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350

KUANetal.

TABLE XXXI.B.3 (Continued)

Clinical endpoints Change in

Study

Year LOE Study design Study groups

Conclusions

Sunet al. 2111

1. Improvement in postoperative SNOT-22 question scores for frustration/restlessness/ irritability, difficulty falling asleep, nasal obstruction, waking up tired, and waking up at night 2. SNOT-22 score for olfaction worsened after surgery 1. UPSIT scores (mean 37.3 months after treatment) ranged from 8 to 38 2. Six (43%) patients had residual

2021 4

Retrospective case series

26 patients who underwent

SNOT-22 score

endoscopic resection of Kadish stage C ONB and were evaluated a median of 42.3 months after surgery 14 patients with ONB who underwent endoscopic resection with preservation of

Tajudeen et al. 1361

2016 4

Retrospective case series

Posttreatment

UPSIT scores

one olfactory bulb and adjuvant RT

smell function, two (14%) of whom had normal or mildly reduced smell

Abbreviations: ASB-QOL, Anterior Skull Base QOL; bETC, bilateral endoscopic resection with transnasal craniectomy; EQ-5D VAS, validated global [(EuroQol 5D) Visual Analog Scale; FACT-NP, Functional Assessment Cancer Therapy—Nasopharynx; HADS, Hospital Anxiety Depression Scale; MDASI-22, MD Anderson Symptom Inventory-Head and Neck (MDASI-HN); ONB, olfactory neuroblastoma; QOL, quality of life; SNM, sinonasal malignancy; SNOT, Sino-Nasal Outcome Test; uERTC, Unilateral endoscopic resection with transnasal craniectomy; UW-QOL, University of Washington-Quality Life.

outcomes in trials. Here, we review the data on treatment morbidity and QOL outcomes in SNM.

QOL, as measured by the Anterior Skull Base Question naire (ASBQ) and the FACT-NP questionnaires, respec tively, at a median of 2 and 5 years after completion of therapy. 2103,2113 Furthermore, both studies found that diminished sinonasal-specific QOL was associated with worse general QOL and symptoms of anxiety and depres sion. Lee et al. examined a large national database and found that diagnoses of mental health disorders increased from 22% to 31% after SNM diagnosis. All treatment modal ities were associated with increased odds of development of mental health disorder, but receipt of RT was associ ated with the highest odds for development. 2119 Substantial rates of depression and anxiety are also noted in multiple other studies. 2088,2120,2121 Due to the proximity to critical brain structures, neu rocognitive effects frequently follow SNM treatment. Sharma et al. found that 63% of patients experienced neu rocognitive deficits in at least one domain after treatment for SNM, and patients self-reported impaired memory. 490 General QOL following multimodality treatment

A General QOL following multimodality treatment

As noted in a focus group study examining symptoms that persistently affect QOL after SNM treatment, multi modality SNM treatment impacts multiple aspects of QOL including visual changes, nasal crusting, memory changes, loss of work and hobby, and change in family relationships (Table XXXII.1). 2075 In a recent review by Noel et al., the authors found that physical QOL in survivors tended to be affected by physical symptoms such as headache and nasal congestion, while emotional QOL was affected by social isolation and cognitive changes. 2066 In most studies, QOL is worse in the first several months after treatment but improves in most domains over time. 2088,2114–2116 Simi larly, performance status has also been shown to improve with time after treatment. 2117 A recent study by Fisher et al. examined general health-related QOL (HRQOL) after SNM treatment via the SF-36 and found HRQOL equiva lent to controls without SNM at a median of 9 years after treatment. 2118 Despite improvements of many general QOL metrics over time, multiple studies have shown that symptoms related to the sinonasal region do not completely resolve in many patients. Recent studies by Tyler et al. and Phillips et al. found that patients had decreased sinonasal

Aggregate level of evidence

C (Level 1: one study; Level 3: six studies; Level 4: two studies) Treatment of SNM is critical to long-term survival and disease control.

Benefit

(Continued)