Assessment of Quality of Life in Recurrent and Metastatic Head and Neck Cancer after Oral Metronomic Chemotherapy: A Prospective Interventional StudyCorrespondence Address :
Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India.
Introduction: Most of the Recurrent or Metastatic (R/M) Head and Neck Squamous Cell Carcinomas (HNSCC) patients are treated only by palliative treatment. Metronomic Chemotherapy (MC) low doses is an emerging therapeutic option in these patients. It exerts tumour angiogenesis, stimulate anticancer immune response, induces tumour dormancy and offers a significant improvement in Quality of Life (QoL) with minimal toxicity.
Aim: To assess the changes in QoL in patients with metastatic, recurrent (M/R) HNSCC receiving MC.
Materials and Methods: This was a prospectively interventional hospital based study from February 2015 to September 2018, conducted at Cancer Research Institute, Himalayan Institute of Medical Sciences, SRHU University, Dehradun. A total of 175 patients older than 18 years, with Eastern Cooperative Oncology Group (ECOG) performance status score < 2, with M/R HNSCC, not amenable to any radical treatment, were equally distributed by lottery method in three arms, in those receiving Capecitabine (Arm A, n: 59), Celecoxib and Methotrexate (Arm B, n: 62); and placebo with best supportive care (Arm C, n: 54). In addition to demographic and baseline clinical characteristics, patients were assessed by physical examination and questioned to score their QoL by European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) at presentation and followed every month for two months.
Results: A total of 175 patients (the mean age was 56.73 ±6.84 years with male preponderance 77.71%) were analysed in the study. A 60% suffered from carcinoma oral cavity (N: 105), followed by carcinoma oropharynx (24%) (N: 42), carcinoma larynx and carcinoma hypopharynx consisted rest 16% (N: 28). Altogether the QoL was quite divergent amongst the three arms. Symptom score for fatigue, dyspnoea, loss of appetite, nausea and vomiting showed rise representing worsening in Arm A and Arm C; whilst these symptoms also showed fall in symptom score in Arm B (Fatigue: p-value 0.007; Dyspnoea; p-value 0.042; Appetite loss: p-value 0.008 Nausea: p-value 0.02; Vomiting: p-value 0.03). There was a statistically significant improvement in overall QoL QLQ-C30 score from baseline in the Methotrexate and Celecoxib arm (Arm B) compared with Capacitabine and with placebo.
Conclusion: Metronomic Chemotherapy (MC) with Methotrexate and Celecoxib seems promising and well tolerated in patients with metastatic or advanced HNSCC as compared to Capacitabine or keeping on symptomatic treatment solely.
Carcinomas, Low dose chemotherapy, Methotrexate, Palliative
Date of Submission: Feb 08, 2021
Date of Peer Review: Mar 24, 2021
Date of Acceptance: Apr 26, 2021
Date of Publishing: Jul 01, 2021
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 10, 2021
• Manual Googling: Apr 20, 2021
• iThenticate Software: May 25, 2021 (23%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)