2745 - Severe Sleep-Related Symptoms at Start of Radiotherapy Predict Poorer Survival in Oropharyngeal Cancer: Results from a Longitudinal Symptom Cohort
Presenter(s)
W. Floyd1, R. Gaur2, C. Dede3, G. T. Carevic4, D. I. Rosenthal5, A. S. Garden5, G. B. Gunn5, S. J. Frank6, S. Y. Lai7, K. A. Hutcheson8, A. C. Moreno5, S. A. Faiz9, and C. D. Fuller7; 1Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, 2University of Missouri–Kansas City, Kansas City, MO, 3The University of Texas MD Anderson Cancer Center, Houston, TX, 4University of Texas- Houston School of Medicine, Houston, TX, 5Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 6Department of Genitourinary Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 7Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 8MD Anderson Cancer Center, Houston, TX, 9Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
Purpose/Objective(s): Sleep disturbances are under-recognized in head and neck cancer. We hypothesized that severe sleep-related symptoms would be associated with worse overall survival in oropharyngeal cancer (OPC) patients receiving radiotherapy (RT).
Materials/Methods: We queried a longitudinal cohort of 372 OPC patients treated with curative-intent RT at a single institution. All completed the MD Anderson Symptom Inventory–Head and Neck (MDASI-HN) at baseline at time of diagnosis and at the start of RT. Sleep related symptoms scores included “fatigue”, “disturbed sleep”, and “drowsiness”(mild=0–3, moderate=4–6, severe=7–10). Key timepoints included baseline, start/end of RT, and six months post-RT. Clinical data were collected, and overall survival was evaluated using Kaplan-Meier/log-rank tests and multivariable Cox proportional hazards models (adjusted for age, sex, T/N stage, induction chemotherapy, and surgery); the proportional hazards assumption was confirmed.
Results: Median age was 60 years (91% male), with a median actuarial follow-up of 84 months. Most patients had T1–T2 disease (67%) and nodal involvement (88%). 77% had concurrent chemoradiotherapy, 14% received induction chemotherapy, 20% had prior surgical resection; median RT dose was 69.96 Gy in 33 fractions, via IMRT/IMPT. Severe fatigue, disturbed sleep, and drowsiness were infrequent at baseline (4%, 5.4% and 5.1% respectively), and at RT start (3.8%,5.1% and 5.7%), but peaked at RT end (14%, 11.6% and 19.9%) and had returned to near baseline by six months after RT (5.7%, 7.3%, 7.5%). In Cox proportional hazard models, at RT start, severe fatigue (HR=7.2, 95% CI 1.8-23.5, p=0.0021), severe sleep disturbance (HR=4.61, 95% CI 1.47-12), and severe drowsiness (HR=5.65, 95% CI 1.75-16.8) were independently associated with significantly worse overall survival. Other than age, no other variable was independently associated with worse overall survival in the model, including severe sleep related symptoms at baseline, end of RT or at six months after RT completion.
Conclusion: In this study, severe sleep related symptoms were uncommon at baseline or RT start, but a substantial proportion of OPC patients in our study experienced clinically meaningful sleep disturbances by the end of radiotherapy. At an average follow up of 84 months, severe fatigue, drowsiness and sleep disturbance at RT start were all independently associated with worse OS in OPC. These findings suggest the importance of assessing sleep disturbances as well as the potential physiologic correlates thereof (e.g. apnea/hypopnea, sarcopenia) as a part of comprehensive care. Future prospective studies should assess whether sleep related symptoms can serve as a prognostic factor in OPC and determine whether targeted sleep interventions can improve outcomes in this population.