Late Lower Cranial Neuropathy in Oropharyngeal Cancer Patients

Survivors of oropharyngeal cancers who developed late lower cranial neuropathy (LCNP) reported having worse cancer treatment–related symptoms, according to the results of a survey conducted at the University of Texas MD Anderson Cancer Center.

“The study findings suggest the need for long-term surveillance of late LCNP among patients with head and neck cancer and oropharyngeal cancer, particularly in light of epidemiologic trends that suggest increasing numbers of oropharyngeal cancer survivors at risk of late symptoms in the immediate years ahead,” wrote Puja Aggarwal, BDS, MPH, of the department of head and neck surgery at MD Anderson, and colleagues, in JAMA Otolaryngology-Head & Neck Surgery.

The study included 889 survivors of oropharyngeal cancer nested within a retrospective cohort of survivors treated at MD Anderson from 2000 to 2013. To be eligible for the study, participants had to be disease free and to have had completed their last treatment more than 1 year before the study survey.

The researchers were looking at a change in the mean of the top 5 most severely scored symptoms of all 22 core and head and neck–specific symptoms from the MD Anderson Symptom Inventory Head and Neck Cancer Module (MDASI-HN).

The majority of included patients had been treated with radiotherapy (99.1%). Of the included patients, 4% developed late LCNP, defined as onset 3 months or more after cancer therapy. The median time to onset of LCNP was 5.25 years after radiotherapy. The researchers noted that the mean radiation dose among survivors with late LCNP was slightly higher compared with survivors without late LCNP (70 Gy vs 69.3 Gy).

The survey revealed that those with late LCNP had significantly worse mean treatment-related symptom scores compared with those without LCNP (4.5 for LCNP vs 2.5 for patients without LCNP). After adjusting for age, survival time, sex, therapeutic modality, T stage, subsite, radiation therapy modality, smoking status, and normal diet before treatment, late LCNP was significantly associated with a worse mean top 5 MDASI-HN symptom score, a finding that “reflects a moderate effect size of LCNP on most prevalent symptoms in this survivor population,” the researchers wrote.

Late LCNP was also significantly associated with single-item scores for difficulty swallowing or chewing, mucus, fatigue, choking, and voice or speech symptoms.

“Of interest, among individual components of the interference domain, late LCNP was more strongly associated with activity-related interference but not psychosocial-related scores, but this association was also not statistically significant,” the researchers wrote. “These findings might suggest a more lasting burden of LCNP on activity as opposed to emotional distress.”

A higher proportion of survivors with LCNP reported severe (20.0% vs 5.8%) and moderate (40.05% vs 15.6%) symptoms.

“Given the high degree of symptom burden, integration of interdisciplinary supportive care should be given early to potentially attenuate or slow the functional burden of LCNP,” the researchers wrote. “Targeted and individualized treatments must take into consideration patient perspectives, and routine symptom screening using validated patient-reported outcomes, such as the MDASI-HN, in patients with LCNP may also be of value to prioritize areas for intervention.”