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Patient Safety and Quality Improvement

(398) Predictors of Symptom Burden in Head and Neck Cancer Treatment

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Mikayla Renee Bisignani, BS

    Medical Student
    University of Pittsburgh School of Medicine
    Pittsburgh, Pennsylvania, United States

    • Senior Author(s)

  • Mikayla Renee Bisignani, BS

    Medical Student
    University of Pittsburgh School of Medicine
    Pittsburgh, Pennsylvania, United States

    • Author(s)

  • JL

    Jinhong Li, MS

    Graduate Student Researcher
    University of Pittsburgh School of Public Health
    Pittsburgh, Pennsylvania, United States

  • JJ

    Jonas T. Johnson, MD

    Emeritus Chairman and Emeritus Distinguished Service Professor
    University of Pittsburgh Medical Center
    Pittsburgh, Pennsylvania, United States

  • Marci Lee Nilsen, PhD, RN, CHPN

    Assistant Professor
    University of Pittsburgh
    Pittsburgh, Pennsylvania, United States

  • DP

    Debra Pickford, BSN, RN

    University of Pittsburgh Medical Center, Department of Otolaryngology, USA

  • LS

    Lindsay Savinda, MS, CCC-SLP

    University of Pittsburgh Medical Center, Department of Otolaryngology, USA

Disclosure(s):
Mikayla Renee Bisignani, BS: No relevant relationships to disclose.
Jinhong Li, MS: No relevant relationships to disclose.
Jonas T. Johnson, MD: No relevant relationships to disclose.
Marci Lee Nilsen, PhD, RN, CHPN: No relevant relationships to disclose.


Introduction: Treatment for head and neck cancer squamous cell carcinoma (SCC) adversely impacts patient’s short- and long-term quality of life; improved survival comes at a cost to the survivors’ functional capacity and physical health. The hypothesis of this study is that symptoms throughout treatment will differ based on location of HNSCC, type of treatment, and social determinants of health.

Methods: The subjects in this study were recruited from the UPMC Eye and Ear Institute. Participants were diagnosed with primary, SCC of the paranasal sinuses, nasal cavity, oral cavity, tongue, salivary glands, nasopharynx, oropharynx, or larynx/hypopharynx between January 2020 and May 2022. During visits to the Hillman Cancer Center, patients were given the MDASI-Symptom Inventory survey biweekly. Univariable and multivariable regression models were used to identify factors associated with high symptom burden while controlling for other confounders.

Results: The five most severe symptoms were pain, mucus in mouth or throat, problems tasting food, lack of appetite, and dry mouth. The predictors of high symptom burden, as measured by the mean of the five most severe symptoms, include tumor location in the oropharynx (β=1.0,95% CI=[0.01,2.0],p=0.049), education of bachelor’s degree or higher (β=0.82,95% CI=[0.00,1.6],p=0.05) and undergoing chemotherapy in addition to radiation (β=0.85,95% CI=[0.05,1.6],p=0.036). The other variables analyzed— sex, marital status, income, difficulty paying for basic needs, and tumor stage— were not found to be significant predictors of high symptom burden.

Conclusions: In patients diagnosed with head and neck SCC, there are detectable variables that can be identified pre-treatment which predict patients are at risk for a higher symptom burden during treatment. It is critical that care teams identify patients with these risk factors so that they can be better prepared to manage these life-threatening symptom burdens; ultimately, this will aid in reducing the additional psychological and financial stressors of ER visits and hospital admissions during treatment.