Patient experience, functional and quality of life outcomes in patients receiving surgical and non-surgical treatment for residual, recurrent, or new oropharyngeal cancer in a previously irradiated field: A systematic review

Abstract

BACKGROUND: National guidance recommends counselling on functional (swallowing/ speech/ voice) and quality of life outcomes (QoL) for patients with recurrent, residual or new primary head and neck cancer (HNC) in a previously irradiated field (ReRuNeR). AIM: To investigate the measurement and reporting of function and QoL outcomes and patient/carer experience for ReRuNeR, focussing exclusively on oropharyngeal cancer (OPC). METHODS: Systematic narrative review of quantitative/qualitative studies. RESULTS: Seventeen articles reporting functional/ QoL outcomes following surgery were included. Gastrostomy dependence was the primary method of reporting function. Previously validated outcome measures (OMs) were used for reporting swallowing in four, speech in one and QoL in two trials. Qualitative data or non-surgical studies reporting function/QoL outcomes specific to ReRuNeR OPC were not identified. Methodological issues and heterogeneity noted across studies including absent baseline data, varying/ undefined timepoints for outcome measurement and the use of unvalidated tools. Patient-reported swallowing outcomes were mixed. Whereas instrumental assessment of swallowing showed a deterioration in safety/ efficiency. A post-surgical decline in speech was noted. Stable overall HR-QoL was reported but an increase in specific symptoms including speech, saliva and swallowing were noted. Pooled long term gastrostomy feeding rate was 23.42% (95% CI 10.2 to 36.6) (n = 108). CONCLUSION: A core dataset of patient and clinician-rated OMs is required to provide a comprehensive understanding of functional and QoL complications with ReRuNeR OPC. In combination with patient/carer experience data, these data can be used to inform pre-treatment counselling, rehabilitation and future clinical trial design.