Quality of Life after Treatment for Advanced Laryngeal Cancer

Abstract

The last two decades have seen increasing adoption of chemoradiation protocols for the treatment of laryngeal cancer, despite varying data about how effective these treatments are on critical outcomes such as swallowing. The relative rarity of these tumors prevents single institutions from assembling the number of patients needed to achieve meaningful insights, and therefore there is need for multi-institutional prospective data collection to understand the effects of treatment after advanced laryngeal cancer. Unfortunately, the challenges and high costs of multi-institutional data collection and data management have discouraged head and neck cancer clinicians from pursuing large, multi-institutional prospective studies to address these questions.

We are at a point where clinicians have strong opinions but little data, while we are recommending drastically different forms of treatment for our patients. This talk will focus on the state of evidence to date and our best understanding of quality of life after treatment for advanced laryngeal cancer. We will discuss the rationale for the Treatment for Advanced Laryngeal Cancer (TALC) cohort study. This non-randomized, multi-institutional cohort study is now reaching completion, and was started with the principle goal of identifying predictors of swallowing function after treatment.

We will the success of the TALC study in gathering data in multi-institutional fashion. The TALC study uses a novel approach to data collection, because although it involves multiple North American institutions, it has only one paid research coordinator. Data collection and management is handled at the central coordinating site with the help of a web-based data collection tool. This common, shared website (https://talc.ahc.umn.edu/) has capability for data entry, collection, and storage. It also houses study documents, including regulatory documents and paper back-up data collection forms.

The study has now completed enrollment and results of the trial are still being analyzed. We have enrolled 279 patients, well over the original target of 220 patients. Of 45 North American institutions who obtained IRB approval to participate, 39 institutions were able to contribute patients. We have complete data on 158 patients who have survived a full year, and have completed all forms and CT scans. We are still collecting final data on a number of other patients, and preliminary insights into swallowing function are intriguing. The findings will be presented at the 9th International Conference on Head & Neck Cancer in Seattle, Washington, USA in August of 2016.

The TALC study provides incremental improvement for not only understanding of outcomes after treatment for advanced laryngeal cancer, but also a basis for future efforts in multi-institutional prospective data collection with inexpensive infrastructure. We hope that this framework will encourage interested, collaborative head and neck surgeons around the world to pursue common data collection.