Patient reported dry mouth: Instrument comparison and model performance for correlation with quality of life in head and neck cancer survivors

MD Anderson Head and Neck Cancer Symptom Working Group; Mona Kamal; David I Rosenthal; Stefania Volpe; Ryan P Goepfert; Adam S Garden; Katherine A Hutcheson; Karine A Al Feghali; Mohamed Ahmed Mohamed Meheissen; Salman A Eraj; Amy E Dursteler; Bowman Williams; Joshua B Smith; Jeremy M Aymard; Joel Berends; Aubrey L White; Steven J Frank; William H Morrison; Richard Cardoso; Mark S Chambers; Erich M Sturgis; Tito R Mendoza; Charles Lu; Abdallah S R Mohamed; Clifton D Fuller; G Brandon Gunn

doi:10.1016/j.radonc.2017.10.037

Patient reported dry mouth: Instrument comparison and model performance for correlation with quality of life in head and neck cancer survivors

Radiother Oncol. 2018 Jan;126(1):75-80. doi: 10.1016/j.radonc.2017.10.037. Epub 2017 Dec 8.

Authors

MD Anderson Head and Neck Cancer Symptom Working Group; Mona Kamal¹, David I Rosenthal², Stefania Volpe³, Ryan P Goepfert⁴, Adam S Garden², Katherine A Hutcheson⁴, Karine A Al Feghali⁵, Mohamed Ahmed Mohamed Meheissen⁶, Salman A Eraj⁷, Amy E Dursteler⁷, Bowman Williams², Joshua B Smith⁷, Jeremy M Aymard⁸, Joel Berends⁹, Aubrey L White⁷, Steven J Frank², William H Morrison², Richard Cardoso⁴, Mark S Chambers⁴, Erich M Sturgis¹⁰, Tito R Mendoza¹¹, Charles Lu¹¹, Abdallah S R Mohamed¹², Clifton D Fuller¹³, G Brandon Gunn¹⁴

Affiliations

¹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
² Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
³ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; University of Milan, Department of Oncology and Hemato-Oncology, Milano, Italy.
⁴ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
⁵ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center, Lebanon.
⁶ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt.
⁷ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, USA.
⁸ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Abilene Christian University, USA.
⁹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; University of Texas Health Science Center at San Antono, USA.
¹⁰ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, USA.
¹¹ Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA.
¹² Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt; MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, USA.
¹³ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, USA.
¹⁴ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: gbgunn@mdanderson.org.

Abstract

Purpose: To identify a clinically meaningful cut-point for the single item dry mouth question of the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN).

Methods: Head and neck cancer survivors who had received radiation therapy (RT) completed the MDASI-HN, the University of Michigan Hospital Xerostomia Questionnaire (XQ), and the health visual analog scale (VAS) of the EuroQol Five Dimension Questionnaire (EQ-5D). The Bayesian information criteria (BIC) were used to test the prediction power of each tool for EQ-5D VAS. The modified Breiman recursive partitioning analysis (RPA) was used to identify a cut point of the MDASI-HN dry mouth score (MDASI-HN-DM) with EQ-5D VAS, using a ROC-based approach; regression analysis was used to confirm the threshold effect size.

Results: Two-hundred seven respondents formed the cohort. Median follow-up from the end of RT to questionnaire completion was 88 months. The single item MDASI-HN-DM score showed a linear relationship with the XQ composite score (ρ = 0.80, p < 0.001). The MDASI-HN-DM displayed improved model performance for association with EQ-5D VAS as compared to XQ (BIC of 1803.7 vs. 2016.9, respectively). RPA showed that an MDASI-HN-DM score of ≥6 correlated with EQ-5D VAS decline (LogWorth 5.5).

Conclusion: The single item MDASI-HN-DM correlated with the multi-item XQ and performed favorably in the prediction of QOL. A MDASI-HN-DM cut point of ≥6 correlated with decline in QOL.

Keywords: Dry mouth; Head and neck; Patient reported outcomes; Prediction model; Quality of life; Survivors.

Publication types

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

MeSH terms

Adult
Aged
Aged, 80 and over
Bayes Theorem
Cancer Survivors
Cohort Studies
Female
Head and Neck Neoplasms / physiopathology
Head and Neck Neoplasms / radiotherapy*
Humans
Male
Middle Aged
Quality of Life
Radiation Injuries / diagnosis*
Radiation Injuries / etiology*
Self Report
Surveys and Questionnaires
Xerostomia / diagnosis*
Xerostomia / etiology*

Abstract

Publication types

MeSH terms

Grants and funding