled evenly from 0 (worst) to 100 (best). Factor analysis was conducted using principal component analysis for extraction followed by a Varimax rotation.

Results: To date, a total of 207 survivors were identified with a median 3.0 years since the completion of their cancer treatment. Three clusters were revealed through the analysis: social/emotional, mastication/speech, and dysphagia. The social/emotional cluster consisted of 7 symptoms: pain, appearance, activity, recreation, shoulder, mood, and anxiety. The second cluster consisted of oral cavity functions including chewing and speech. Finally, the third cluster, dysphagia, comprised swallowing, taste and saliva.

Conclusion: Factor analysis revealed three prevailing symptoms clusters for HNC survivors. These results illustrate the complex and persistent nature of symptoms and late and long-term effects experienced by HNC survivors. The results of our analysis suggest additional research is needed to develop and implement interventions, which leverage the experience of a multidsicplinary team, to address these symptoms and treatment-effects experience by HNC survivors. Further work needs to identify if symptoms clusters change over time to tailor and personalize survivorship care and planning.