Purpose: This report examines global quality of life (QoL) and patient subgroups based on five aspects of functioning in human papillomavirus-associated oropharyngeal cancer (HPV-OPC) survivors treated with (chemo)radiotherapy (CRT/RT).
Methods: HPV-OPC survivors ≥12 months post-radical CRT/RT completed the EORTC QLQ-C30, MDASI-HN and PROMIS Anxiety (7a) and Depression (8a) questionnaires. Regression models were used to examine associations between global QoL and sociodemographic, clinical and patient-reported characteristics. Subgroups identified via two-step clustering of QLQ-C30 functioning scales were compared on the same set of characteristics using t-tests or Pearson’s chi-square as appropriate. Effect size estimates were calculated to quantify the size of subgroup differences and associations.
Results: There were 136 patients enrolled: male (84%), median age 61y (42-87y) and median time since CRT/RT completion 2.8y (1-5.4y).
Associations between global QoL and sociodemographic characteristics were not significant. Worse QoL was associated with bilateral radiotherapy (estimate 13.6; 95%CI: 4.9-22.3), higher mean symptom (estimate -4.2/unit; 95%CI:-6.1,-2.3) and interference scores (estimate -6.1/unit, 95%CI:-7.7,-4.6) and those reporting worse anxiety (estimate -0.8/unit; 95%CI:-1.2,-0.5;) and depression (estimate -1.2/unit, 95%CI:-1.6,-0.8).
High (n=93) and low (n=41) functioning-based subgroups were formed from auto-clustering statistics. All five functioning scales were important in differentiating clusters; the mean between-group differences between functioning scales were large-sized and clinically important (Cohen’s d: 1.57-2.29). Medium- to large-sized, clinically important differences were observed on all but three of the remaining QLQ-C30 symptom scales/items (Cohen’s d: 0.90-1.98). Large-sized differences were observed on the MDASI-HN symptom and activity inference scales and PROMIS scales (Cohen’s d: 0.80-2.03). Differences and associations between subgroup status and sociodemographic and clinical characteristics were trivial to small-sized and non-significant.
Conclusions: In this cohort of HPV-OPC survivors, global QoL was associated with unilateral radiotherapy, symptom severity and interference, and emotional distress. Low functioning HPV-OPC survivors exhibit higher levels of symptom burden, symptom interference and emotional distress.