Rapid Fire Best of the Best Poster Oral Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Quality of life, functioning and emotional distress in survivors of human papillomavirus associated oropharyngeal cancer (#393)

Lachlan McDowell 1 2 , Georgina Casswell 1 , Allison Drosdowsky 3 , Mathias Bressel 4 , Andrew Coleman 1 , Sudi Shrestha 1 , Ieta D'Costa 1 , Tsien Fua 1 , Albert Tiong 1 , Chen Liu 1 , Danny Rischin 2 5 , Karla Gough 3 6
  1. Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  2. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
  3. Department of Cancer Experiences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  4. Centre for Biostatistics and Clinical Trials , Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  5. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  6. Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia

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.