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Comparison of Methods for Eliciting Multiattribute Utilities for Prostate Cancer
Poster Viewing Abstracts S645
Volume 84 Number 3S Supplement 2012
3135 Comparison of Methods for Eliciting Multiattribute Utilities for Prostate Cancer M.H. Phillips, A. Burt, and A. Hartzler; University of Washington, Seattle, WA Purpose/Objective(s): To determine the accuracy of utilities acquired from Time Trade Off (TTO) and Standard Gamble (SG) exercises for the purpose of individual decision-making and to evaluate the efficacy of multiattribute utility (MAU) algorithms in modeling preferences in the treatment of prostate cancer. Materials/Methods: Ten health states characterizing levels of complications in three normal tissues (bowel, bladder, sexual) were selected from the 48 total possible health states. Five physicians (under IRB approval) first completed direct health state and direct profile rankings based on a visual analog scale. They then completed the TTO and SG exercises for eliciting multiattribute utilities of the ten states. The entire interview took approximately 2 hours. TTO scores were adjusted using certainty equivalents; SG scores were adjusted using prospect theory. The direct ranking exercises were used to validate the utility measurements and resultant MAU models. Results: TTO and SG were both able to predict accurately direct health state (rho(TT0) Z 0.855, rho(SG) Z 0.875) and direct health ranking (rho(TTO) Z 0.866, rho(SG) Z 0.851). Average error between the MAU model and the acquired utility was greater for TTO than SG (TTO average error Z 0.096, SG average error Z 0.059) but the difference between TTO and SG was not statistically significant. There was a tendency for participants to weight the bowel attribute most heavily, with the results that the models were best at predicting states with moderate or greater bowel problems. Subjectively, the participants found the direct ranking exercises the most trying. Conclusions: Direct health state ranking could be accurately predicted by both bias-corrected TTO and bias-corrected SG utilities. Neither method consistently outperformed the other in statistical analysis. Therefore, either method can be employed in a simplified patient interview to elicit utilities and construct an MAU model. It is important to note that if the interview is based on TTO, certainty equivalents must be gathered simultaneously in order to make the appropriate bias adjustment to TTO utilities. These results allow a streamlined, yet accurate, method to be used for obtaining patient-specific utilities and constructing patient-specific multiattribute utility models for use in decision making algorithms. Author Disclosure: M.H. Phillips: None. A. Burt: None. A. Hartzler: None.
3136 Quality of Life With Adjuvant Radiation Therapy Following Transoral Robotic Surgery (TORS) for Head-and-Neck Cancer T.J. Carpenter, V. Gupta, M.H. Buckstein, E.C. Ko, M.R. Posner, and E.M. Genden; Mount Sinai Medical Center, New York, NY Purpose/Objective(s): To evaluate objective measures of quality of life in patients receiving adjuvant radiation therapy (RT) or chemoradiation (CRT) after TORS for treatment of head and neck cancer. Specifically, overall treatment time, treatment delays, acute toxicity, and long-term functional outcomes were assessed. Materials/Methods: We retrospectively reviewed all patients treated with TORS and adjuvant RT or CRT for head and neck cancer from April 2007 to December 2011. Patients were evaluated before, during, and regularly after treatment to determine their disease status and head and neck-specific functional status. Data regarding treatment parameters and functional outcomes were analyzed. Results: A total of 124 patients underwent TORS. Of the cohort of 33 patients receiving adjuvant treatment, 9 received RT alone and 24 received CRT. Primary subsites were tonsil (70%), base of tongue (18%), soft palate (6%), and larynx (3%). Pathologic staging included: T1 40% (13/33), T2 55% (18/33), N0 6% (2/33), N1 33% (11/33), N2a 30% (10/33), N2b 27% (9/33), N2c 3% (1/33). Adjuvant RT indications included close margins (2/ 33), perineural invasion (0/33), lymphovascular invasion (5/33), pT3-4 (0/
33), or pN2-3 disease (3/33). Indications for adjuvant CRT were positive margins (8/33) or extranodal extension (15/33). Median treatment time (from surgery to completion of RT) was 87 days. Median time from surgery to start of RT was 41 days. Median RT duration was 33 fractions in 45 days. Median dose was 66 Gy. Treatment breaks occurred in 6/33 of patients (median duration, 1 day). Acute toxicity data was available for 31 patients. No acute grade 4-5 toxicity occurred. Grade 3 mucosal and pharyngeal toxicity occurred in 10 and 8 patients, respectively. One patient required a PEG tube postoperatively (prior to RT), 6 patients received prophylactic PEG tubes and 7 of the remaining 26 patients (27%) underwent PEG tube placement during RT. One patient (3%) was PEG-dependent at 6 months and no patients were PEG-dependent at 12 months. Median duration of PEG-dependence was 3 months (range, 0-11 months). Median weight loss was 14.1 lbs. With 10-month median follow up (range, 0-51 months), 31/33 patients are alive and 30/33 patients are locally controlled. 1-year actuarial overall survival and locoregional control rates are 97% in both. Conclusions: This study demonstrates that adjuvant RT after TORS for head and neck cancer is safe and favorably tolerated. Compared to historical controls, patients exhibited favorable treatment duration, rates of toxicity, and PEG-dependence and comparable overall survival and locoregional control, albeit with limited follow-up. Author Disclosure: T.J. Carpenter: None. V. Gupta: None. M.H. Buckstein: None. E.C. Ko: None. M.R. Posner: None. E.M. Genden: None.
3137 Dry Mouth and Sticky Saliva – Quality of Life Domains Most Affected in the Acute Toxicity Phase of Radiation Therapy S. Tribius,1 C. Prosch,1 M. Raguse,1 E. Reemts,1 A. Kruell,1 C. Petersen,1 and S. Singer2; 1University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 2University of Leipzig, Leipzig, Germany Purpose/Objective(s): The objective of this study was to evaluate the effect of curative radiation therapy (RT) on different domains of quality of life (QOL) in head and neck cancer patients depending on surgery prior to RT and concurrent chemotherapy (CRT). Materials/Methods: One hundred twenty-nine patients with locally advanced head and neck cancer (LAHNC) completed the EORTC QLQC30 and H&N35 questionnaires at the beginning (t0) and the end (t1) of radiation therapy, and 6-8 weeks after radiation therapy at first follow-up (t2). All patients received intensity modulated radiation therapy (IMRT) to a total dose of 60-70 Gy with conventional fractionation (2 Gy/d). The following domains were tested: Physical functioning, global quality of life, fatigue, nausea and vomiting, dry mouth, sticky saliva and swallowing. Statistical testing of radiation effects was performed using general linear models with repeated measures, adjusting for the effects of age, initial surgery and simultaneous chemotherapy. Results: Radiation therapy affects QOL significantly. In all domains but fatigue QOL decreased significantly between t0 and t1 and often recovered until t2, however dry mouth and sticky saliva stayed at high levels until t2. Significant effect modification with primary surgery was found at sticky saliva (pZ0.02) and swallowing (pZ0.002), while there was only weak evidence for a joint effect with simultaneous chemotherapy in physical functioning (pZ0.06) and global quality of life (pZ0.09; table, rounded values). Conclusions: Despite the use of IMRT, radiation therapy has a negative effect on several domains of quality of life but not on fatigue. Most of these effects are short-term with a significant recovery by 6-8 weeks after radiation therapy. After RT, swallowing returns almost to baseline in Poster Viewing Abstract 3137; Table with and without prior surgery
Mean symptom scores for patients
no surgery
dry mouth sticky saliva swallowing
surgery
t0
t1
t2
t0
t1
t2
23 16 24
78 80 70
76 78 50
37 42 41
64 84 68
69 69 42
Volume 84 Number 3S Supplement 2012
3135 Comparison of Methods for Eliciting Multiattribute Utilities for Prostate Cancer M.H. Phillips, A. Burt, and A. Hartzler; University of Washington, Seattle, WA Purpose/Objective(s): To determine the accuracy of utilities acquired from Time Trade Off (TTO) and Standard Gamble (SG) exercises for the purpose of individual decision-making and to evaluate the efficacy of multiattribute utility (MAU) algorithms in modeling preferences in the treatment of prostate cancer. Materials/Methods: Ten health states characterizing levels of complications in three normal tissues (bowel, bladder, sexual) were selected from the 48 total possible health states. Five physicians (under IRB approval) first completed direct health state and direct profile rankings based on a visual analog scale. They then completed the TTO and SG exercises for eliciting multiattribute utilities of the ten states. The entire interview took approximately 2 hours. TTO scores were adjusted using certainty equivalents; SG scores were adjusted using prospect theory. The direct ranking exercises were used to validate the utility measurements and resultant MAU models. Results: TTO and SG were both able to predict accurately direct health state (rho(TT0) Z 0.855, rho(SG) Z 0.875) and direct health ranking (rho(TTO) Z 0.866, rho(SG) Z 0.851). Average error between the MAU model and the acquired utility was greater for TTO than SG (TTO average error Z 0.096, SG average error Z 0.059) but the difference between TTO and SG was not statistically significant. There was a tendency for participants to weight the bowel attribute most heavily, with the results that the models were best at predicting states with moderate or greater bowel problems. Subjectively, the participants found the direct ranking exercises the most trying. Conclusions: Direct health state ranking could be accurately predicted by both bias-corrected TTO and bias-corrected SG utilities. Neither method consistently outperformed the other in statistical analysis. Therefore, either method can be employed in a simplified patient interview to elicit utilities and construct an MAU model. It is important to note that if the interview is based on TTO, certainty equivalents must be gathered simultaneously in order to make the appropriate bias adjustment to TTO utilities. These results allow a streamlined, yet accurate, method to be used for obtaining patient-specific utilities and constructing patient-specific multiattribute utility models for use in decision making algorithms. Author Disclosure: M.H. Phillips: None. A. Burt: None. A. Hartzler: None.
3136 Quality of Life With Adjuvant Radiation Therapy Following Transoral Robotic Surgery (TORS) for Head-and-Neck Cancer T.J. Carpenter, V. Gupta, M.H. Buckstein, E.C. Ko, M.R. Posner, and E.M. Genden; Mount Sinai Medical Center, New York, NY Purpose/Objective(s): To evaluate objective measures of quality of life in patients receiving adjuvant radiation therapy (RT) or chemoradiation (CRT) after TORS for treatment of head and neck cancer. Specifically, overall treatment time, treatment delays, acute toxicity, and long-term functional outcomes were assessed. Materials/Methods: We retrospectively reviewed all patients treated with TORS and adjuvant RT or CRT for head and neck cancer from April 2007 to December 2011. Patients were evaluated before, during, and regularly after treatment to determine their disease status and head and neck-specific functional status. Data regarding treatment parameters and functional outcomes were analyzed. Results: A total of 124 patients underwent TORS. Of the cohort of 33 patients receiving adjuvant treatment, 9 received RT alone and 24 received CRT. Primary subsites were tonsil (70%), base of tongue (18%), soft palate (6%), and larynx (3%). Pathologic staging included: T1 40% (13/33), T2 55% (18/33), N0 6% (2/33), N1 33% (11/33), N2a 30% (10/33), N2b 27% (9/33), N2c 3% (1/33). Adjuvant RT indications included close margins (2/ 33), perineural invasion (0/33), lymphovascular invasion (5/33), pT3-4 (0/
33), or pN2-3 disease (3/33). Indications for adjuvant CRT were positive margins (8/33) or extranodal extension (15/33). Median treatment time (from surgery to completion of RT) was 87 days. Median time from surgery to start of RT was 41 days. Median RT duration was 33 fractions in 45 days. Median dose was 66 Gy. Treatment breaks occurred in 6/33 of patients (median duration, 1 day). Acute toxicity data was available for 31 patients. No acute grade 4-5 toxicity occurred. Grade 3 mucosal and pharyngeal toxicity occurred in 10 and 8 patients, respectively. One patient required a PEG tube postoperatively (prior to RT), 6 patients received prophylactic PEG tubes and 7 of the remaining 26 patients (27%) underwent PEG tube placement during RT. One patient (3%) was PEG-dependent at 6 months and no patients were PEG-dependent at 12 months. Median duration of PEG-dependence was 3 months (range, 0-11 months). Median weight loss was 14.1 lbs. With 10-month median follow up (range, 0-51 months), 31/33 patients are alive and 30/33 patients are locally controlled. 1-year actuarial overall survival and locoregional control rates are 97% in both. Conclusions: This study demonstrates that adjuvant RT after TORS for head and neck cancer is safe and favorably tolerated. Compared to historical controls, patients exhibited favorable treatment duration, rates of toxicity, and PEG-dependence and comparable overall survival and locoregional control, albeit with limited follow-up. Author Disclosure: T.J. Carpenter: None. V. Gupta: None. M.H. Buckstein: None. E.C. Ko: None. M.R. Posner: None. E.M. Genden: None.
3137 Dry Mouth and Sticky Saliva – Quality of Life Domains Most Affected in the Acute Toxicity Phase of Radiation Therapy S. Tribius,1 C. Prosch,1 M. Raguse,1 E. Reemts,1 A. Kruell,1 C. Petersen,1 and S. Singer2; 1University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 2University of Leipzig, Leipzig, Germany Purpose/Objective(s): The objective of this study was to evaluate the effect of curative radiation therapy (RT) on different domains of quality of life (QOL) in head and neck cancer patients depending on surgery prior to RT and concurrent chemotherapy (CRT). Materials/Methods: One hundred twenty-nine patients with locally advanced head and neck cancer (LAHNC) completed the EORTC QLQC30 and H&N35 questionnaires at the beginning (t0) and the end (t1) of radiation therapy, and 6-8 weeks after radiation therapy at first follow-up (t2). All patients received intensity modulated radiation therapy (IMRT) to a total dose of 60-70 Gy with conventional fractionation (2 Gy/d). The following domains were tested: Physical functioning, global quality of life, fatigue, nausea and vomiting, dry mouth, sticky saliva and swallowing. Statistical testing of radiation effects was performed using general linear models with repeated measures, adjusting for the effects of age, initial surgery and simultaneous chemotherapy. Results: Radiation therapy affects QOL significantly. In all domains but fatigue QOL decreased significantly between t0 and t1 and often recovered until t2, however dry mouth and sticky saliva stayed at high levels until t2. Significant effect modification with primary surgery was found at sticky saliva (pZ0.02) and swallowing (pZ0.002), while there was only weak evidence for a joint effect with simultaneous chemotherapy in physical functioning (pZ0.06) and global quality of life (pZ0.09; table, rounded values). Conclusions: Despite the use of IMRT, radiation therapy has a negative effect on several domains of quality of life but not on fatigue. Most of these effects are short-term with a significant recovery by 6-8 weeks after radiation therapy. After RT, swallowing returns almost to baseline in Poster Viewing Abstract 3137; Table with and without prior surgery
Mean symptom scores for patients
no surgery
dry mouth sticky saliva swallowing
surgery
t0
t1
t2
t0
t1
t2
23 16 24
78 80 70
76 78 50
37 42 41
64 84 68
69 69 42