Follow-up for human papillomavirus-related oropharynx cancer concentrated on unequal symptom change (FOCUS): Prospective patient-reported outcome collection.
cancer of oropharynx
follow‐up care
patient‐reported outcome measures
Journal
Head & neck
ISSN: 1097-0347
Titre abrégé: Head Neck
Pays: United States
ID NLM: 8902541
Informations de publication
Date de publication:
29 Apr 2024
29 Apr 2024
Historique:
revised:
12
03
2024
received:
26
10
2023
accepted:
09
04
2024
medline:
29
4
2024
pubmed:
29
4
2024
entrez:
29
4
2024
Statut:
aheadofprint
Résumé
Post-treatment surveillance recommendations for oropharyngeal cancer do not vary with p16 status despite the differences in outcomes. The optimal algorithm personalizing follow-up for these patients remains undefined. Here, we evaluate the feasibility and utility of incorporating electronic patient-reported outcomes (ePROs) and circulating tumor DNA (ctDNA) into routine surveillance for patients treated for p16+ oropharynx cancer. A prospective registry was developed in which ePROs and ctDNA were incorporated into routine surveillance among patients with oropharynx cancer. ePROs were emailed monthly for 1 year and blood HPV ctDNA testing was performed every 3-6 months. The primary objective was to assess patient compliance with ePRO-based surveillance with adequate compliance defined as ≥85% of patients completing monthly ePROs. Sensitivity, specificity, and positive/negative predictive values to detect recurrence were calculated for ePROs, HPV ctDNA, or the combination. Of 122 patients who initially expressed interest, 76 completed the electronic consent process and 44/76 (58%) were compliant with monthly surveys over 1 year; thus adequate compliance was not achieved. Technical difficulties associated with ePRO receipt through email largely limited participation. Provider feedback was significantly associated with heightened ePRO compliance. One hundred and six patients had ctDNA testing with a mean number of three tests per patient. Sensitivity to detect recurrence was 75% for the combination of ePROs and ctDNA. Despite lower than anticipated compliance with ePROs, our findings show promise for incorporation of HPV ctDNA into surveillance paradigms for HPV-related oropharynx cancer with suggestions of methods to optimize ePRO formats for personalized surveillance.
Sections du résumé
BACKGROUND
BACKGROUND
Post-treatment surveillance recommendations for oropharyngeal cancer do not vary with p16 status despite the differences in outcomes. The optimal algorithm personalizing follow-up for these patients remains undefined. Here, we evaluate the feasibility and utility of incorporating electronic patient-reported outcomes (ePROs) and circulating tumor DNA (ctDNA) into routine surveillance for patients treated for p16+ oropharynx cancer.
METHODS
METHODS
A prospective registry was developed in which ePROs and ctDNA were incorporated into routine surveillance among patients with oropharynx cancer. ePROs were emailed monthly for 1 year and blood HPV ctDNA testing was performed every 3-6 months. The primary objective was to assess patient compliance with ePRO-based surveillance with adequate compliance defined as ≥85% of patients completing monthly ePROs. Sensitivity, specificity, and positive/negative predictive values to detect recurrence were calculated for ePROs, HPV ctDNA, or the combination.
RESULTS
RESULTS
Of 122 patients who initially expressed interest, 76 completed the electronic consent process and 44/76 (58%) were compliant with monthly surveys over 1 year; thus adequate compliance was not achieved. Technical difficulties associated with ePRO receipt through email largely limited participation. Provider feedback was significantly associated with heightened ePRO compliance. One hundred and six patients had ctDNA testing with a mean number of three tests per patient. Sensitivity to detect recurrence was 75% for the combination of ePROs and ctDNA.
CONCLUSION
CONCLUSIONS
Despite lower than anticipated compliance with ePROs, our findings show promise for incorporation of HPV ctDNA into surveillance paradigms for HPV-related oropharynx cancer with suggestions of methods to optimize ePRO formats for personalized surveillance.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Livestrong Foundation
Informations de copyright
© 2024 The Authors. Head & Neck published by Wiley Periodicals LLC.
Références
Chaturvedi AK, Engels EA, Pfeiffer RM, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011;29(32):4294‐4301.
van Gysen K, Stevens M, Guo L, et al. Validation of the 8(th) edition UICC/AJCC TNM staging system for HPV associated oropharyngeal cancer patients managed with contemporary chemo‐radiotherapy. BMC Cancer. 2019;19(1):674.
Ng SP, Johnson JM, Gunn GB, et al. Significance of negative posttreatment 18‐FDG PET/CT imaging in patients with p16/HPV‐positive oropharyngeal cancer. Int J Radiat Oncol Biol Phys. 2018;102(4):1029‐1035.
Fakhry C, Zhang Q, Gillison ML, et al. Validation of NRG oncology/RTOG‐0129 risk groups for HPV‐positive and HPV‐negative oropharyngeal squamous cell cancer: implications for risk‐based therapeutic intensity trials. Cancer. 2019;125(12):2027‐2038.
Ang KK, Harris J, Wheeler R, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363(1):24‐35.
Guo T, Rettig E, Fakhry C. Understanding the impact of survival and human papillomavirus tumor status on timing of recurrence in oropharyngeal squamous cell carcinoma. Oral Oncol. 2016;52:97‐103.
Lechner M, Liu J, Masterson L, Fenton TR. HPV‐associated oropharyngeal cancer: epidemiology, molecular biology and clinical management. Nat Rev Clin Oncol. 2022;19(5):306‐327.
Tota JE, Best AF, Zumsteg ZS, Gillison ML, Rosenberg PS, Chaturvedi AK. Evolution of the oropharynx cancer epidemic in the United States: moderation of increasing incidence in younger individuals and shift in the burden to older individuals. J Clin Oncol. 2019;37(18):1538‐1546.
Masroor F, Corpman D, Carpenter DM, Ritterman Weintraub M, Cheung KHN, Wang KH. Association of NCCN‐recommended posttreatment surveillance with outcomes in patients with HPV‐associated oropharyngeal squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg. 2019;145(10):903‐908.
Basch E, Deal AM, Kris MG, et al. Symptom monitoring with patient‐reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol. 2016;34(6):557‐565.
Basch E, Deal AM, Dueck AC, et al. Overall survival results of a trial assessing patient‐reported outcomes for symptom monitoring during routine cancer treatment. JAMA. 2017;318(2):197‐198.
Gharzai LA, Li P, Jaworski E, et al. Can patient reported quality of life predict locoregional recurrence in oropharyngeal cancer? Int J Radiat Oncol Biol Phys. 2020;106:1199‐1200.
Imbimbo M, Alfieri S, Botta L, et al. Surveillance of patients with head and neck cancer with an intensive clinical and radiologic follow‐up. Otolaryngol Head Neck Surg. 2019;161(4):635‐642.
Chera BS, Kumar S, Shen C, et al. Plasma circulating tumor HPV DNA for the surveillance of cancer recurrence in HPV‐associated oropharyngeal cancer. J Clin Oncol. 2020;38(10):1050‐1058.
Adilbay D, Lele S, Pang J, Asarkar A, Calligas J, Nathan CA. Circulating human papillomavirus DNA in head and neck squamous cell carcinoma: possible applications and future directions. Cancers (Basel). 2022;14(23):5946.
Gharzai LA, Burger N, Li P, et al. Patient burden with current surveillance paradigm and factors associated with interest in altered surveillance for early stage HPV‐related oropharyngeal cancer. Oncologist. 2021;26(8):676‐684.
Bjordal K, Hammerlid E, Ahlner‐Elmqvist M, et al. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐H&N35. J Clin Oncol. 1999;17(3):1008‐1019.
Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients: the M.D. Anderson symptom inventory. Cancer. 2000;89(7):1634‐1646.
Binenbaum Y, Amit M, Billan S, Cohen JT, Gil Z. Minimal clinically important differences in quality of life scores of oral cavity and oropharynx cancer patients. Ann Surg Oncol. 2014;21(8):2773‐2781.
Yom SS, Torres‐Saavedra P, Caudell JJ, et al. Reduced‐dose radiation therapy for HPV‐associated oropharyngeal carcinoma (NRG Oncology HN002). J Clin Oncol. 2021;39(9):956‐965.
Swisher‐McClure S, Lukens JN, Aggarwal C, et al. A phase 2 trial of alternative volumes of oropharyngeal irradiation for de‐intensification (AVOID): omission of the resected primary tumor bed after transoral robotic surgery for human papilloma virus‐related squamous cell carcinoma of the oropharynx. Int J Radiat Oncol Biol Phys. 2020;106(4):725‐732.
Ferris RL, Flamand Y, Weinstein GS, et al. Phase II randomized trial of transoral surgery and low‐dose intensity modulated radiation therapy in resectable p16+ locally advanced oropharynx cancer: an ECOG‐ACRIN cancer research group trial (E3311). J Clin Oncol. 2022;40(2):138‐149.
Basch E, Stover AM, Schrag D, et al. Clinical utility and user perceptions of a digital system for electronic patient‐reported symptom monitoring during routine cancer care: findings from the PRO‐TECT trial. JCO Clin Cancer Inform. 2020;4:947‐957.
Malik A, Nair S, Sonawane K, et al. Outcomes of a telephone‐based questionnaire for follow‐up of patients who have completed curative‐intent treatment for oral cancers. JAMA Otolaryngol Head Neck Surg. 2020;146(12):1102‐1108.
Denis F, Basch E, Septans AL, et al. Two‐year survival comparing web‐based symptom monitoring vs routine surveillance following treatment for lung cancer. JAMA. 2019;321(3):306‐307.
Su W, Miles BA, Posner M, et al. Surveillance imaging in HPV‐related oropharyngeal cancer. Anticancer Res. 2018;38(3):1525‐1529.
Cao Y, Haring CT, Brummel C, et al. Early HPV ctDNA kinetics and imaging biomarkers predict therapeutic response in p16+ oropharyngeal squamous cell carcinoma. Clin Cancer Res. 2022;28(2):350‐359.
Ringash J. Survivorship and quality of life in head and neck cancer. J Clin Oncol. 2015;33(29):3322‐3327.
Townes TG, Navuluri S, Pytynia KB, et al. Assessing patient‐reported symptom burden of long‐term head and neck cancer survivors at annual surveillance in survivorship clinic. Head Neck. 2020;42(8):1919‐1927.
Gharzai LA, Mierzwa M, Peipert JD, et al. Development of a brief toxicity‐focused patient‐reported outcome measure for head and neck cancer radiotherapy treatment: the Functional Assessment of Cancer Therapy—Head and Neck Radiotherapy (FACT‐HN‐RAD) Index. American Head and Neck Society Annual Meeting 2023, Montreal CA.