TY - JOUR
T1 - Work outcomes after intensity- modulated proton therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for oropharyngeal cancer
AU - Smith, Grace L.
AU - Fu, Shuangshuang
AU - Ning, Matthew S.
AU - Nguyen, Diem Khanh
AU - Busse, Paul M.
AU - Foote, Robert L.
AU - Garden, Adam S.
AU - Gunn, Gary B.
AU - Fuller, Clifton D.
AU - Morrison, William H.
AU - Chronowski, Gregory M.
AU - Shah, Shalin J.
AU - Mayo, Lauren L.
AU - Phan, Jack
AU - Reddy, Jay P.
AU - Snider, James W.
AU - Patel, Samir H.
AU - Katz, Sanford R.
AU - Lin, Alexander
AU - Mohammed, Nasiruddin
AU - Dagan, Roi
AU - Lee, Nancy Y.
AU - Rosenthal, David I.
AU - Frank, Steven J.
N1 - Publisher Copyright:
© Copyright 2021 The Author(s).
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Purpose: We compared work outcomes in patients with oropharyngeal cancer (OPC), randomized to intensity-modulated proton (IMPT) versus intensity-modulated photon therapy (IMRT) for chemoradiation therapy (CRT). Patients and Methods: In 147 patients with stage II-IVB squamous cell OPC participating in patient-reported outcomes assessments, a prespecified secondary aim of a randomized phase II/III trial of IMPT (n = 69) versus IMRT (n = 78), we compared absenteeism, presenteeism (i.e., the extent to which an employee is not fully functional at work), and work productivity losses. We used the work productivity and activity impairment questionnaire at baseline (pre-CRT), at the end of CRT, and at 6 months, 1 year, and 2 years. A one-sided Cochran-Armitage test was used to analyze within-arm temporal trends, and a Χ2 test was used to compare between-arm differences. Among working patients, at each follow-up point, a 1-sided Wilcoxon rank-sum test was used to compare work-productivity scores. Results: Patient characteristics in IMPT versus IMRT arms were similar. In the IMPT arm, within-arm analysis demonstrated that an increasing proportion of patients resumed working after IMPT, from 60% (40 of 67) pre-CRT and 71% (30 of 42) at 1 year to 78% (18 of 23) at 2 years (P = 0.025). In the IMRT arm, the proportion remained stable, with 57% (43 of 76) pre-CRT, 54% (21 of 39) at 1 year, and 52% (13 of 25) working at 2 years (P = 0.47). By 2 years after CRT, the between-arm difference between patients who had IMPT and those who had IMRT trended toward significance (P = 0.06). Regardless of treatment arm, among working patients, themost severe work impairments occurred from treatment initiation to the end ofCRT, with significant recovery fromabsenteeism, presenteeism, and productivity impairments by the 2-year follow-up (P, 0.001 for all). Higher magnitudes of recovery from absenteeism (at 1 year, P = 0.05; and at 2 years, P = 0.04) and composite work impairment scores (at 1 year, P = 0.04; and at 2 years, P = 0.04) were seen in patients treated with IMPT versus those treated with IMRT. Conclusion: In patients with OPC receiving curative CRT, patients randomized to IMPT demonstrated increasing work and productivity recovery trends. Studies are needed to identify mechanisms underlying head and neck CRT treatment causing work disability and impairment.
AB - Purpose: We compared work outcomes in patients with oropharyngeal cancer (OPC), randomized to intensity-modulated proton (IMPT) versus intensity-modulated photon therapy (IMRT) for chemoradiation therapy (CRT). Patients and Methods: In 147 patients with stage II-IVB squamous cell OPC participating in patient-reported outcomes assessments, a prespecified secondary aim of a randomized phase II/III trial of IMPT (n = 69) versus IMRT (n = 78), we compared absenteeism, presenteeism (i.e., the extent to which an employee is not fully functional at work), and work productivity losses. We used the work productivity and activity impairment questionnaire at baseline (pre-CRT), at the end of CRT, and at 6 months, 1 year, and 2 years. A one-sided Cochran-Armitage test was used to analyze within-arm temporal trends, and a Χ2 test was used to compare between-arm differences. Among working patients, at each follow-up point, a 1-sided Wilcoxon rank-sum test was used to compare work-productivity scores. Results: Patient characteristics in IMPT versus IMRT arms were similar. In the IMPT arm, within-arm analysis demonstrated that an increasing proportion of patients resumed working after IMPT, from 60% (40 of 67) pre-CRT and 71% (30 of 42) at 1 year to 78% (18 of 23) at 2 years (P = 0.025). In the IMRT arm, the proportion remained stable, with 57% (43 of 76) pre-CRT, 54% (21 of 39) at 1 year, and 52% (13 of 25) working at 2 years (P = 0.47). By 2 years after CRT, the between-arm difference between patients who had IMPT and those who had IMRT trended toward significance (P = 0.06). Regardless of treatment arm, among working patients, themost severe work impairments occurred from treatment initiation to the end ofCRT, with significant recovery fromabsenteeism, presenteeism, and productivity impairments by the 2-year follow-up (P, 0.001 for all). Higher magnitudes of recovery from absenteeism (at 1 year, P = 0.05; and at 2 years, P = 0.04) and composite work impairment scores (at 1 year, P = 0.04; and at 2 years, P = 0.04) were seen in patients treated with IMPT versus those treated with IMRT. Conclusion: In patients with OPC receiving curative CRT, patients randomized to IMPT demonstrated increasing work and productivity recovery trends. Studies are needed to identify mechanisms underlying head and neck CRT treatment causing work disability and impairment.
KW - Oropharyngeal cancer
KW - Patient-reported outcomes
KW - Productivity
KW - Proton therapy
KW - Work
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U2 - 10.14338/IJPT-20-00067.1
DO - 10.14338/IJPT-20-00067.1
M3 - Article
C2 - 34285958
AN - SCOPUS:85115749252
SN - 2331-5180
VL - 8
SP - 319
EP - 327
JO - International Journal of Particle Therapy
JF - International Journal of Particle Therapy
IS - 1
ER -