Work Outcomes after Intensity-Modulated Proton Therapy (IMPT) versus Intensity-Modulated Photon Therapy (IMRT) for Oropharyngeal Cancer

Grace L. Smith, MD, PhD, MPH; Shuangshuang Fu, PhD; Matthew S. Ning, MD, MPH; Diem-Khanh Nguyen, BA; Paul M. Busse, MD, PhD; Robert L. Foote, MD; Adam S. Garden, MD; Gary B. Gunn, MD; Clifton D. Fuller, MD, PhD; William H. Morrison, MD; Gregory M. Chronowski, MD; Shalin J. Shah, MD; Lauren L. Mayo, MD; Jack Phan, MD, PhD; Jay P. Reddy, PhD; James W. Snider III, MD; Samir H. Patel, MD; Sanford R. Katz, MD; Alexander Lin, MD; Nasiruddin Mohammed, MD; Roi Dagan, MD, MS; Nancy Y. Lee, MD; David I. Rosenthal, MD; Steven J. Frank, MD

doi:10.14338/IJPT-20-00067.1

International Journal of Particle Therapy (Jun 2021)

Work Outcomes after Intensity-Modulated Proton Therapy (IMPT) versus Intensity-Modulated Photon Therapy (IMRT) for Oropharyngeal Cancer

Grace L. Smith, MD, PhD, MPH,
Shuangshuang Fu, PhD,
Matthew S. Ning, MD, MPH,
Diem-Khanh Nguyen, BA,
Paul M. Busse, MD, PhD,
Robert L. Foote, MD,
Adam S. Garden, MD,
Gary B. Gunn, MD,
Clifton D. Fuller, MD, PhD,
William H. Morrison, MD,
Gregory M. Chronowski, MD,
Shalin J. Shah, MD,
Lauren L. Mayo, MD,
Jack Phan, MD, PhD,
Jay P. Reddy, PhD,
James W. Snider III, MD,
Samir H. Patel, MD,
Sanford R. Katz, MD,
Alexander Lin, MD,
Nasiruddin Mohammed, MD,
Roi Dagan, MD, MS,
Nancy Y. Lee, MD,
David I. Rosenthal, MD,
Steven J. Frank, MD

Affiliations

Grace L. Smith, MD, PhD, MPH: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Shuangshuang Fu, PhD: 2 Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Matthew S. Ning, MD, MPH: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Diem-Khanh Nguyen, BA: 3 University of California Riverside School of Medicine, Riverside, CA, USA
Paul M. Busse, MD, PhD: 4 Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Robert L. Foote, MD: 5 Department of Radiation Oncology, Mayo Clinic and Mayo Clinic School of Medicine and Science, Rochester, MN, USA
Adam S. Garden, MD: 8 Willis-Knighton Proton Therapy Center, Shreveport, LA, USA
Gary B. Gunn, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Clifton D. Fuller, MD, PhD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
William H. Morrison, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Gregory M. Chronowski, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Shalin J. Shah, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Lauren L. Mayo, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Jack Phan, MD, PhD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Jay P. Reddy, PhD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
James W. Snider III, MD: 6 Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
Samir H. Patel, MD: 7 Department of Radiation Oncology, Mayo Clinic and Mayo Clinic School of Medicine and Science, Phoenix, AZ, USA
Sanford R. Katz, MD: 8 Willis-Knighton Proton Therapy Center, Shreveport, LA, USA
Alexander Lin, MD: 9 Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
Nasiruddin Mohammed, MD: 10 Northwestern Medicine Chicago Proton Center, Warrenville, IL, USA
Roi Dagan, MD, MS: 11 Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
Nancy Y. Lee, MD: 12 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
David I. Rosenthal, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Steven J. Frank, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

DOI: https://doi.org/10.14338/IJPT-20-00067.1
Journal volume & issue: Vol. 8, no. 1
pp. 319 – 327

Abstract

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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, the most severe work impairments occurred from treatment initiation to the end of CRT, with significant recovery from absenteeism, 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.

Published in International Journal of Particle Therapy

ISSN: 2331-5180 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Science: Physics: Nuclear and particle physics. Atomic energy. Radioactivity
Website: https://www.sciencedirect.com/journal/international-journal-of-particle-therapy

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