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Performance status predicted patient-reported toxicity better than age after head and neck RT

Patients aged ≥70 reported similar or lower symptom burden, whereas PS ≥2 consistently predicted worse toxicity and slower recovery after radical RT.

RadOncToday · ·1 min read

KEY POINTS

  • This analysis used the prospective UK Head and Neck 5000 cohort, recruited across 76 centres. It included 3,250 patients with oral cavity, oropharyngeal or laryngeal squamous cell carcinoma treated with definitive or adjuvant curative-intent RT with or without concurrent systemic therapy.
  • The age analysis included all 3,250 patients, including 665 aged ≥70 years; the performance-status analysis included 2,295 patients, including 406 with WHO PS ≥2. Patient-reported outcomes were assessed at baseline, 4 months, 12 months and 3–5 years.
  • Older age itself did not predict greater patient-reported toxicity. After adjustment, patients ≥70 actually had lower odds of worse mouth pain (OR 0.72, 95% CI 0.58–0.89; p=0.002) and xerostomia (OR 0.79, 95% CI 0.65–0.96; p=0.02), with no significant age effect for most other symptoms.
  • Performance status told a different story. PS ≥2 was associated with greater symptom severity across the overall cohort, including mouth pain (OR 1.63), xerostomia (OR 1.63), dysgeusia (OR 1.73), dysphonia (OR 1.44) and feeding-tube use (OR 1.60). Recovery was generally slower and less complete.
  • Symptom burden usually peaked around the 4-month assessment and improved by 12 months. By 3–5 years, most patient-reported outcomes in the overall, oropharyngeal and oral-cavity cohorts had returned toward or below baseline, although xerostomia and dysgeusia remained persistent.
  • Despite these differences, RT completion was remarkably high: >97% completed definitive RT and >94% completed adjuvant RT, regardless of age or performance status. For example, definitive RT completion was 99.8% in patients <70 versus 98.1% in those ≥70, and 99.6% with PS 0–1 versus 97.6% with PS ≥2.
  • Interpretation is limited by selection and attrition. Everyone enrolled had already been judged fit enough for radical therapy, 955 patients lacked baseline PS, only 1,971 entered multivariable PRO analysis, and questionnaire return fell from 70.9% at baseline to 23.3% at 3–5 years.

CLINICAL TAKEAWAY

Chronological age alone appears to be a poor reason to withhold radical head and neck RT from an otherwise appropriately selected patient. Performance status is much more informative for anticipating symptom burden and recovery, and PS ≥2 patients may need substantially more intensive nutritional, swallowing and multidisciplinary support even when they successfully complete treatment.

SOURCE

Clinical Oncology