Severe sleep-related symptoms tracked with worse survival after oropharyngeal cancer radiotherapy

KEY POINTS

• The study included 372 patients with oropharyngeal cancer treated with curative-intent RT with or without chemotherapy. Patient-reported symptoms were collected prospectively using the MDASI-HN at RT start, during treatment and through follow-up; median follow-up was 84 months.
• Fatigue, sleep disturbance and drowsiness were generally mild before treatment but worsened substantially during RT. At treatment completion, 26% reported severe fatigue, 15% severe sleep disturbance and 18% severe drowsiness.
• Symptoms largely recovered after treatment. By six months, severe fatigue had fallen to 6%, severe sleep disturbance to 4% and severe drowsiness to 2%, approaching pretreatment levels.
• Symptoms present before the first RT fraction carried a strong prognostic signal. Severe fatigue at RT start was associated with worse overall survival (HR 3.58), as was severe sleep disturbance (HR 5.08) and severe drowsiness (HR 7.76).
• Longitudinal symptom burden showed similar associations. Compared with mild symptoms, severe average daily fatigue was associated with an HR of 5.05, severe sleep disturbance with an HR of 3.86, and severe drowsiness with an HR of 8.24 for mortality.
• When fatigue, sleep disturbance and drowsiness were combined, severe cumulative symptom burden was associated with markedly poorer survival (HR 14.25, 95% CI 2.76 to 57.25), although the wide confidence interval reflects limited events and substantial uncertainty.
• These associations should not be interpreted as evidence that sleep symptoms themselves cause mortality. Important potential confounders including HPV status, performance status, smoking and alcohol exposure were not available as complete validated covariates, and only 32 deaths occurred in the survival cohort.

CLINICAL TAKEAWAY

SOURCE

Radiotherapy and Oncology