Survival in patients with relapsed/metastatic squamous cell head and neck cancer (SCHNC) is poor. Dysphagia, fatigue, dyspnoea and pain are common symptoms. Percutaneous endoscopic gastrostomy tube (PEG), tracheostomy and analgesics are frequently needed for supportive care. In addition to best supportive care, palliative systemic chemotherapy can be delivered in select patients with a good performance status.
We retrospectively analysed the outcome of patients with relapsed or primary metastatic SCHNC treated with palliative chemotherapy at the Institute of Oncology Ljubljana, Slovenia in years 2014 and 2015. We evaluated the impact of performance status (PS), pain control and the presence of PEG and/or tracheostomy on overall survival (OS).
43 patients (median age at diagnosis 59 years, range 40-78) were referred to a medical oncologist for palliative chemotherapy treatment. Primary cancer locations were oral cavity (18%), oropharynx (35%), larynx (16%), hypopharynx (26%) and paranasal sinuses (5%). The PS score was either 0 (19%), 1 (64%) or 2 (17%). 42% of patients had recurrence loco-regionally, 30% loco-regionally with distant metastases and 28% had distant metastases only. 16% of patients had PEG, 7% tracheostomy and 27% both PEG and tracheostomy. Palliative chemotherapy administered was either 5FU/cisplatin/cetuximab, methotrexate or paclitaxel. Median OS in all patients was 14.4 months (95% CI 11.8-16.9). Patients with PS 0-1 had longer median OS than patients with PS 2 (15.3 vs. 3.8 months; p = 0.068). The presence of PEG and/or tracheostomy did not compromise chemotherapy treatment or adversely affect OS. Additionally, we found that patients with suboptimally managed pain tended to have shorter survival than patients with optimal analgesic support (3.8 vs. 9.5 months; p = 0.06).
Presence of PEG and/or tracheostomy do not compromise OS in patients with relapsed/metastatic SCHNC. Patients with optimal pain control and PS 0-1 live longer.
Clinical trial identification
Legal entity responsible for the study
Onkološki Inštitut Ljubljana
All authors have declared no conflicts of interest.