Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Cancer. 2019 Apr 15;125(8):1281-1289. doi: 10.1002/cncr.31920. Epub 2019 Jan 15.
In the era of deintensification, little data are available regarding patients' treatment preferences. The current study evaluated treatment-related priorities, concerns, and regret among patients with head and neck squamous cell cancer (HNSCC).
A total of 150 patients with HNSCC ranked the importance of 10 nononcologic treatment goals relative to the oncologic goals of cure and survival. The level of concern regarding 11 issues and decision regret was recorded. Median rank was reported overall, and factors associated with odds of rank as a top 3 priority were modeled using logistic regression.
Among the treatment effects analyzed, the odds of being a top 3 priority was especially high for cure (odds, 9.17; 95% confidence interval [95% CI], 5.05-16.63), followed by survival and swallow (odds, 1.26 [95% CI, 0.88-1.80] and odds, 0.85 [95% CI, 0.59-1.21], respectively). Prioritization of cure, survival, and swallow was similar based on human papillomavirus (HPV) tumor status. By increasing decade of age, older participants were found to be significantly less likely than younger individuals to prioritize survival (odds ratio, 0.72; 95% CI, 0.52-1.00). Concerns regarding mortality (P = .04) and transmission of HPV to the patient's spouse (P = .03) were more frequent among participants with HPV-associated HNSCC. Regret increased with additional treatment modalities (P = .02).
Patients with HNSCC overwhelming prioritize cure, followed by survival and swallow. The decreased prioritization of survival by older age supports further examination of treatment preference by age. The precedence of oncologic over nononcologic priorities among patients regardless of HPV tumor status supports the conservative adoption of deintensification regimens until the interplay between competing oncologic and nononcologic treatment goals is better understood.
在减量化治疗的时代，关于患者治疗偏好的数据很少。本研究评估了头颈部鳞状细胞癌（HNSCC）患者的治疗相关优先级、关注点和遗憾。
共纳入 150 例 HNSCC 患者，对 10 种非肿瘤治疗目标相对于治愈和生存的肿瘤学目标的重要性进行了排序。记录了 11 个问题的关注程度和决策遗憾程度。报告了中位数排名，使用逻辑回归对排名前 3 位的可能性相关因素进行了建模。
在分析的治疗效果中，治愈的排名前 3 位的可能性特别高（优势比，9.17；95%置信区间[95%CI]，5.05-16.63），其次是生存和吞咽（优势比分别为 1.26[95%CI，0.88-1.80]和 0.85[95%CI，0.59-1.21]）。根据人乳头瘤病毒（HPV）肿瘤状态，治愈、生存和吞咽的优先级相似。随着年龄每增加 10 年，与年轻个体相比，年龄较大的参与者显著不太可能将生存作为首要目标（优势比，0.72；95%CI，0.52-1.00）。HPV 相关 HNSCC 患者更频繁地关注死亡率（P=.04）和 HPV 传染给患者配偶的风险（P=.03）。随着治疗方式的增加，遗憾也随之增加（P=.02）。
HNSCC 患者最优先考虑治愈，其次是生存和吞咽。年龄较大的患者生存优先级降低，支持进一步根据年龄检查治疗偏好。无论 HPV 肿瘤状态如何，患者对肿瘤学优先于非肿瘤学的重视程度支持保守采用减量化治疗方案，直到更好地理解竞争的肿瘤学和非肿瘤学治疗目标之间的相互作用。
