2404 - Assessment of the Appropriateness of the Selection for Radiotherapy Intensity from a Quality of Life (EORTC QLQ-C30) Perspective in Older Cancer Patients
Presenter(s)
S. Kuribayashi1, K. Murofushi2, K. Ohnishi3, S. Hayakawa2, K. Tsuchida4, Y. Inoue5, A. Ohkawa6, T. Ishida7, Y. Machitori8, M. Murakami9, and D. Takizawa10; 1Tokyo Women's Medical University, Tokyo, Japan, 2Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan, 3National cetner for global health and medicine, Chiba, Japan, 4Kanagawa Cancer Center, Yokohama, Japan, 5Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Japan, 6Mito Medical Center, Ibaraki, Japan, 7University of Tsukuba Hospital, Tsukuba, Japan, 8Tokyo Metropolitan Bokutou Hospital, Tokyo, Japan, 9Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan, 10Hitachi General Hospital, Ibaraki, Japan
Purpose/Objective(s): Older patients with cancer have more diverse social and physical backgrounds than younger patients. Therefore, treatment strategies should be tailored to their health status. In clinical practice, it is difficult to assess whether the selected treatment intensity is appropriate for a patient’s health and quality of life (QOL), although treatment efficacy, treatment completion rate, and incidence of serious adverse events are factors that can be used to infer appropriateness. We previously evaluated the predictive factors for reduced radiotherapy intensity based on radiation oncologist experience. Subsequently, in this study, we evaluated the appropriateness of the treatment intensity selection based on radiation and medical oncologist’s experience from a patient-reported outcome (PRO) perspective.
Materials/Methods: We prospectively enrolled patients with non-metastatic cancer (= 70 years) between November 2020 and February 2022. Primary tumors included head and neck, lung, esophageal, breast, pancreatic, bladder, uterine, and prostate cancers. Reduced treatment intensity implied changes to the irradiation field, radiotherapy schedule and/or concurrent chemotherapy from the standard based on primary tumor guidelines. PRO was assessed using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ C-30) scores before radiotherapy and at 3–5 and 8–16 weeks post-radiotherapy. A clinically relevant change was defined as a difference of = 10 points.
Results: Overall, 320 patients were enrolled from 13 centers. Of these, 294 patients were available for analysis. The median age was 77 (range, 70–92). Treatment policies were modified in 72 patients (24%). Of them, 23 (8%) changed their radiotherapy policies. Planned therapy and radiotherapy were completed in 258 and 292 patients (88 and 99%, respectively). Forty-three patients (15%) experienced = grade 3 acute adverse events. When analyzing the quality of life using the EORTC QLQ-C30 in the standard and reduced intensity treatment groups, none of the observed differences between before and after radiotherapy were = 10 points in either group. In the analysis of QOL in the patients with and without = grade 3 adverse events, physical functioning, role functioning and dyspnea scales deteriorated by = 10 points in patients with = grade 3 adverse events, whereas patients without = grade 3 adverse events showed no change in = 10 points between before and after radiotherapy. Although dyspnea showed a trend towards improvement 3 months after radiotherapy, physical and role functioning scales did not improve.
Conclusion: The intensity of radiation or treatment, determined by experienced radiation and medical oncologists, was appropriately selected from a PRO perspective. Nevertheless, it is necessary to pay attention to the deterioration of QOL after radiotherapy for older patients with = grade 3 adverse events.