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Pre-treatment psychoeducational intervention and outcomes in head and neck cancer patients undergoing radiotherapy

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Abstract

Background

To investigate the relationship between attendance to a pre-treatment psychoeducational intervention (prehab) with treatment outcomes and toxicities in patients receiving radiotherapy for head and neck cancers (HNCs).

Methods

Patients were included from prehab inception in 2013 to 2017, comparing overall survival (OS), locoregional recurrence-free survival (LRFS), and locoregional recurrence (LRR) between prehab attendees (PA) and non-attendees (PNA). Multivariable analysis was performed for OS and LRFS.

Results

Among 864 PA and 1128 PNA, 2-year OS was 88% vs 80% (p < 0.001), and LRFS was 84% vs 75% (p < 0.001). On multivariable analysis (MVA), OS and LRFS were independently and unfavourably associated with PNA. The PA cohort had a lower frequency of a “rocky treatment course” compared with the PNA cohort (52/150, 35% vs 71/150, 47%; p = 0.034).

Conclusions

Prehab at our institution is associated with improved long-term oncologic outcomes. Prospective data is needed to better understand this association.

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Acknowledgements

We would like to acknowledge the Princess Margaret Head & Neck Cancer Survivorship Programme.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

    Nauman H. Malik, Maurene McQuestion, Michael C. Tjong, Dana Keilty, Shao Hui Huang & Jolie Ringash

  2. Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada

    Nauman H. Malik, Maurene McQuestion, Michael C. Tjong, Dana Keilty, Shao Hui Huang, Joanne Pun & Jolie Ringash

  3. Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada

    Manjula Maganti

  4. University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada

    Manjula Maganti

  5. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Maurene McQuestion

  6. Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada

    Eric Monteiro & Jolie Ringash

  7. Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada

    Raymond Woo-Jun Jang

  8. Department of Speech Language Pathology, University of Toronto, Toronto, ON, Canada

    Andrea Gomes

  9. Clinical Nutrition, Princess Margaret Cancer Centre, Toronto, ON, Canada

    Joanne Pun

Authors
  1. Nauman H. Malik
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  2. Manjula Maganti
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  3. Maurene McQuestion
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  4. Michael C. Tjong
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  5. Dana Keilty
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  6. Eric Monteiro
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  7. Shao Hui Huang
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  8. Raymond Woo-Jun Jang
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  9. Andrea Gomes
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  10. Joanne Pun
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  11. Jolie Ringash
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Nauman Malik, Jolie Ringash, Manjula Maganti, Michael Tjong, and Dana Keilty. The first draft of the manuscript was written by Nauman Malik, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jolie Ringash.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study received institutional review board approval prior to commencing.

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All authors provided consent for publication of the manuscript in its current form.

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Appendix. Prehab class details

Appendix. Prehab class details

The prehab class was developed and initially team-taught by a clinical nurse specialist, a speech language pathologist, and a registered dietician. As the team increased their shared expertise and familiarity, more recently, team members may take turns teaching all the class content. Information is delivered didactically using PowerPoint, and in English; however, patients and their caregivers (who are welcome in the class) are encouraged to interrupt with questions at any time, and caregivers or a family member may translate quietly to patients during the class as needed. Unfortunately, medical translators are not provided by our hospital for educational interventions. There is no “one on one” counselling or specific follow-up as part of the class. The class was designed to complement the personalized patient education provided by the healthcare team at the patients’ usual appointments. Content focuses on support resources, managing side effects, preventing swallowing dysfunction, and maintaining nutrition and hydration. Patients are booked into prehab within their first 2 weeks of radiation treatment, and the class is offered up to 6 times a month. Evaluations are collected on how well-prepared patients feel after the class on about coping with side effects from treatment.

Fig. 1
figure 1

Overall survival stratified by prehab class attendance

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Fig. 2
figure 2

Overall survival stratified by experiencing a rocky treatment course

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Table 1 Baseline patient, disease, and treatment variables of full cohort, stratified by prehab attendance
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Table 2 Multivariable analyses for baseline, disease, and treatment variables in full cohort and association with oncologic outcomes in attendees vs non-attendees to prehab class
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Table 3 Risk factors associated with rocky treatment course (RTC) as well as component variables of RTC examined in a smaller random sample of attendees and non-attendees
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Malik, N.H., Maganti, M., McQuestion, M. et al. Pre-treatment psychoeducational intervention and outcomes in head and neck cancer patients undergoing radiotherapy. Support Care Cancer 29, 1643–1652 (2021). https://doi.org/10.1007/s00520-020-05627-2

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  • DOI: https://doi.org/10.1007/s00520-020-05627-2

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