Gharzai Laila A, Burger Nicholas, Li Pin, Jaworski Elizabeth M, Henderson Caitlin, Spector Matthew, Rosko Andy, Chen Michelle M, Prince Mark E, Bradford Carol R, Malloy Kelly M, Stucken Chaz L, Swiecicki Paul, Worden Francis, Schipper Matthew J, Schonewolf Caitlin A, Shah Jennifer, Jagsi Reshma, Chinn Steve, Shuman Andrew, Casper Keith, Mierzwa Michelle L
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.
Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Oncologist. 2021 Aug;26(8):676-684. doi: 10.1002/onco.13784. Epub 2021 Apr 29.
Optimal surveillance paradigms for survivors of early stage human papillomavirus (HPV)-related oropharyngeal cancer are not well defined. This study aimed to characterize patient interest in and factors associated with an altered surveillance paradigm.
We surveyed patients with Stage I or II HPV-related oropharyngeal cancer treated at a tertiary care institution from 2016 to 2019. Primary outcomes were descriptive assessment of patient knowledge, interest in altered surveillance, burdens of in-person appointments, and priorities for surveillance visits. Ordinal regression was used to identify correlates of interest in altered surveillance.
Sixty-seven patients completed surveys from February to April 2020 at a median of 21 months since completing definitive treatment. A majority (61%) of patients were interested in a surveillance approach that decreased in-person clinic visits. Patients who self-identified as medical maximizers, had higher worry of cancer recurrence, or were in long-term relationships were less likely to be interested. Patients reported significant burdens associated with surveillance visits, including driving distance, time off work, and nonmedical costs. Patients were most concerned with discussing cancer recurrence (76%), physical quality of life (70%), mortality (61%), and mental quality of life (52%) with their providers at follow-up visits.
Patients with early stage HPV-related oropharyngeal cancers are interested in altered surveillance approaches, experience significant burdens related to surveillance visits, and have concerns that are not well addressed with current surveillance approaches, including physical and mental quality of life. Optimized surveillance approaches should incorporate patient priorities and minimize associated burdens.
The number of patients with HPV-related oropharyngeal cancers is increasing, and numerous clinical trials are investigating novel approaches to treating these good-prognosis patients. There has been limited work assessing optimal surveillance paradigms in these patients. Patients experience significant appointment-related burdens and have concerns such as physical and mental quality of life. Additionally, patients with early stage HPV-related oropharyngeal cancers express interest in altered surveillance approaches that decrease in-person clinic visits. Optimization of surveillance paradigms to promote broader survivorship care in clinical practice is needed.
早期人乳头瘤病毒（HPV）相关口咽癌幸存者的最佳监测模式尚未明确界定。本研究旨在描述患者对改变监测模式的兴趣以及与之相关的因素。
我们对2016年至2019年在一家三级医疗机构接受治疗的I期或II期HPV相关口咽癌患者进行了调查。主要结果是对患者知识、对改变监测的兴趣、亲自就诊负担以及监测访视优先级的描述性评估。采用有序回归来确定对改变监测感兴趣的相关因素。
67名患者于2020年2月至4月完成了调查，自完成确定性治疗以来的中位时间为21个月。大多数（61%）患者对减少亲自到诊所就诊的监测方法感兴趣。自我认定为医疗最大化者、对癌症复发担忧较高或处于长期关系中的患者不太可能感兴趣。患者报告了与监测访视相关的重大负担，包括驾车距离、请假和非医疗费用。患者在随访就诊时最关心与医生讨论癌症复发（76%）、身体生活质量（70%）、死亡率（61%）和精神生活质量（52%）。
早期HPV相关口咽癌患者对改变监测方法感兴趣，经历了与监测访视相关的重大负担，并且目前的监测方法未能很好地解决他们的担忧，包括身体和精神生活质量。优化的监测方法应纳入患者的优先事项并尽量减少相关负担。
HPV相关口咽癌患者的数量正在增加，许多临床试验正在研究治疗这些预后良好患者的新方法。在评估这些患者的最佳监测模式方面，相关工作有限。患者经历了与就诊相关的重大负担，并存在身体和精神生活质量等担忧。此外，早期HPV相关口咽癌患者对减少亲自到诊所就诊的改变监测方法表示感兴趣。需要优化监测模式，以在临床实践中促进更广泛的生存护理。
