6th ICHNO Abstract Book

6th ICHNO 6 th ICHNO Conference International Conference on innovative approaches in Head and Neck Oncology 16 – 18 March 2017 Barcelona, Spain __________________________________________________________________________________________ page 57

2 Tenon Hospital, Radiation oncology, Paris, France 3 Institut Gustave Roussy, Head & Neck Surgical & Medical Oncology, Villejuif, France 4 Centre Jean Bernard, Oncology, Le Mans, France 5 MSD France, Market access, Courbevoie, France 6 Institut de Cancérologie de Lorraine - Alexis Vautrin, Medical oncology, Vandoeuvre Les Nancy, France 7 CNRS, GREQAM, Marseille, France Purpose or Objective Health-related quality-of-life generic instruments such as EQ-5D are recommended for use in cost-effectiveness analysis of new cancer treatments in most European countries. However, EQ-5D-related utility estimates are inexistent for head and neck (H&N) cancer patients. The study objective was to estimate EQ-5D-related utility from the Karnofsky index recorded at hospital for French patients with H&N cancer. Material and Methods We completed a retrospective cohort study using the French National Hospital Discharge (PMSI) database that contains all public and private claims for acute care (MCO) and post-acute care (SSR and HAD) in 2008-2013. Of all adult patients identified with squamous cell carcinoma (ICD-10: C00-C06; C09-C14; C30.0; C31; C32), we selected all 53,257 incident cases in 2010-2012 without a personal history of cancer. Patients’ trajectory was defined according to 3 phases-of-care: 1) initial care (first 6 months after diagnosis), by cancer stage (early I/II; advanced III/IVb; distant metastatic IVc); 2) continuing care without relapse (6 months after diagnosis); and 3) relapse care in the follow-up of patients without distant metastasis at diagnosis. EQ-5D utility estimates for all phases-of-care were derived from the Karnofsky index recorded in post-acute care (HAD) by a three-steps procedure: 1) in post-acute care (HAD), the Karnofsky index (0 to 100) was calibrated with the EQ-5D utility metric (-0.53 to 1) used in France (Chevalier Eur J Health Econ 2013); 2) in post-acute care (HAD and SSR), EQ-5D utility was estimated from the functional relationship between the Karnofsky index and 6 Activities of Daily Living recorded weekly; 3) in all patients (HAD, SSR, MCO), EQ-5D utility was averaged by phase-of-care and corrected for sample selection bias from acute care (MCO) to post-acute care (HAD, SSR) with the Heckman selection model. Results Patients were 78.2% male with a median (IQR) age of 61 (54-71) at diagnosis and 20,582 (38.6%) patients died in the follow-up. In post-acute care (HAD and SSR), 15,096 patients were identified at any phase-of-care with a mean (std) EQ-5D utility of 0.148 (0.227) and 0.071 (0.107) after correcting for sample selection bias. Overall (HAD, SSR, MCO), 94,456 patients were identified at any phase-of-care with a mean (std) EQ-5D utility of 0.133 (0.114). Patients diagnosed at early or advanced stage had higher mean EQ-5D utility than patients diagnosed with distant metastasis at diagnosis or relapsing in the follow-up. Patients with laryngeal cancer had higher mean EQ-5D utility than others. Though, mean EQ-5D utility primarily decreased with an older age at diagnosis and the number of severe comorbidities other than H&N cancer. Conclusion EQ-5D-related utility was poor in a national sample of patients with H&N cancer and even worse in presence of frequent, severe comorbidities.

1 pts (1.7%). Finally, G1/G2 weight loss occurred in 6 pts (10%) and G3 in 1 (1.7%) pts. Overall G3 late toxicity was observed in 8 pts, of them 6 pts required nutritional support and 2 pts placement of PEG due to weight loss and The IMRT technique has proven to be feasible for treatment of oral cancer with acceptable acute and late toxicities. Overall, G3 acute and late toxicities occurred in 26% and 13% respectively. Our study showed better results compared with the data in literature. Nevertheless, it is mandatory to identify the pts who are at high risk of severe toxicity to get a better clinical management of this subset of pts. PO-119 Does mucosal appearance predict mucosal PRO in oropharyngeal carcinoma treated with chemoimrt? M. Hickman 1 , T. Shantakuma 1 , S. Meade 1 , C. Fong 1 , P. Sanghera 1 , A. Hartley 1 1 University Hospital Birmingham, Radiotherapy, Birmingham, United Kingdom Purpose or Objective The importance of patient reported outcomes (PRO) as opposed to physician scored toxicity grading has been increasingly recognised. However, historical response relationships exist between dose and mucosal appearance. The purpose of this study was to investigate the ability of mucosal appearance scored in differing ways to predict mucosal PRO. Material and Methods Patients undergoing chemoimrt for oropharyngeal cancer were examined during treatment and in the recovery phase. The presence of a patch of confluent mucositis > 1cm in area was scored as grade 3. On each examination a grade was reported for the whole visible oral and oropharyngeal mucosa and for this volume divided into quadrants and octants. Patients were also asked to respond to the PRO-CTCAE question: What was the severity of your mouth or throat symptoms at their worst? The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each method of scoring the appearance of the mouth in predicting severe or very severe mucosal PRO was calculated. Results Data from 124 examinations was included in this analysis. The sensitivity, specificity, PPV and NPV respectively for the following scoring methods were: at least 1 area of grade 3 mucositis in the whole visible oral and oropharyngeal mucosa- 75%, 73%, 83%, 61% ; at least 2 quadrants with grade 3 mucositis 71%, 83%, 89%, 60%; at least 3 octants with grade 3 mucositis 66%, 86%, 89%, 58%. Conclusion A high positive predictive value of mucosal examination in predicting mucosal PRO can be achieved if grade 3 mucositis is scored by dividing the visible oral and oropharyngeal mucosa into quadrants or octants. Quadrants seem to offer the best compromise between sensitivity and specificity. The negative predictive value of all methods of scoring was disappointing. This underlines both the importance of recording PRO in routine practice and clinical trials and the need to consider concomitant factors including levels of provision of analgesia and psychological support. PO-120 Head and neck cancers are associated with poor EQ-5D-related utility in France (EPICORL study) M. Schwarzinger 1 , F. Huguet 2 , S. Témam 3 , Y. Pointreau 4 , M. Bec 5 , C. Even 3 , L. Geoffrois 6 , L. Lévy-Bachelot 5 , S. Luchini 7 1 THEN Translational Health Economics Network, Public health, Paris, France dysphagia. Conclusion