背景:尽管目前对早期头颈部鳞状细胞癌(SCCHN)患者的治疗具有潜在的治愈性,复发率高。复发或转移性(R/M)SCCHN患者预后差,疾病负担大,包括健康相关生活质量受损(HRQoL),生产力损失和间接成本,例如需要照顾者的支持。这项研究的目的是描述R/MSCCHN及其一线治疗对患者和护理人员生活质量的影响,使用来自欧洲的真实世界证据进行日常活动和工作效率。
方法:这是法国R/MSCCHN患者的多中心回顾性研究,德国,意大利,西班牙和联合王国纳入患者和护理人员调查,和医生报告的医疗图表审查,在2019年1月至5月期间进行。医生确诊的18岁或以上的患者R/MSCCHN完成了四项经过验证的疾病活动指标及其对生活质量和工作效率的影响,同时,护理人员还填写了问卷以评估提供护理的负担。医生提供了临床特征的数据,患者管理,测试历史和治疗模式。
结果:共有195名医学/临床肿瘤学家提供了937名患者的数据,主要是男性(72%)。几乎一半的患者年龄在65岁以上。最常见的症状是疲劳(43%),体重减轻(40%),疼痛(35%)和吞咽困难(32%)。EXTREME方案是超过一半患者中最常见的一线治疗方案,报告中度或极度疼痛/不适的人,和焦虑/抑郁,与一般人群相比,自我护理问题导致健康状况下降。只有14%的员工缺勤或出勤率很高,超过一半的患者有照顾者,他们的照顾负担很大。
结论:我们的结果为与R/MSCCHN相关的多方面负担提供了现实世界的见解。HRQoL差和日常活动受损的组合,社会生活和就业说明了R/MSCCHN对患者及其护理人员的更广泛影响,并强调需要新的1L治疗方案来改善这种癌症的人文和生产力负担。
BACKGROUND: Although current therapy for patients with early-stage squamous cell carcinoma of the head and neck (
SCCHN) is potentially curative, the recurrence rate is high. Patients with recurrent or metastatic (R/M)
SCCHN have a poor prognosis and substantial disease burden, including impaired health-related quality of life (HRQoL), productivity loss and indirect costs, such as need for caregiver support. The aim of this study was to characterize the impact of R/M
SCCHN and its first-line treatment on patient and caregiver quality of life, daily activities and work productivity using real-world evidence from Europe.
METHODS: This was a multicentre retrospective study of patients with R/M
SCCHN in France, Germany, Italy, Spain and the United Kingdom incorporating patient and caregiver surveys, and a physician-reported medical chart review, conducted between January and May 2019. Patients aged 18 or over with a physician confirmed diagnosis R/M
SCCHN completed four validated measures of disease activity and its impact on quality of life and work productivity, while caregivers also completed questionnaire to assess the burden of providing care. Physicians provided data for clinical characteristics, patient management, testing history and treatment patterns.
RESULTS: A total of 195 medical/clinical oncologists provided data for 937, predominantly male (72%) patients, with almost half of patients aged over 65 years. The most frequently reported symptoms were fatigue (43%), weight loss (40%), pain (35%) and difficulty swallowing (32%). The EXTREME regimen was the most common first line therapy in over half of patients, who reported moderate or extreme pain/discomfort, and anxiety/depression, and problems with self-care resulting in a diminished health status compared with the general population. Only 14% were employed with high absenteeism or presenteeism, and over half of patients had a caregiver for whom the burden of care was substantial.
CONCLUSIONS: Our results provide real-world insight into the multi-faceted burden associated with R/M SCCHN. The combination of poor HRQoL and the impairment in daily activities, social life and employment illustrates the wider impact of R/M SCCHN on patients and their caregivers, and highlights a need for novel 1 L treatment regimens to improve the humanistic and productivity burdens of this cancer.