Proceedings of the 49th Annual ASTRO Meeting S581

Models of UQOL vs. Specific Urinary Complaints (p values shown)

Urinary Symptom Baseline Finish 6 Months 1 Year 2 Years

Incomplete Emptying

\0.001 — — 0.002 —

Frequency

— \0.001 — \0.001 \0.001

Intermittency

— — — — 0.004

Urgency

— \0.001 \0.001 \0.001 0.004

Weak Stream

\0.001 — \0.001 — 0.001

Straining

0.03 — — — —

Nocturia

\0.001 0.013 \0.001 0.015 —

Author Disclosure: M.M. Hardy, None; J.M. Robertson, None; M. Balasubramaniam, None.

2684 Assessment of Quality of Voice After Radiotherapy in Early Glottic Cancer

J. P. Agarwal, G. K. Bachher, C. M. Waghmare, P. Pai, S. Shrivastava, K. Dinshaw

Tata Memorial Centre, Mumbai, India

Purpose/Objective(s): Quality of voice after radiotherapy in early glottic cancer is ill-defined in the literature. The purpose of thisstudy was to assess voice quality in patient of early glottic cancer treated with radiotherapy.

Materials/Methods: 133 patients of early glottic cancer treated with radical radiotherapy (RT) in Tata Memorial Hospital fromJanuary 2001 to December 2006 were screened. Of whom 37 eligible patients with no past history of head neck RT or surgeryapart from excision biopsy or laser excision of vocal cord lesion were studied. Voice analysis was done pre-treatment and 3 monthlyafter RT. Recording of sustained vowel /e/ was analysed using Dr. Speech version 5 for selected acoustical parameters like max-imum intensity (MaxInt), minimum intensity (MinInt), average intensity (AvInt), maximum frequency (MaxFre), minimumfrequency (MinFre), average frequency (AvFre), habitual frequency (HabFre), harmonics to noise ratio (HNR), maximum phona-tion time (MPT), shimmer (S), jitter (J), hoarseness, harshness and breathiness. The statistical analysis was done using Student’st-test for normal distributions and Wilcoxon test, Mann-Whitney U test for non-normal distributions.

Results: Out of this 37 patients, 31 were male and 6 were female. The mean age at presentation was 56.65 year. 20 patients weresmoker, 16 were non-smoker and smoking habits of one patient was not known. 23 patients were staged as T1 and 14 as T2 disease.One patient had received concurrent chemo-radiotherapy. Four patients had undergone pretreatment excision biopsy or laser ex-cision of vocal cord lesion. Patients were treated either with Cobalt (15 patients) or 6 MV photon (22 patients) using small-field (#36 cm2 in 22 patients) or wide-field (.36 cm2 in 15 patients) RT to the dose of 5504 cGy in 16 fractions to 7000 cGy in 35 fractions.Only single patient had local recurrence and was salvaged.

It was observed that Int and MPT increases while Fre decreases significantly after RT when compared with pretreatment group(n = 37). The subgroup analysis showed, improvement was much better with T2 disease, Cobalt teletherapy, large field RT andwith the lesions involving anterior commisure.

31 male patients when studied showed similar results. In addition it showed, worse the pretreatment hoarseness, harshness andbreathiness, better it became after RT. When post-RT voice parameters were compared with gender matched historical controls,there was significant difference between MinInt, MinFre, S and J. MPT improves after radiotherapy, but does not comes to thenormal. Gender matched historical control voice parameters of females when compared with voice parameters of post-RT femalepatients, showed significant difference only in J.

Conclusions: Voice quality improves 3–9 months after radiotherapy. However, it does not come to normal. Post-RT voice qualityof females was better than males.

Author Disclosure: J.P. Agarwal, None; G.K. Bachher, None; C.M. Waghmare, None; P. Pai, None; S. Shrivastava, None;K. Dinshaw, None.

2685 A Randomized Prospective Trial of the Effect of Video Radiation Oncology Education on Patient Anxiety

C. A. Hahn1, R. Raynor1, L. Fish1, J. Day1, B. Brigidi1, D. Hollis1, E. C. Halperin2

1Duke University Medical Center, Durham, NC, 2University of Louisville School of Medicine, Louisville, KY

Purpose/Objective(s): The efficacy of a video education tool for anxiety reduction in adult Radiation Oncology patients wasassessed in a randomized prospective trial.

Materials/Methods: All new adult cancer patients seen at five Radiation Oncology Clinics operated by an academic departmentwere eligible. Subjects completed self-administered anxiety instruments at baseline and two weeks after initiation of treatment: theState-Trait Anxiety Inventory (STAI) and the Stress Management Scale of the National Comprehensive Cancer Network (NCCN).The STAI is a 15 minute standardized assessment of anxiety. The State subscale measures temporary anxiety while Trait measuresstable anxiety-proneness. The NCCN is a two-minute single item visual analog scale. Enrolled subjects were assigned by clusterrandomization. Control group received standard verbal and written educational materials. Experimental group was given a 20-min-ute health education video developed by the Duke Radiation Oncology Department. Analyses were performed to assess the impactof the video on subject anxiety levels, correlation between STAI and NCCN scores and variables correlating with anxiety levels.

Results: 389 subjects were enrolled, 325 completed valid follow-up data and were analyzed. 238 (73%) were female, 256 (79%)white and 61 (19%) African American. Mean age was 55.8 years, (s.d.13.5; range 18–88.) Cancer diagnosis was breast in155 (48%) of subjects. Site of enrollment was at tertiary care center in 122 (38%), community hospital in 154 (47%) and rural

S582 I. J. Radiation Oncology d Biology d Physics Volume 69, Number 3, Supplement, 2007

care setting in 49 (15%). Univariate analyses revealed no significant differences in STAI State subscale for video vs. control arm(control�0.31 vs. video�0.48, p = 0.15). Subjects with breast cancer exhibited larger decreases in anxiety than subjects with otherdiagnoses (�0.55 vs. �0.26, p = 0.01). For the Trait subscale, there was a trend towards a decrease in anxiety for the video arm(control 0.05 vs. video�0.13 p = 0.07). Within the Trait subscale, younger subjects,\58 years of age, exhibited greater decreasesin anxiety than older subjects (�0.13 vs. 0.07, p = 0.05). Multivariate analysis controlling for baseline Trait score and tertiary ver-sus community treatment site showed subjects on the video arm experienced significant decrease in STAI Trait scores when com-pared to subjects in the control arm (p\0.03). Controlling for baseline Trait, intervention and age, subjects at tertiary care centersexperienced a significantly greater decrease in Trait scores than subjects at community hospitals (p = 0.03). NCCN scores wereavailable on 292 subjects and demonstrated positive correlation with baseline STAI scores. Multivariate analyses found that sleep(p = 0.0017), worry (p = 0.0005) and sadness (p = 0.0026) all significantly contributed to higher NCCN scores.

Conclusions: Video education for adult radiation oncology patients can decrease anxiety levels in certain patients. The greatestimpact was seen for subjects with breast cancer, enrolled at tertiary care centers or of younger age. These factors should influenceclinicians in terms of counseling certain patient groups to consider educational aids such as videos to better meet patient needs.NCCN scores correlated well with the results of the STAI. Brief anxiety measures may be substituted for lengthier inquirieswith similar results, which supports use of these tools in clinical practice.

Author Disclosure: C.A. Hahn, None; R. Raynor, None; L. Fish, None; J. Day, None; B. Brigidi, None; D. Hollis, None;E.C. Halperin, None.

2686 Swallowing Quality of Life in Advanced Larynx and Hypopharynx Cancer Treated With Organ

Preservation vs Surgery

K. Chu1, N. Read1, E. Winquist1, I. Zhang2, V. Venkatesan1, J. Yoo2, J. Franklin2, A. Hammond1, K. Fung2

1London Regional Cancer Program, London, ON, Canada, 2Department of Otolaryngology, London, ON, Canada

Background: Advanced laryngeal cancer (CA) is managed with total laryngectomy (TL) and post-operative radiation (RT) or con-current chemoradiation (CRT). Both achieve similar survival rates, but organ preservation does not necessarily imply functionalpreservation. In particular, swallowing QOL is not well studied.

Purpose/Objective(s): To comprehensively evaluate swallowing in patients following treatment for advanced larynx and hypo-pharynx CA.

Materials/Methods: All consecutive patients with stage III/IV larynx or hypopharynx CA were identified from a single institutionbetween 1999–2005 who were .1 year post curative treatment with surgery ± adjuvant RT/CRT, RT, or CRT. Objective swallow-ing measures included tube feeding, tube feed duration, and esophageal strictures and dilatations. Subjective swallowing was eval-uated using 3 validated questionnaires assessing: dysphagia–MD Anderson Dysphagia Inventory (MDADI), general QOL–Headand Neck Quality of Life (HNQOL), and nutrition–Scored Patient Generated Subjective Global Assessment (PG-SGA). Outcomeswere compared between treatment groups.

Results: 120 patients were analyzed where 97 patients had laryngeal vs. 23 with hypopharyngeal CA. 58 patients were alive at timeof analysis. 65 patients were treated with surgery (19 had surgery alone), 32 with RT alone, and 22 with CRT. Tube feeding rateswere higher with CRT, 68.2%, compared to surgery and adjuvant treatment, 25.0% (p = 0.002), surgery alone, 23.5% (p = 0.010),and RT alone, 25.8% (p = 0.002). Compared to surgery alone (0%) and RT alone (0%), CRT was associated with higher incidenceof tube feed duration .5 months, 75% (p = 0.044 and p = 0.003 respectively). On multivariate analysis, use of chemotherapy (p\0.0001) and presence of local recurrence (p = 0.037) was related to tube feeding requirement. Surgery with adjuvant treatmenttrended to have more strictures, 31.8% than RT alone, 12.9%, (p = 0.098).

38 patients completed questionnaires. No differences were found between surgery with or without adjuvant treatment comparedto CRT. Surgical patients scored lower on the HNQOL emotional subscale, 69.9, compared to RT alone 90.0, (p = 0.044). Sub-group analyses showed that larynx CA patients scored higher on HNQOL eating, 80.2 vs. 58.9 (p = 0.027) and pain 78.0 vs. 52.7(p = 0.021) subscales than hypopharynx CA. PG-SGA nutritional scores were worse in hypopharynx 8.7, vs. larynx CA 5.2(p = 0.019) and Stage IV 7.8, vs. Stage III 4.2 (p = 0.039). MDADI did not show differences between treatment groups.

Conclusions: Organ preservation with CRT is associated with more frequent and prolonged use of nutritional support in the shortterm, but long term QOL appears to be similar to patients treated with radical surgery.

Author Disclosure: K. Chu, None; N. Read, None; E. Winquist, None; I. Zhang, None; V. Venkatesan, None; J. Yoo, None;J. Franklin, None; A. Hammond, None; K. Fung, None.

2687 A 3-Year Assessment of Bowel Function Quality of Life (QOL) in Prostate Cancer Patients Receiving

Monotherapy Radiation Therapy

A. J. Calcaterra1, G. Boyea2, K. Saputo2, M. Wallace2, M. Balasubramaniam2, G. Gustafson1, A. Martinez2

1William Beaumont Hospital–Troy, Troy, MI, 2William Beaumont Hospital–Royal Oak, Royal Oak, MI

Purpose/Objective(s): To assess and compare the QOL of prostate cancer patients receiving External Beam Radiation Therapy(EBRT), monotherapy via High Dose Rate (HDR) brachytherapy, or Palladium (Pd) implants. Results are based on patients’ self-report of bowel function.

Materials/Methods: 467 consecutive patients with prostate cancer treated with radiation therapy as primary treatment were en-rolled in our HIC approved QOL assessment study between November 2001 and March 2007. To date, 105 patients have reacheda 3-year follow-up time point and have completed the Rectal Function Study Questionnaire–Schiffler Oncology Center: 73 EBRT,21 HDR, and 11 Pd. Questionnaires were completed prior to radiation, at the end of treatment for EBRT or 2-weeks post-implantfor brachytherapy (fini), 6-months, 1-, 2-, and 3- years post-treatment. Patients answered questions regarding frequency, urgency,consistency of stools, abdominal and hemorrhoidal discomfort, rectal bleeding, stool continence, bedtime bowel movements, com-pleteness of evacuation, and overall QOL (10 variables). Responses were analyzed using the Generalized Estimating Equationapproach. Trends were analyzed for significance comparing treatment modalities, time, and use of hormones. p-values \0.05were significant.