6th ICHNO Abstract Book

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6th ICHNO page 57
6th ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
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1 pts (1.7%). Finally, G1/G2 weight loss occurred in 6 pts
(10%) and G3 in 1 (1.7%) pts. Overall G3 late toxicity was
observed in 8 pts, of them 6 pts required nutritional
support and 2 pts placement of PEG due to weight loss and
dysphagia.
Conclusion
The IMRT technique has proven to be feasible for
treatment of oral cancer with acceptable acute and late
toxicities. Overall, G3 acute and late toxicities occurred
in 26% and 13% respectively. Our study showed better
results compared with the data in literature.
Nevertheless, it is mandatory to identify the pts who are
at high risk of severe toxicity to get a better clinical
management of this subset of pts.
PO-119 Does mucosal appearance predict mucosal PRO
in oropharyngeal carcinoma treated with chemoimrt?
M. Hickman1, T. Shantakuma1, S. Meade1, C. Fong1, P.
Sanghera1, A. Hartley1
1University Hospital Birmingham, Radiotherapy,
Birmingham, United Kingdom
Purpose or Objective
The importance of patient reported outcomes (PRO) as
opposed to physician scored toxicity grading has been
increasingly recognised. However, historical response
relationships exist between dose and mucosal appearance.
The purpose of this study was to investigate the ability of
mucosal appearance scored in differing ways to predict
mucosal PRO.
Material and Methods
Patients undergoing chemoimrt for oropharyngeal cancer
were examined during treatment and in the recovery
phase. The presence of a patch of confluent mucositis >
1cm in area was scored as grade 3. On each examination
a grade was reported for the whole visible oral and
oropharyngeal mucosa and for this volume divided into
quadrants and octants. Patients were also asked to
respond to the PRO-CTCAE question: What was the
severity of your mouth or throat symptoms at their worst?
The sensitivity, specificity, positive predictive value (PPV)
and negative predictive value (NPV) for each method of
scoring the appearance of the mouth in predicting severe
or very severe mucosal PRO was calculated.
Results
Data from 124 examinations was included in this analysis.
The sensitivity, specificity, PPV and NPV respectively for
the following scoring methods were: at least 1 area of
grade 3 mucositis in the whole visible oral and
oropharyngeal mucosa- 75%, 73%, 83%, 61% ; at least 2
quadrants with grade 3 mucositis 71%, 83%, 89%, 60%; at
least 3 octants with grade 3 mucositis 66%, 86%, 89%, 58%.
Conclusion
A high positive predictive value of mucosal examination in
predicting mucosal PRO can be achieved if grade 3
mucositis is scored by dividing the visible oral and
oropharyngeal mucosa into quadrants or octants.
Quadrants seem to offer the best compromise between
sensitivity and specificity. The negative predictive value
of all methods of scoring was disappointing. This
underlines both the importance of recording PRO in
routine practice and clinical trials and the need to
consider concomitant factors including levels of provision
of analgesia and psychological support.
PO-120 Head and neck cancers are associated with poor
EQ-5D-related utility in France (EPICORL study)
M. Schwarzinger1 , F. Huguet2, S. Témam3, Y. Pointreau 4,
M. Bec5, C. Even3 , L. Geoffrois6, L. Lévy-Bachelot5, S.
Luchini7
1THEN Translational Health Economics Network, Public
health, Paris, France
2Tenon Hospital, Radiation oncology, Paris, France
3Institut Gustave Roussy, Head & Neck Surgical & Medical
Oncology, Villejuif, France
4Centre Jean Bernard, Oncology, Le Mans, France
5MSD France, Market access, Courbevoie, France
6Institut de Cancérologie de Lorraine - Alexis Vautrin,
Medical oncology, Vandoeuvre Les Nancy, France
7CNRS, GREQAM, Marseille, France
Purpose or Objective
Health-related quality-of-life generic instruments such as
EQ-5D are recommended for use in cost-effectiveness
analysis of new cancer treatments in most European
countries. However, EQ-5D-related utility estimates are
inexistent for head and neck (H&N) cancer patients.
The study objective was to estimate EQ-5D-related utility
from the Karnofsky index recorded at hospital for French
patients with H&N cancer.
Material and Methods
We completed a retrospective cohort study using the
French National Hospital Discharge (PMSI) database that
contains all public and private claims for acute care (MCO)
and post-acute care (SSR and HAD) in 2008-2013. Of all
adult patients identified with squamous cell carcinoma
(ICD-10: C00-C06; C09-C14; C30.0; C31; C32), we selected
all 53,257 incident cases in 2010-2012 without a personal
history of cancer. Patients’ trajectory was defined
according to 3 phases-of-care: 1) initial care (first 6
months after diagnosis), by cancer stage (early I/II;
advanced III/IVb; distant metastatic IVc); 2) continuing
care without relapse (6 months after diagnosis); and 3)
relapse care in the follow-up of patients without distant
metastasis at diagnosis.
EQ-5D utility estimates for all phases-of-care were derived
from the Karnofsky index recorded in post-acute care
(HAD) by a three-steps procedure:
1) in post-acute care (HAD), the Karnofsky index (0 to 100)
was calibrated with the EQ-5D utility metric (-0.53 to 1)
used in France (Chevalier Eur J Health Econ 2013);
2) in post-acute care (HAD and SSR), EQ-5D utility was
estimated from the functional relationship between the
Karnofsky index and 6 Activities of Daily Living recorded
weekly;
3) in all patients (HAD, SSR, MCO), EQ-5D utility was
averaged by phase-of-care and corrected for sample
selection bias from acute care (MCO) to post-acute care
(HAD, SSR) with the Heckman selection model.
Results
Patients were 78.2% male with a median (IQR) age of 61
(54-71) at diagnosis and 20,582 (38.6%) patients died in
the follow-up.
In post-acute care (HAD and SSR), 15,096 patients were
identified at any phase-of-care with a mean (std) EQ-5D
utility of 0.148 (0.227) and 0.071 (0.107) after correcting
for sample selection bias. Overall (HAD, SSR, MCO), 94,456
patients were identified at any phase-of-care with a mean
(std) EQ-5D utility of 0.133 (0.114).
Patients diagnosed at early or advanced stage had higher
mean EQ-5D utility than patients diagnosed with distant
metastasis at diagnosis or relapsing in the follow-up.
Patients with laryngeal cancer had higher mean EQ-5D
utility than others. Though, mean EQ-5D utility primarily
decreased with an older age at diagnosis and the number
of severe comorbidities other than H&N cancer.
Conclusion
EQ-5D-related utility was poor in a national sample of
patients with H&N cancer and even worse in presence of
frequent, severe comorbidities.