Impact of xerostomia and dysphagia on health-related quality of life for head and neck cancer patients

Abstract

ABSTRACT Introduction: Over the last two decades there have been dramatic intensifications in the treatment of head and neck cancer with altered fractionation or concurrent chemotherapy, both of which have been shown to improve survival at the cost of increased toxicity. Specifically, xerostomia and dysphagia negatively impact health-related quality of life (HR-QOL), and incorporation of modern radiotherapy techniques including intensity-modulated radiotherapy and volumetric arc radiotherapy have been designed to mitigate toxicity and impaired HR-QOL. Areas covered: We review the measurement of toxicity and HR-QOL, the impact of xerostomia and dysphagia on HR-QOL, and methods of preserving HR-QOL after head and neck radiotherapy. We also discuss the implications on HR-QOL of de-intensification trials for favorable-risk human papilloma virus related oropharyngeal cancer as well as a randomized trial comparing photon and proton therapy for oropharygeal cancer patients. The role of salivary stem cells and their potential impact on HR-QOL is explored. Expert commentary: With the rise of favorable-risk oropharyngeal cancer, the importance of HR-QOL in these patients has become paramount. Approaches to improve radiation-related xerostomia and dysphagia are emerging from both the physics and biological realms, but these approaches must demonstrate HR-QOL gains with sufficient rigor to justify their use in clinical practice.