Patient-Reported Outcomes Assessing the Impact of Palliative Radiotherapy on Quality of Life and Symptom Burden in Head and Neck Cancer Patients: A Systematic Review

Abstract

Incurable head and neck cancer has a poor prognosis and impairs a patient’s health-related quality of life. Palliative radiotherapy may improve or stabilize health-related quality of life and symptoms, best measured by patient-reported outcomes. There is no systematic analysis if palliative radiotherapy for head and neck cancer improves or stabilizes health-related quality of life or symptoms as validly measured by patient-reported outcomes. Therefore, the primary objective of this systematic review (PROSPERO-ID: CRD42020166434) was to assess the effect of palliative radiotherapy for head and neck cancer on patient-reported outcomes. The secondary objective was to assess the rate and quality of use of patient-reported outcomes in relevant studies claiming a “palliative effect” of radiotherapy. The databases MEDLINE/PubMed, EMBASE, Cochrane CENTRAL, “ClinicalTrials.gov” were searched. Concerning the primary objective, four studies were eligible to assess the effectiveness of palliative radiotherapy as measured by patient-reported outcomes. A narrative synthesis suggests a favorable impact of palliative radiotherapy on health-related quality of life and symptom burden. The risk of bias, however, is considerable and the overall quality of evidence low. Concerning the secondary objective, over 90% of studies claiming a “palliative effect” of palliative radiotherapy did either not use patient-reported outcomes or did so by limited quality. In conclusion, implementation of patient-reported outcomes in studies assessing palliative radiotherapy for head and neck cancer should be fostered. Palliative radiotherapy remains an option for head and neck cancer patients, although more studies focusing on patient-reported outcomes are needed.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42020166434

Assessing Feasibility of Using Quality of Life Questionnaire in Head and Neck Cancer Patients Undergoing Palliative Radiation Therapy

“…In our study, only 8 patients (53%) turned up for follow up visits. There are chances of missing data which gives us wrong interpretation [11]. Murthy et al reported significant attrition rate in their study [14].…”

“…Radiation therapy in curative doses leads to significant toxicity and further negatively impacts the quality of life of incurable patients. Incurable head and neck cancer patients have limited survival [11]. Prognostifying patients in an incurable setting is a difficult task.…”

“…Outcomes are mostly based on clinical response, symptom assessment and questionnaires. Patient reported outcomes are key to evaluate quality of life [11].…”

Retrospective Study of Palliative Radiotherapy in Locally Advanced and Metastatic Head and Neck Carcinoma: A Single Institution Study

“…Most published series have shown comparable outcomes in respect to survival , symptomatic improvement and quality of life irrespective of dose and fractionation used. 9,10,12,14,16,17 Radiation oncologist individualises treatment decision according to the assessment of the patient's symptoms, disease burden, comorbidities, performance status, weight loss, and anemia etc., also taking into the personal consideration of the patient. Therefore the fractionation scheme used becomes a surrogate for such factors.…”

Stereotactic Radiotherapy in Early-Stage Breast Cancer in Neoadjuvant and Exclusive Settings: A Systematic Review

“…Recent experience has shown that stereotactic RT, in different clinical scenarios, could lead to improved quality survival compared to conventional RT, also in emerging centers [16][17][18][19]. Stereotactic RT, with the reduction of treatment course, resulted in higher compliance and adherence to treatment schedule even for old patients and in palliative setting [20][21][22]. An alternative approach for the treatment of BC including neoadjuvant RT has been investigated; evidence has shown that the combination of neoadjuvant chemotherapy and RT can result in a potential benefit in terms of tumor control and tolerance [23,24].…”