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The objective of this prospective study was to examine whether pre- and post-treatment quality of life is associated with survival, after adjusting for demographic, clinical, and lifestyle factors in patients with head and neck cancer.
Les auteurs ont constitué une cohorte de 948 patients atteints de cancer de la tête et du cou nouvellement diagnostiqués et traités par (chimio)radiothérapie primaire ou adjuvante avec intention curative.
They evaluated the patients’ quality of life in the form of a questionnaire, including a large number of variables, particularly environmental. These questionnaires were completed by the patients before their treatment, as well as at different times after treatment (6 weeks, 6 months and 12 months).
The results obtained were analyzed according to the Cox model, a multivariate logistic regression approach commonly used in medical research to analyze survival time data as a function of a set of covariates (here, factors associated with quality of life).
– Better quality of life is significantly associated with longer survival, after adjustment for demographic, clinical, and lifestyle factors. These criteria include overall quality of life, physical activity, emotional, cognitive, and social status before treatment and at 6 weeks, 6 months, and 12 months after treatment.
– Quality of life measured 6 weeks after treatment compared with the situation before treatment was not significantly associated with survival. This may be due to the fact that shortly after treatment, many patients are still suffering from the acute side effects of the treatment and therefore the short-term change in quality of life is not yet a discriminating factor. Most of these acute side effects disappear after 6 months of treatment.
– Decreased physical activity and worsened emotional state (including “depressive symptoms”) at 6 and 12 months after treatment were significantly associated with shorter survival. This association had already been demonstrated in previous studies on different types of cancers, including breast cancer.
– Tracking changes in quality of life (especially physical activity, and emotional state) over time in clinical practice seems important, as these scores may be sensitive in signaling clinical deterioration. Monitoring of symptoms (such as dyspnea, fatigue, and pain) in routine patient care appears to be associated with increased survival compared with usual care. This may be due to nurses’ early responses to symptom alerts with clinical interventions and better tolerance of chemotherapy compared with the usual care group.
Monitoring quality of life in clinical practice can identify patients at risk following treatment. This could further improve cancer care in a timely and effective manner.
Our rapid tests reflect our desire to personalize medicine by optimizing both the effectiveness of radiotherapy treatments and the prevention of toxicities.
We have developed a predictive model of acute toxicity after radiation therapy for patients with ENT cancers, using both our RADIODTECT® test, and dosimetric factors of normal tissues.
We do not all have the same sensitivity to radiation as used in radiotherapy. Measuring this radiosensitivity makes it possible to assess the risk of side effects before treatment and thus improve the overall quality of life of treated patients.
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