Aggarwal P, et al. - Among long-term oropharyngeal cancer (OPC) survivors included in this large survey study, researchers assessed the association of late lower cranial neuropathy (LCNP, a rare but potentially disabling result of radiotherapy and other head and neck cancer therapies) with severity of cancer treatment-related symptoms and subsequent general functional impairment. A link between late LCNP and symptom burden was indicated by the level of cancer treatment–related symptoms reported by OPC survivors with late LCNP. These data could help with the development and implementation of strategies for LCNP surveillance and management.

Methods

• This cross-sectional survey study was conducted from January 1, 2000 to December 31, 2013, and analyzed 889 OPC survivors nested within a retrospective cohort of OPC survivors treated at MD Anderson Cancer Center.
• Disease free subjects with completed OPC treatment 1 year or more before the survey were eligible survey participants.
• Researchers analyzed data from October 10, 2017 to March 15, 2018.
• Exposures included late LCNP defined by onset 3 months or more after cancer therapy.
• The mean of the top 5 most severely scored symptoms of all 22 core and head and neck cancer–specific symptoms from the MD Anderson Symptom Inventory Head and Neck Cancer Module (MDASI-HN) was the primary outcome variable.
• Mean MDASI-HN interference scores and single-item scores of the most severe symptoms were also analyzed as secondary outcomes.
• Adjusting for clinical covariates, multivariate models regressed MDASI-HN scores on late LCNP status.

Results

• The development of late LCNP was reported in 36 of 889 OPC survivors (4.0%) (753 [84.7%] male; 821 [92.4%] white; median [range] age, 56 [32-84] years; median [range] survival time, 7 [1-16] years).
• Findings showed a significant association of late LCNP with worse mean top 5 MDASI-HN symptom scores (coefficient, 1.54; 95% CI, 0.82-2.26), adjusting for age, survival time, sex, therapeutic modality, T stage, subsite, type of radiotherapy, smoking, and normal diet before treatment.
• Multivariable models revealed a significant association of late LCNP with single-item scores for difficulty swallowing or chewing (coefficient, 2.25; 95% CI, 1.33-3.18), mucus (coefficient, 1.97; 95% CI, 1.03-2.91), fatigue (coefficient, 1.35; 95% CI, 0.40-2.21), choking (coefficient, 1.53; 95% CI, 0.65-2.41), and voice or speech symptoms (coefficient, 2.30; 95% CI, 1.60-3.03).
• In addition, data demonstrated no significant link between late LCNP and mean interference scores after correction for multiple comparisons (mean interference coefficient, 0.72; 95% CI, 0.09-1.35).