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Edwards DM, Gharzai LA, Wang W, Mayo C, Suresh K, Schipper M, Evans JR, Malloy K, Chinn SB, Prince M, Spector M, Shuman A, Stucken C, Swiecicki PL, Worden F, Jarema J, Henderson C, Kovach A, Brenner C, Shah JL, Mierzwa ML, Casper K. Follow-up for human papillomavirus-related oropharynx cancer concentrated on unequal symptom change (FOCUS): Prospective patient-reported outcome collection. Head Neck 2024. [PMID: 38680087 DOI: 10.1002/hed.27778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/12/2024] [Accepted: 04/09/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Post-treatment surveillance recommendations for oropharyngeal cancer do not vary with p16 status despite the differences in outcomes. The optimal algorithm personalizing follow-up for these patients remains undefined. Here, we evaluate the feasibility and utility of incorporating electronic patient-reported outcomes (ePROs) and circulating tumor DNA (ctDNA) into routine surveillance for patients treated for p16+ oropharynx cancer. METHODS A prospective registry was developed in which ePROs and ctDNA were incorporated into routine surveillance among patients with oropharynx cancer. ePROs were emailed monthly for 1 year and blood HPV ctDNA testing was performed every 3-6 months. The primary objective was to assess patient compliance with ePRO-based surveillance with adequate compliance defined as ≥85% of patients completing monthly ePROs. Sensitivity, specificity, and positive/negative predictive values to detect recurrence were calculated for ePROs, HPV ctDNA, or the combination. RESULTS Of 122 patients who initially expressed interest, 76 completed the electronic consent process and 44/76 (58%) were compliant with monthly surveys over 1 year; thus adequate compliance was not achieved. Technical difficulties associated with ePRO receipt through email largely limited participation. Provider feedback was significantly associated with heightened ePRO compliance. One hundred and six patients had ctDNA testing with a mean number of three tests per patient. Sensitivity to detect recurrence was 75% for the combination of ePROs and ctDNA. CONCLUSION Despite lower than anticipated compliance with ePROs, our findings show promise for incorporation of HPV ctDNA into surveillance paradigms for HPV-related oropharynx cancer with suggestions of methods to optimize ePRO formats for personalized surveillance.
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Affiliation(s)
- Donna M Edwards
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Laila A Gharzai
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois, USA
| | - Weilin Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Krithika Suresh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph R Evans
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly Malloy
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven B Chinn
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Spector
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew Shuman
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chaz Stucken
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul L Swiecicki
- Department of Medicine, Hematology-Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Francis Worden
- Department of Medicine, Hematology-Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer Jarema
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Caitlin Henderson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Amanda Kovach
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad Brenner
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer L Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith Casper
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
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Gharzai LA, Burger N, Li P, Jaworski EM, Henderson C, Spector M, Rosko A, Chen MM, Prince ME, Bradford CR, Malloy KM, Stucken CL, Swiecicki P, Worden F, Schipper MJ, Schonewolf CA, Shah J, Jagsi R, Chinn S, Shuman A, Casper K, Mierzwa ML. Patient Burden with Current Surveillance Paradigm and Factors Associated with Interest in Altered Surveillance for Early Stage HPV-Related Oropharyngeal Cancer. Oncologist 2021; 26:676-684. [PMID: 33823077 DOI: 10.1002/onco.13784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/26/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION 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. IMPLICATIONS FOR PRACTICE 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.
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Affiliation(s)
- Laila A Gharzai
- 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
| | - Nicholas Burger
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Pin Li
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth M Jaworski
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Caitlin Henderson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Spector
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andy Rosko
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle M Chen
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Swiecicki
- Department of Medical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Francis Worden
- Department of Medical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Caitlin A Schonewolf
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Reshma Jagsi
- 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
| | - Steve Chinn
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew Shuman
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith Casper
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
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