Quality-Adjusted Life Years and Disability-Adjusted Life Years Are Better With Concurrent Chemoradiation Therapy Than Induction Chemotherapy Followed by Chemoradiation Therapy in Nasopharyngeal Carcinoma

Abstract

Introduction As traditional measures such as overall survival (OS) or disease-free survival (DFS) alone do not give a holistic view of the outcomes of a treatment paradigm, we determine to add the evidence of quality-adjusted life year (QALY) and disability-adjusted life year (DALY) to the outcomes of the nasopharyngeal carcinoma patients (NCP) treated with definitive chemoradiation therapy (chemoRT) with or without induction chemotherapy (induction chemo). Methods This is a retrospective analysis of 85 NCPs treated at an academic state institution. The OS estimated by the Kaplan-Meier method and the multivariate Cox regression model determined the co-variables associated with the OS. The relationship between QALYs gained and DALYs saved were calculated from age of the disease onset, duration of the disease, quality of life (QoL) and disability weights. Results Of the 85 eligible NCPs of this cohort, the disease frequency distribution per the World Health Organization (WHO) classification was 41.2% for Type-I, 42.4% for Type-II, and 16.5% for Type-III. The median follow-up (24 months). The five-year OS of patients treated with concurrent chemoRT vs . induction chemo followed by concurrent chemoRT was 54.7 vs . 14.8% for WHO Type I, 60.1 vs. 58.3% for WHO Type II, and 83.3 vs. 50.0% for WHO Type III (p=0.029). The average DALYs saved with concurrent chemoRT were 12.2 years vs. 5 years for induction chemo followed by concurrent chemoRT. The average QALYs gained with concurrent chemoRT were 6.9 years vs. 3.1 years for induction chemo followed by concurrent chemoRT. Conclusion Patients treated with concurrent chemoRT had an increased QoL when compared to induction chemo followed by concurrent chemoRT. The average DALYs saved were higher in the patients treated with concurrent chemoRT than treated with induction chemo followed by concurrent chemoRT.

Impact of induction chemotherapy with concurrent chemoradiotherapy on nasopharyngeal carcinoma: A meta-analysis of randomized controlled trials

“…Induction chemotherapy appears to result in better quality of life as compared with those without induction chemotherapy, and the finding may be due to few toxicities in patients with nasopharyngeal carcinoma after IC-CCRT ( 46 , 47 ). However, another study indicates that patient receiving IC-CCRT may have lower quality-adjusted life year and disability-adjusted life year than those receiving CCRT ( 48 ). Because quality of life might affect decision-making, further studies are warranted to investigate the relevant outcomes between IC-CCRT and CCRT.…”

Health Insurance Coverage and Survival Outcomes among Nasopharyngeal Carcinoma Patients: A SEER Retrospective Analysis

“…12,13 In the United States, the incidence of NPC is <1 case per 100,000 person-years, accounting for only 2% of all head and neck malignancies. 14 The World Health Organization (WHO) categorizes NPC into keratinizing carcinoma, squamous cell carcinoma (SCC), undifferentiated and differentiated nonkeratinizing carcinoma, and basaloid SCC. 13,15 The percentage of NPC patients in the United States with keratinizing carcinoma is 25%, while 63 and 12% have undifferentiated nonkeratinizing and differentiated keratinizing, respectively.…”

“…16 Treatment for NPC depends on stage of disease with stage I requiring radiotherapy with increasing evidence for concurrent treatment with chemotherapy in patients diagnosed with stages II and III disease. 14,17 After radiotherapy and chemotherapy, surgical intervention is the preferred method for regional recurrence in the neck and salvage surgery is recommended for local recurrence. 18,19 Nonkeratinizing NPC has a 51% overall 5-year survival rate, while keratinizing NPC is 6%.…”