title: Risk factors for clinician-reported symptom clusters in patients with advanced head and neck cancer in a phase 3 randomized clinical trial: RTOG 0129.
abstract: BACKGROUND
  Chemoradiotherapy has become the standard of care for head and neck squamous cell carcinoma; however, those patients often experience multiple treatment-related symptoms or symptom clusters. Two symptom clusters have been identified for this population. Little is known about the risk factors of these symptom clusters.
  
  
  METHODS
  Subjects comprised 684 patients who were treated with concurrent chemoradiotherapy in a phase 3 randomized clinical trial. This trial compared standard fractionation radiotherapy to accelerated fractionation radiotherapy. Symptom clusters were evaluated at the end of the first and the second cycle of chemotherapy, and 3 months after the start of radiotherapy. Mixed-effect modeling was used to observe risk factors for symptom clusters.
  
  
  RESULTS
  Race and education were independent predictors for the head and neck cluster, whereas sex and history of tobacco use were independent predictors for the gastrointestinal cluster. Primary cancer site was only significant for the head and neck cluster when other factors were not controlled: patients with oropharyngeal cancer had more severe symptoms in the head and neck clusters than did patients with laryngeal cancer. In addition, patients receiving accelerated fractionation radiotherapy experienced more symptoms of radiomucositis, pain, and nausea at 3 months after the start of radiotherapy than those receiving standard fractionation radiotherapy.
  
  
  CONCLUSIONS
  Demographic characteristics were more predictive to symptom clusters, whereas clinical characteristics, such as cancer site and treatment arms, were more significant for individual symptoms. Knowing the risk factors will enhance the capability of clinicians to evaluate patients' risk of severe symptom clusters and to personalize management strategies.
authors: School of Nursing, Emory University, Atlanta, Georgia.
authors: Canhua
authors: C
authors: Xiao
authors: Alexandra
authors: A
authors: Hanlon
authors: Qiang
authors: Q
authors: Zhang
authors: Benjamin
authors: B
authors: Movsas
authors: Kian
authors: K
authors: Ang
authors: David I
authors: DI
authors: Rosenthal
authors: P Félix
authors: PF
authors: Nguyen-Tan
authors: Harold
authors: H
authors: Kim
authors: Quynh
authors: Q
authors: Le
authors: Deborah Watkins
authors: DW
authors: Bruner
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000628:therapy*; D059248:Chemoradiotherapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D044469:Racial Groups; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking; D013577:Syndrome
chemical_list: D011838:Radiation-Sensitizing Agents
keywords: chemoradiation; head and neck neoplasms; risk factors; symptom clusters