Exploratory study of long-term health-related quality of life in patients with surgically treated primary parotid gland cancer

Quality of Life Outcomes for Parotid Malignancies

BACKGROUND

This study describes patient-reported outcome measures (PROMs) and associated factors in patients who underwent surgery for malignant parotid tumors (MPT).

METHODS

This is a retrospective study of all surgically treated MPT patients in a multidisciplinary head and neck cancer (HNC) survivorship clinic (2017-2023). PROMs included University of Washington Quality of Life Questionnaire (UW-QOL), Eating Assessment Tool (EAT-10), Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Neck Disability Index (NDI), and Insomnia Severity Index. Multivariable regression analysis was used to investigate clinical predictors associated with PROMs.

RESULTS

In 62 MPT patients, the prevalence of clinically relevant dysphagia symptoms (EAT-10), elevated symptoms of depression (PHQ-8), moderate/severe symptoms of anxiety (GAD-7), moderate/severe neck pain with activities of daily living (NDI), and moderate/severe symptoms of insomnia at last follow-up was 32.3%, 15.5%, 7.1%, 17.7%, and 7.2%, respectively. Nonparametric one-sided test revealed that patients treated with adjuvant CRT had significantly worse physical QOL, social-emotional QOL, and swallowing scores than patients treated with surgery alone (p = 0.01, p = 0.02, p = 0.03, respectively); that patients treated with surgery and adjuvant RT had significantly worse physical QOL and social-emotional QOL than patients treated with surgery alone (p < 0.01, p = 0.01, respectively) and that patients treated with surgery and adjuvant CRT had significantly worse swallowing and neck pain than patients treated with surgery and adjuvant RT (p = 0.03, p = 0.05, respectively).

CONCLUSIONS

In patients with surgically treated MPT, adjuvant CRT and RT were associated with worse PROMs.

LEVEL OF EVIDENCE

4 Laryngoscope, 2024.

An analysis of health-related quality of life in children and adolescents after parotidectomy based on patient-reported outcomes

PURPOSE

To assess health-related quality of life (HRQoL) and its influencing factors in these pediatric patients undergoing parotidectomy.

METHODS

This was a cross-sectional study that included 37 children and adolescents (≤ 19 years) with parotid gland tumors who were treated in Sichuan Cancer Hospital between January 2006 and November 2021. HRQoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). The Wilcoxon rank sum test was used to analyze the factors influencing patients' HRQoL.

RESULTS

37 children and adolescents were included in the study, including 22 cases of benign tumors and 15 cases of malignant tumors. All patients underwent surgery, and some patients with malignant tumors received radiotherapy or chemotherapy. Malignancy, permanent facial palsy, and Frey syndrome were associated with worse HRQoL in children and adolescents with parotid gland tumors. Radiotherapy and no cervical lymph node dissection were associated with worse HRQoL in pediatric patients with malignancy. The surgical approach of parotid is not a factor influencing HRQoL.

CONCLUSION

Factors associated with HRQoL in children and adolescents with parotid gland tumors include pathological types, permanent facial palsy, and Frey syndrome. In addition, factors affecting patients with malignancy include lateral lymph node dissection and radiotherapy.

Psychological Aspects of Facial Palsy

This article discusses the psychological effects of facial palsy (FP) in adults. FP is the abnormal functioning of facial muscles resulting from temporary or permanent damage of the facial nerves. Following facial paralysis, patients can develop motor and psychosocial functioning issues impacting quality of life. In addition, real or perceived judgment in social settings of those with FP increases the risk of low self-esteem, anxiety, and depression. Currently, most available research focuses on surgical patients and suggests a lack of psychological support throughout the affliction. A multidisciplinary approach when treating patients with FP can help improve the patient's quality of life.

[Posttherapeutic quality of life after treatment of salivary gland cancer]

BACKGROUND

In addition to overall survival and recurrence-free interval, posttherapeutic quality of life has been established as an independent criterion for treatment evaluation. Thereby, both the specific changes in the head and neck region and their objectification represent a particular challenge for the assessment of quality of life. There are different validated questionnaires available.

OBJECTIVE

Based on the literature, an overview of the relevant questionnaire instruments is given and the specific aspects in patients with salivary gland cancer are presented.

MATERIALS AND METHODS

A selective literature search was conducted to collect publications dealing with the assessment of health-related quality of life in head and neck tumor patients. The papers were critically appraised and summarized.

RESULTS

There are some validated questionnaires available to measure quality of life in patients with head and neck tumors as well as a few specific questionnaires for patients after parotidectomy.

CONCLUSION

By assessing quality of life using standardized questionnaire instruments, disease and treatment consequences can be objectified. Thus, the need for supportive measures, e.g., for rehabilitation in facial nerve palsy, can be identified more reliably.

Pre-treatment quality of life in patients with salivary gland cancer in comparison with those of head and neck cancer patients

INTRODUCTION

Salivary gland cancer (SGC) is a rare malignant tumor arising from the salivary glands, with a variety of clinical and biological behaviors different from head and neck cancer (HNC). Because of the rarity of SGC, there are limited data on pre-treatment quality of life (QoL). Therefore, we evaluated the pre-treatment QoL in SGC patients by stage and compared it with that of HNC patients.

METHODS

From a prospective registry of HNC patients (2016-2020), we selected 225 patients with SGC, and 912 patients with oral cavity (OC) and oropharyngeal cancer (OPC) who were diagnosed in the same period as the HNC control group. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and HNC-Specific Module (H&N35) were used to assess QoL.

RESULTS

SGC patients had a statistically better baseline QoL (69.8 vs. 64.0), emotional (82.1 vs. 78.8), cognitive (92.0 vs. 88.7), and social function (86.3 vs. 80.5), and fewer symptoms than HNC patients. The estimated average QoL differences between SGC patient diagnosed at stages I and IV was -12.9. Especially, advanced-stage of tumors was associated with much lower role functioning and emotional functioning scores in SGC patients, compared to those in HNC patients, among females and of younger age.

DISCUSSION

Although the overall QoL score was higher in SGC patients than in HNC patients, specific domains were significantly affected in SGC patients according to the tumor stage. Females and those of younger age were more affected by severity of disease in SGC.

STUDY REGISTRATION

ClinicalTrials.gov Identifier NCT02546895.

Risk factors associated with patient-reported fatigue among long-term oropharyngeal carcinoma survivors

BACKGROUND

The study objective is to identify risk factors associated with fatigue among long-term OPC survivors.

METHODS

This cross-sectional study included disease-free OPC survivors treated curatively between 2000 and 2013 who were surveyed from September 2015 to July 2016. The outcome variable was patient-reported fatigue. Multivariable logistic regression was used to identify factors associated with moderate to severe fatigue.

RESULTS

Among 863 OPC survivors, 17.4% reported moderate to severe fatigue. Self-reported thyroid problems (OR: 2.01; p = 0.003), current cigarette smoking at time of survey (OR: 3.85; p = 0.001), late lower cranial neuropathy (OR: 3.44; p = 0.002), and female sex (OR: 1.91; p = 0.010) were concurrent risk factors of reporting moderate to severe fatigue. Ipsilateral intensity-modulated radiotherapy (OR: 0.18; p = 0.014) was associated with lower risk of reporting moderate to severe fatigue.

CONCLUSIONS

Our study identified thyroid problems, smoking, and late lower cranial neuropathy as associated with moderate to severe fatigue. These findings should be further validated in prospective studies to address fatigue among OPC survivors.

Health-related quality of life in patients with major salivary gland carcinoma

PURPOSE

To evaluate the health-related quality of life (QOL) in patients with major salivary gland carcinoma (MSGC).

METHODS

45 patients with MSGC completed the University of Washington Quality of Life (UWQOL) questionnaire. Results and factors influencing quality of life were analyzed using Mann-Whitney U test.

RESULTS

24 patients were male, 21 patients were female, and median age was 57 years. 33 patients presented with early stage (UICC stage I or II) cancer. All patients had surgery as initial therapy. The UWQOL domains with the worst results were 'appearance', 'activity' and 'anxiety'. Factors influencing QOL were sex, tumor stage, comorbidities, follow-up time, tumor grade, postoperative radiation therapy and facial nerve dysfunction.

CONCLUSIONS

Diagnosis and treatment of MSGC has influence on overall QOL. Postoperative radiation has the greatest impact on QOL. This is one of the largest study evaluating QOL in patients with salivary gland carcinoma using the UWQOL.