937P - Pain, fatigue and depression symptom cluster in head and neck cancer survivors

Background

Pain, fatigue and depression are commonly seen in cancer survivors and may co-occur. The extent of these symptoms occurring, alone or together, in head and neck cancer (HNC) is unknown. Using data from the Head and Neck 5000 cohort, we (i) investigated prevalence of the pain, fatigue, depression symptom cluster and (ii) explored its association with health-related quality of life (HRQoL).

Methods

Sociodemographic and clinical data were collected from participants at cohort recruitment (pre-treatment). At 12-months post-recruitment, cancer-related pain, fatigue and HRQoL were measured using the EORTC QLQ-C30, and depression using the Hospital Anxiety & Depression Scale (HADS). Cut-offs to define presence of clinically-important symptoms were: pain ≥25, fatigue ≥39 and depression ≥8. Associations between HRQoL score (on scale 1-100; higher score=better HRQoL) and the symptom cluster (0/1/2/3 symptoms), adjusted for clinical and sociodemographic variables, were assessed using multivariate linear regression.

Results

2,207 patients were included in the analysis. 47.3% had one or more symptoms of pain, fatigue or depression at clinically important levels. 20.3% had any one symptom, 13.7% had any two symptoms and 13.4% had all three symptoms. In the multivariate analysis, number of symptoms was strongly associated with HRQoL. After adjusting for other variables, presence of any one symptom was associated with a 13.4 point decrease (95% CI -15.2 to -11.7) in HRQoL, any two symptoms with a 26.3 point decrease (95% CI -28.3 to -24.3) and all three symptoms with a 42.3 point decrease (95% CI -44.3 to -40.2) in the HRQoL.

Conclusions

There is a high prevalence of the pain, fatigue and depression cluster in HNC survivors with over one in ten experiencing all three symptoms at 12-months. They have a significant negative impact on HRQoL. More attention should be given to identifying survivors experiencing this symptom cluster. Interventions targeted at addressing the cluster symptoms may help improve HRQoL amongst HNC survivors.

Clinical trial identification

N/A

Editorial acknowledgement

Funding

National Institute for Health and Care Research (NIHR).

Disclosure

All authors have declared no conflicts of interest.