Impact of Early Supportive Care Assessment on treatment decision in head and neck cancer before concomitant chemoradiotherapy

• DOI: 10.1007/s00520-022-07078-3
• Publication Date: 2022-04-27T22:02:36Z
• Authors: François Cherifi; Maud Villemin; Frederique Bisiaux; Alison Johnson; Heidi Solem Laviec; Audrey Rambeau
• Keywords: Concomitant; Chemoradiotherapy

Abstract Objective: To assess the impact on oncological treatment and supportive care interventions in patients treated with chemoradiation (CRT) for advanced head and neck cancer (HNC) of a global pretherapeutic comprehensive supportive care assessment performed in an outpatient supportive care clinic (OSCC). Methods: In this monocentric prospective observational study, we included all patients considered for CRT (exclusive or post-operative) for advanced HNC from February 2019 to March 2020. The following frailty indicators were assessed: comorbidities (Charlson Index), nutritional status, altered functional ability (ADL and IADL), social precarity (EPICES score), cognitive impairment (MoCA score), addictive habits and pain.Results: OSCC led to a change in treatment for 13.7% of patients, mainly de-escalations. Ninety-three percent of patients had at least one altered domain, including 50% with three or more altered domains. Cognitive function was the most frequently altered domain (66.7%). Altered functional ability was significantly associated with treatment de-escalation after OSCC. Treatment interruptions were significantly associated with treatment de-escalation and social precarity. De-escalation was also associated with a significantly poorer PFS (median of 23.2 mos. vs 8.8 mos., HR=2.18 95%IC[1.02- 4.63] p=0.037)) and a non-significant trend towards worse OS (median 23.3mos. vs not reached (HR = 2.16 95%CI[0.88-5.31] p=0.0836).Conclusion: We strongly encourage the creation of OSCC for patients treated with chemoradiation for HNC. This practice, through an exhaustive assessment, favors therapeutic adaptation, personalized follow-up and optimization of supportive care.