A Preliminary Validation of an Optimal Cutpoint in Total Number of Patient-Reported Symptoms in Head and Neck Cancer for Effective Alignment of Clinical Resources With Patients’ Symptom Burden

Abstract

Background: Patients with head and neck cancer (HNC) often experience high symptom burden leading to lower quality of life (QoL). Objective: This study aims to conceptually model optimal cutpoint by examining where the total number of patient-reported symptoms exceeds patients’ coping capacity, leading to a decline in QoL in patients with HNC. Methods: Secondary data analysis of 105 individuals with HNC enrolled in a clinical usefulness study of the NYU Electronic Patient Visit Assessment (ePVA), a digital patient-reported symptom measure. Patients completed ePVA and European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 v3.0. The total number of patient-reported symptoms was the sum of symptoms as identified by the ePVA questionnaire. Analysis of variance was used to define the optimal cutpoint. Results: Study participants had a mean age of 61.5, were primarily male (67.6%), and had stage IV HNC (53.3%). The cutpoint of 10 symptoms was associated with a significant decline of QoL (F = 44.8, P < .0001), dividing the population into categories of low symptom burden (<10 symptoms) and high symptom burden (≥10 symptoms). Analyses of EORTC function subscales supported the validity of 10 symptoms as the optimal cutpoint (physical: F = 28.3, P < .0001; role: F = 21.6, P < .0001; emotional: F = 9.5, P = .003; social: F = 33.1, P < .0001). Conclusions: In HNC, defining optimal cutpoints in the total number of patient-reported symptoms is feasible. Implications for Practice: Cutpoints in the total number of patient-reported symptoms may identify patients experiencing a high symptom burden from HNC. What is Foundational: Using optimal cutpoints of the total number of patient-reported symptoms may help effectively align clinical resources with patients’ symptom burden.