Prospective Evaluation of Patient Priorities in Human Papillomavirus-Driven Oropharyngeal Cancer Using the Chicago Priorities Scale: Considerations for Future Clinical Trial Design.

Abstract

This study examined head and neck cancer treatment outcome priorities in patients with human papillomavirus-associated oropharyngeal cancer (HPVOPC) before and 12 months after (chemo)radiation therapy ([C]RT). Eligible patients were diagnosed with HPVOPC suitable for curative-intent primary [C]RT. Study data included responses to a modified version of the Chicago Priorities Scale (CPS-modified) and select items from the MDASI Head and Neck Cancer Module. Analysis included descriptive statistics, McNemar's test for binary matched-pairs, and general linear models. The CPS-modified was completed by 99 patients before [C]RT, 91 twelve months after [C]RT, and 90 at both assessments. Treatment outcomes classified as top priorities were comparable before and 12 months after [C]RT: "being cured of my cancer" (cure, 93%/91%), "living as long as possible" (survival, 69%/66%), "being able to swallow all foods and drinks" (swallow, 56%/56%), "having a normal amount of energy" (energy, 51%/48%), and "having no pain" (pain, 51%/48%). After [C]RT, cure and survival were ranked highest (1 of 13) by 65 of 90 (72%) and 12 of 90 (13%) patients, respectively, and swallow was ranked above cure, survival, pain, energy, "keeping my normal sense of taste and smell" (senses) and "having a comfortably moist mouth" (moist mouth) by 14%, 36%, 47%, 55%, 56%, and 66% of patients, respectively. More patients identified senses and moist mouth as a top priority 12 months after [C]RT than before [C]RT (26%/44%, P = .002; and 19%/39%, P = .003, respectively). Selected MDASI Head and Neck Cancer Module symptom severity scores did not differ by CPS-modified priority groupings (top vs middle/lower) 12 months after [C]RT (all P > .05). For patients with HPVOPC, the most important treatment outcome priorities remained stable before and 12 months after [C]RT. After C[RT], only 56% of HPVOPC survivors considered swallowing a top priority. Patient priorities should be considered when designing future de-escalation treatment strategies, considering the excellent outcomes with standard treatment.