title: Nomogram for predicting symptom severity during radiation therapy for head and neck cancer.
abstract: OBJECTIVE
  Radiation therapy (RT), with or without chemotherapy, can cause significant acute toxicity among patients treated for head and neck cancer (HNC), but predicting, before treatment, who will experience a particular toxicity or symptom is difficult. We created and evaluated 2 multivariate models and generated a nomogram to predict symptom severity during RT based on a patient-reported outcome (PRO) instrument, the MD Anderson Symptom Inventory-Head and Neck Module (MDASI-HN).
  
  
  METHODS
  This was a prospective, longitudinal, questionnaire-based study.
  
  
  METHODS
  Tertiary cancer care center.
  
  
  METHODS
  Subjects were 264 patients with HNC (mostly oropharyngeal) who had completed the MDASI-HN before and during therapy. Pretreatment variables were correlated with MDASI-HN symptom scores during therapy with multivariate modeling and then were correlated with the composite MDASI-HN score during week 5 of therapy.
  
  
  RESULTS
  A multivariate model incorporating pretreatment PROs better predicted MDASI-HN symptom scores during treatment than did a model based on clinical variables and physician-rated patient performance status alone (Akaike information criterion = 1442.5 vs 1459.9). In the most parsimonious model, pretreatment MDASI-HN symptom severity (P < .001), concurrent chemotherapy (P = .006), primary tumor site (P = .016), and receipt of definitive (rather than adjuvant) RT (P = .044) correlated with MDASI-HN symptom scores during week 5. That model was used to construct a nomogram.
  
  
  CONCLUSIONS
  Our model demonstrates the value of incorporating baseline PROs, in addition to disease and treatment characteristics, to predict patient symptom burden during therapy. Although additional investigation and validation are required, PRO-inclusive prediction tools can be useful for improving symptom interventions and expectations for patients being treated for HNC.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Tommy
authors.initials: T
authors.lastname: Sheu
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Clifton David
authors.initials: CD
authors.lastname: Fuller
authors.affiliation: Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Tito R
authors.initials: TR
authors.lastname: Mendoza
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Beth M
authors.initials: BM
authors.lastname: Beadle
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Phan
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Ehab Y
authors.initials: EY
authors.lastname: Hanna
authors.affiliation: Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Lu
authors.affiliation: Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cleeland
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA gbgunn@mdanderson.org.
authors.forename: G Brandon
authors.initials: GB
authors.lastname: Gunn
mesh_terms: D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000523:psychology / Q000532:radiotherapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D063868:Patient Outcome Assessment; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011832:Radiation Injuries / Q000150:complications*; D011878:Radiotherapy / Q000009:adverse effects; D018570:Risk Assessment; D057566:Self Report; D012720:Severity of Illness Index
keywords: MD Anderson Symptom Inventory–Head and Neck Module; nomogram; patient-reported outcome; prediction tool; symptom burden
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