Experts Create Instrument to Measure Functional Outcomes in Head and Neck Cancer

Edmonton-33 instrument could serve as a single all-inclusive measure for functional outcomes in patients with head and neck cancer, according to findings from a qualitative study (JAMA Otolaryngol Head Neck Surg. 2020 Apr 9. Epub ahead of print).

“Incorporation of patient perspectives, or patient-reported outcomes, in functional outcome measures has been gaining prominence in the literature on reconstructive surgery,” explained Adrian Mendez, MD, PhD, Division of Otolaryngology–Head and Neck Surgery, University of Alberta, Edmonton, Canada, and colleagues, who sought to develop and validate a tool to measure the main functional areas of concern for patients with head and neck cancer.

Between July 1, 2013, and June 30, 2016, Dr Mendez et al conducted a 4-phase mixed-methods qualitative study at a quaternary head and neck oncology center in Edmonton. Patients with squamous cell carcinoma involving subsites of the head and neck (ie, oral cavity, oropharynx, hypopharynx, and larynx) who completed therapy at least 1 year prior were recruited for the study from Canada, the United States, and Finland.

Overall, phases 1, 2, 3, and 4 of the study included 10 patients, 5 patients, 10 patients, and 25 patients, respectively. The primary end points were the clinical correspondence of Edmonton-33 instrument scores with swallowing, speech, dry mouth, and chewing assessment outcomes.

Findings showed a strong correlation between Edmonton-33 instrument scores and the swallowing scores of the MD Anderson Dysphagia Inventory (r = 0.77; 95% CI, 0.49-1.0), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire–Head and Neck 35 (EORTC QLQ–H&N35; r = –0.73; 95% CI, –1.0 to –0.44), and the modified barium swallow test (r = –0.60; 95% CI, –0.94 to –0.25).

In addition, instrument scores were observed to strongly correlate with the Speech Handicap Index scores (r = –0.64; 95% CI, –0.97 to –0.31), word intelligibility scores (r = 0.61; 95% CI, 0.27-0.95), and sentence intelligibility scores (r = 0.55; 95% CI, 0.19-0.91).

A correlation that was moderate-to-strong was seen between the Edmonton-33 instrument and the EORTC QLQ–H&N35 scores in the dry mouth (r = –0.54; 95% CI, –0.91 to –0.18) and chewing (r = –0.45; 95% CI, –0.84 to –0.06) domains.

“The Edmonton-33 appears to be a validated instrument that will allow patients with head and neck cancer to assess and report their own functional outcomes. It could serve as a single comprehensive measure for functional outcomes,” Dr Mendez and colleagues concluded.—Hina Porcelli