2809 - Anxiety, Depression and Fear of Cancer Recurrence (FCR) in HPV-Associated Oropharyngeal Cancer (HPVOPC) Survivors Treated with Chemoradiation (CRT): Implications for Contemporary Clinical Care
Presenter(s)
L. J. McDowell1,2, J. Corry3, T. Fua4, A. Coleman5, A. Drosdowsky5, D. Rischin1,5, and K. Gough5,6; 1Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia, 2Princess Alexandra Hospital, Brisbane, QLD, Australia, 3GenesisCare St. Vincent's Hospital, Melbourne, Australia, 4Peter MacCallum Cancer Centre, Melbourne, VIC, Australia, 5Peter MacCallum Cancer Center, Melbourne, VIC, Australia, 6Sir Peter MacCallum Department of Oncology, Unviersity of Melbourne, Melbourne, VIC, Australia
Purpose/Objective(s): This planned secondary endpoint analysis aimed to characterize (1) longitudinal patterns of anxiety and depression to 24 months (m) after CRT; (2) changes in FCR severity from 12m to 24m; and (3) survivors’ preferred pathways of FCR/distress support.
Materials/Methods: Eligible HPVOPC patients scheduled for CRT were enrolled in a longitudinal study. Anxiety and depression (PROMIS Anxiety 7a, Depression 8a) were assessed before (baseline, BL) and week 7 (W7) of treatment, and 3-, 12- and 24-months post-CRT (3m, 12m and 24m, respectively). FCR severity (FCRI-SF) was evaluated at 12m and 24m (moderate 13-22 points; severe >22 points). Customized questions explored interest in psychological referral and preferred supportive pathways. FCR scores were compared using Student’s t. Anxiety and depression scores were analyzed using linear mixed models (LMM).
Results: Among 129 eligible patients, 100 enrolled (male, 87%; Mdn age 61y, range 44-77; stage I, 52%). At BL, mean anxiety (M=53.8, SD=9.4) and depression (M=47.1, SD=8.2) scores were within normal limits. Mean anxiety scores were similar at W7, then lower at 3m (-3.2; 95% CI -5,-1.3) through 24m (-5.9; 95% CI -7.9, -4). Mean depression scores were higher at W7 (+5.8; 95% CI 4.1, 7.5), but lower at 12m (-1.9; 95% CI -2.6, 0.8) and 24m (-0.9; 95% CI -2.7, 0.9). Nine (12%) and 0 survivors had moderate and severe anxiety, and 6 (8%) and 1 (1%) moderate and severe depression scores at 24m (n=76), respectively. Mean FCR severity scores were similar at 12m and 24m (M=11.9 vs M=12.2; M difference=0.4, 95% CI 0.8, 1.6, p=0.51) in 71/93 alive and disease-free survivors completing both assessments. The rates of low, moderate and severe FCR were 58%, 30% and 12% at 12m and 50%, 44% and 6% at 24m. Rates of clinically relevant (mod-severe) FCR was stable at 12m and 24m (42% vs 49%, p=NS). Despite clinically significant distress (anxiety, depression or FCR) at 12m and 24m, only 3 and 1 survivors, respectively, consented to a psychological referral. Survivors ranked oncologists as their preferred FCR support (Mdn 1; IQR 1-1), followed by primary care (Mdn=2; IQR 2-2), psychologists (Mdn 4; IQR 3-5), nurses (Mdn 4; IQR 3-5), self-management (Mdn 5; IQR 3-6) and group therapy (Mdn 5; IQR 4-6).
Conclusion: In HPVOPC survivors undergoing CRT, average anxiety and depression scores were within normal limits before and up 24m after treatment despite some significant fluctuations over time. Proportions of survivors with elevated (moderate to severe) scores at 24m were not incompatible with the US general population. Contrary to assumptions that FCR declines over time, our findings indicate stable FCR severity from 12m to 24m, necessitating ongoing clinician awareness. Survivors prioritize oncologists in managing FCR, highlighting the need for oncologist-led support strategies.