Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, United States.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Bloomberg∼Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans Street, Baltimore, MD 21287, United States.
Oral Oncol. 2019 Aug;95:11-15. doi: 10.1016/j.oraloncology.2019.05.016. Epub 2019 Jun 4.
Little is known regarding how human papillomavirus-positive oropharyngeal cancer (HPV-OPC) patient goals change with treatment. This study evaluates whether patient ranking of non-oncologic priorities relative to cure and survival shift after treatment as compared to priorities at diagnosis.
This is a prospective study of HPV-OPC patient survey responses at diagnosis and after treatment. The relative importance of 12 treatment-related priorities was ranked on an ordinal scale (1 as highest). Median rank (MR) was compared using Wilcoxon matched-pairs signed-rank tests. Prevalence of high concern for 11 treatment-related issues was compared using paired t-test. The effect of patient characteristics on change in priority rank and concern was evaluated using linear regression.
Among 37 patients, patient priorities were generally unchanged after treatment compared with at diagnosis, with cure and survival persistently ranked top priority. Having a moist mouth uniquely rose in importance after treatment. Patient characteristics largely did not affect change in priority rank. Concerns decreased after treatment, except concern regarding recurrence.
Treatment-related priorities are largely similar at diagnosis and after treatment regardless of patient characteristics. The treatment experience does not result in a shift of priorities from cure and survival to non-oncologic domains over cure and survival. The rise in importance of moist mouth implies that xerostomia may have been underappreciated as a sequelae of treatment. A decrease in most treatment-related concerns is encouraging, whereas the persistence of specific areas of concern may inform patient counseling.
关于 HPV 阳性口咽癌（HPV-OPC）患者的治疗目标如何随治疗而改变，目前知之甚少。本研究评估了与治疗相比，患者在治疗后相对于治愈和生存对非肿瘤优先事项的排名是否发生变化。
这是一项 HPV-OPC 患者在诊断和治疗后的前瞻性研究。12 项与治疗相关的优先事项的相对重要性按序数量级（1 为最高）进行排名。使用 Wilcoxon 配对符号秩检验比较中位数秩（MR）。使用配对 t 检验比较 11 项与治疗相关问题的高关注度的发生率。使用线性回归评估患者特征对优先级排名和关注度变化的影响。
在 37 名患者中，与诊断时相比，治疗后患者的优先事项基本保持不变，治愈和生存仍被列为首要任务。治疗后，口干的重要性独特地提高了。患者特征在很大程度上不会影响优先级排名的变化。治疗后，担忧程度降低，除了对复发的担忧。
无论患者特征如何，治疗相关的优先事项在诊断时和治疗后基本相似。治疗经历并不会导致优先事项从治愈和生存转移到非肿瘤领域，而超过治愈和生存。口腔干燥症的重要性上升意味着口干可能被低估为治疗的后遗症。大多数与治疗相关的担忧程度降低令人鼓舞，而对特定领域的担忧持续存在可能为患者咨询提供信息。
