Effects Of The Radio-Therapeutic Treatment Of Ent Cancers On Quality Of Life, The Orco National Observatory

Purpose/Objective: The aim of the study was to identify and to measure the effects of the bucco-pharyngeal complications of the radiotherapy on the quality of life of ENT cancer patients. Materials/Methods: This study was a prospective observational study realised in France among radiation oncologists. This survey included adult patients suffering from ENT cancer and treated by radiotherapy (in association with chemotherapy or not). No additional exam was required. During each consultation, at the beginning and at the end of the radiotherapy treatment (D0, Dend) the physicians had to fill in a questionnaire. The patients had to fill in three quality of life self-administered questionnaires at D0, Dend and 6 months after the end of the treatment. Three tools were used to assess quality of life : the QLQ C30, a complementary questionnaire specific to ENT cancers, and a questionnaire assessing the salivary glands functioning. Results: From November 2002 to December 2003, forty nine radiation oncologists included 512 patients, in which 80 (16.3%) received Amifostine before the beginning of the radiotherapy. The interim analysis was based on 500 questionnaires at D0, 292 questionnaires at Dend and 258 self-administered questionnaires in pairs (D0, Dend). The mean age was 57.6 years old (33–91 years old). On average, the disease diagnosis was 2.7 months before (0–44 months). On average, patients were treated by radiotherapy during 50.1 days (12–86 days) and the mean total dose was 63.6 grays (40–78 grays). 98.3% of the patients received a conventional radiotherapy, 16.3% of the patients received Amifostine before the beginning of the radiotherapy, 46.7% of the patients received a combined chemotherapy. At the end of the treatment 38.8% of the patients had a grade 2 mucitis, 21.5% a grade 3 and 1% a grade 4. 44.6% of the patients presented a xerostomia of grade 1, 42.2% a xerostomia of grade 2 (RTOG scales). The functional and symptomatic domains assessed thanks to the QLQ C30 showed a significant impairment of the general health and quality of life of the patients between D0 and Dend (p<0.001). Concerning the third domain of the QLQ C30, only the items ≪loss of appetite≫ and ≪constipation≫ were statistically more significant at Dend than at D0 (p<0.001). The complementary specific questionnaire showed an increase of the oro-dental pain and discomfort. Concerning the salivary glands functioning, apart from the ≪dry mouth ≫ and the ≪ discomfort caused by the overlay denture ≫, a significant decrease of the abilities to eat and to express oneself (p<0.001) was noticed between D0 and Dend. Conclusions: The bucco-pharyngeal complications usually found in ENT cancers after radiotherapy treatment have a real impact on quality of life, especially on the oro-dental discomfort and the salivary glands functioning. Furthermore, the domains of the QLQ C30 most impaired by the radiotherapy are: the cognitive function, physical activity, social and emotional life.