Priorities, concerns, and regret among patients with head and neck cancer

Cancer. 2019 Apr 15;125(8):1281-1289. doi: 10.1002/cncr.31920. Epub 2019 Jan 15.

Abstract

Background: In the era of deintensification, little data are available regarding patients' treatment preferences. The current study evaluated treatment-related priorities, concerns, and regret among patients with head and neck squamous cell cancer (HNSCC).

Methods: A total of 150 patients with HNSCC ranked the importance of 10 nononcologic treatment goals relative to the oncologic goals of cure and survival. The level of concern regarding 11 issues and decision regret was recorded. Median rank was reported overall, and factors associated with odds of rank as a top 3 priority were modeled using logistic regression.

Results: Among the treatment effects analyzed, the odds of being a top 3 priority was especially high for cure (odds, 9.17; 95% confidence interval [95% CI], 5.05-16.63), followed by survival and swallow (odds, 1.26 [95% CI, 0.88-1.80] and odds, 0.85 [95% CI, 0.59-1.21], respectively). Prioritization of cure, survival, and swallow was similar based on human papillomavirus (HPV) tumor status. By increasing decade of age, older participants were found to be significantly less likely than younger individuals to prioritize survival (odds ratio, 0.72; 95% CI, 0.52-1.00). Concerns regarding mortality (P = .04) and transmission of HPV to the patient's spouse (P = .03) were more frequent among participants with HPV-associated HNSCC. Regret increased with additional treatment modalities (P = .02).

Conclusions: Patients with HNSCC overwhelming prioritize cure, followed by survival and swallow. The decreased prioritization of survival by older age supports further examination of treatment preference by age. The precedence of oncologic over nononcologic priorities among patients regardless of HPV tumor status supports the conservative adoption of deintensification regimens until the interplay between competing oncologic and nononcologic treatment goals is better understood.

Keywords: decision making; head and neck neoplasms; human papillomavirus (HPV); oropharyngeal neoplasms; patient preference.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Decision Making*
  • Female
  • Head and Neck Neoplasms / therapy*
  • Head and Neck Neoplasms / virology
  • Health Priorities / classification*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Papillomaviridae
  • Papillomavirus Infections / therapy*
  • Patient Satisfaction
  • Patient-Centered Care
  • Prospective Studies
  • Squamous Cell Carcinoma of Head and Neck / therapy*
  • Squamous Cell Carcinoma of Head and Neck / virology
  • Survival Analysis
  • Treatment Outcome