Dissertation committee:
Πλατώνη Καλλιόπη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ (Επιβλέπουσα)
Κουλουλίας Βασίλειος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Νικολάτου – Γαλίτη Ουρανία, Καθηγήτρια, Οδοντιατρική Σχολή, ΕΚΠΑ
Σεϊμένης Ιωάννης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κυροδήμος Ευθύμιος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεωργακόπουλος Ιωάννης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Καραβασίλης Ευστράτιος, Επίκουρος Καθηγητής, Ιατρική Σχολή, Δημοκρίτειο Πανεπιστήμιο Θράκης
Summary:
Background: Head and neck cancer is a very common and fatal type of malignancy worldwide, but with the progress of science it can now be effectively treated with modern radiotherapy techniques. Radiotherapy is a cornerstone in the treatment of this type of cancer, but it is associated with a high incidence of side effects, which have a significant impact on patients' quality of life.
Objective: This study aims to evaluate the quality of life and satisfaction, based on clinical and laboratory data, of patients with head and neck cancer who have received treatment through advanced radiotherapy techniques. Additionally, it seeks to document dosimetry and toxicity data in these patients and to utilize these findings in the development of treatments with minimal side effects.
Material and Methods: The study included patients diagnosed with head and neck cancer, aged 18 years or older, who were scheduled to receive VMAT radiotherapy as part of their treatment at the Radiotherapy Unit of the 2nd Radiology Laboratory, University General Hospital "ATTIKON," during the designated time period. The sample consisted of 84 patients, of whom 75 (89.3%) completed all three stages of the questionnaire. Data collection employed the standardized, validated EORTC QLQ-C30 (general quality of life questionnaire) and EORTC QLQ-H&N35 (specific questionnaire for head and neck cancer patients) (Version 3.0) across three time points, in addition to a specially tailored set of questions developed by the research team to assess patient satisfaction.
Results: Of the sample, 73.3% were male, and 84.3% were over the age of 51. The assessment of Quality of Life indicated that the general health index, which had temporarily declined at the end of radiotherapy (from 77.00 to 62.00), showed significant improvement at follow-up, three months post-treatment (78.67).Simultaneously, a significant alleviation of symptoms was noted (p<0.0005), particularly in relation to pain, weight loss, xerostomia, viscous saliva, and swallowing difficulties. These findings are consistent with previous research highlighting a post-treatment reduction in symptom severity. Our investigation into the association between dosimetric parameters, toxicity, and symptoms focused on radiation dose correlation with levels of oral mucositis, a prevalent toxicity in head and neck cancer patients. Notable correlations were observed between toxicity levels and dosimetric metrics, especially in organs at risk (OARs) including oral cavity, swallowing muscles and the parotid glands, underscoring the EORTC approach in evaluating toxicity. Spearman correlation coefficient analysis across two different stages of treatment revealed variable degrees of association between OAR dosimetric data and patient reported symptoms, revealing potential constraints in relying exclusively on quality-of-life questionnaires to evaluate treatment effectiveness. Correlations between the EORTC QLQ-C30 and EORTC QLQ-H&N35 with the adjusted set of service evaluation questions showed a low but statistically significant positive association between physical activity and nursing service evaluation (r=0.234, p=0.043) and the patient-physician relationship (r=0.238, p=0.040). The results for patient satisfaction with the services provided by the unit in all categories in this study were remarkably high. The internal consistency of the adjusted set of service evaluation questions was excellent, with Cronbach's Alpha values spanning from 0.900 to 0.946 across different subcategories.
Conclusions: This study further elucidates the complex dynamics between radiotherapy, Quality of Life (QoL) outcomes, symptom severity, and patient satisfaction with the health services provided. Head and neck cancer significantly affects patients' QoL, primarily due to treatment-related side effects. The results of this research study emphasize the significance of quality of life assessment, integration of toxicity assessments and dosimetric data to enhance treatment outcomes and enable precise monitoring and management of adverse effects in head and neck cancer patients undergoing radiotherapy. Further research and education could provide more meaningful insights into patients' experiences, ultimately improving the quality of care provided.
Keywords:
Quality of life, patient satisfaction, Head and Neck Cancer, Radiation therapy, Dosimetry
