Evaluation of quality of life in patients definitively treated for squamous carcinoma of the head and neck

Laryngeal cancer treatment decision making: A conjoint analysis of general public attitudes and priorities

Objective

Patients with advanced laryngeal cancer are typically presented with divergent treatment options, namely chemoradiation versus total laryngectomy. This study aims to understand general perspectives of the factors involved in this decision-making process.

Methods

Surveys were constructed using specialized conjoint analysis software. Seven attributes integral to the decision-making process for advanced laryngeal cancer treatment were included.

Results

Three hundred one healthy adult volunteers completed the decision-making program. The relative impact of each treatment attribute on decision making across all participants was scored with an average importance score (standard deviation) as follows: Lifespan 22.2% (±8.5), Voicing 21.4% (±5.9), Swallowing 19.1% (±7.3), Cancer Cure 14.9% (±6.2), Mode of Breathing 11.0% (±3.7), Self-Image 6.7% (±2.9), and Treatment Type 4.8% (±3.0).

Conclusions

General public opinion ranked lifespan, voicing, and swallowing aspects as similarly important, and all were ranked more important than probability of cure. These data demonstrate a variety of priorities among participants and the need for tailored discussions when determining treatment choice for advanced laryngeal cancer.

Level of Evidence

Level 4.

Development and Evaluation of the Psychometric Properties of the Tamil Version of Eating Assessment Tool - 10 (EAT-10): Preliminary Findings from Persons with Head and Neck Cancer

Aims: This study aimed to develop and evaluate the psychometric properties of the Tamil version of the Eating Assessment Tool (EAT-10). Setting & Study Design: Prospective cross-sectional study on persons with Head and Neck Cancer (HNC) during their follow-up for oncological and swallowing consultation at a tertiary care hospital and healthy individuals recruited from the community. Methods: The study was conducted in two phases: (1) translation and development of the Tamil version of EAT-10 and (2) administration of Tamil EAT-10 to assess internal consistency reliability, test-retest reliability and known-group validity. 92 participants with HNC in the clinical group and 149 healthy adults in the control group completed the Tamil EAT-10. In addition, a subgroup of 20 participants with HNC repeated the questionnaire within a week to assess test-retest reliability. Results: The Cronbach alpha for the 10 items was 0.96 indicating high internal consistency reliability. The test-retest reliability of the individual items and the total scores (r = 0.98) of the Tamil version of EAT-10 were high. The total EAT-10 scores for the HNC group (14.4 ± 11.5) were significantly higher (p < 0.001) than the scores for healthy adults (0.72 ± 2.0). Conclusion: The Tamil version of the EAT-10 developed in this study is a reliable and valid self-administered tool for identifying concerns related to swallowing among persons treated for HNC and healthy adults. This tool can be implemented for clinical practice and research in dysphagia among a Tamil-speaking population.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03376-8.

The impact of induction chemotherapy on long-term quality of life in patients with locoregionally advanced nasopharyngeal carcinoma: Outcomes from a randomised phase 3 trial

BACKGROUND

Our previous trial confirmed that induction chemotherapy (IC) improved long-term survival outcomes in patients with locoregionally advanced nasopharyngeal carcinoma (NPC). In this study, we investigated the impact of IC on long-term quality of life (QoL) in this cohort.

METHODS

Our trial was a randomised, open-label phase 3 trial comparing IC followed by concurrent chemoradiotherapy (CCRT) versus CCRT alone in patients with stage III-IVB (except T3N0-1) NPC. All participants completed two self-administered questionnaires, the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30) and the EORTC QLQ Head and Neck Cancer-Specific Module (H&N35). As per protocol, the questionnaires had to be completed before knowledge of treatment allocation by the patient (baseline). Patients were then approached to enroll at the time of the present study period.

RESULTS

Ultimately, QoL data from 228 patients were included in the analysis. Most scales were both statistically and clinically decreased in both groups between baseline and the latest follow-up. The IC followed by CCRT group had significantly better outcome in role functioning, cognitive functioning, social functioning, fatigue, pain, and constipation in QLQ-C30 scales at the last follow-up. Similarly, in H&N35 scales, a significantly better result was observed in pain, sexuality, sticky saliva, pain killers use, nutritional supplements, and weight loss, but a poorer result in senses problems, for those treated by IC followed by CCRT.

CONCLUSION

IC followed by CCRT seemed to have better long-term QoL outcomes compared with CCRT alone in patients with locoregionally advanced NPC.

The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020

Cancers that arise in the head and neck region are comprised of a heterogeneous group of malignancies that include carcinogen- and human papillomavirus (HPV)-driven mucosal squamous cell carcinoma as well as skin cancers such as cutaneous squamous cell carcinoma, basal cell carcinoma, melanoma, and Merkel cell carcinoma. These malignancies develop in critical areas for eating, talking, and breathing and are associated with substantial morbidity and mortality despite advances in treatment. Understanding of advances in the management of these various cancers is important for all multidisciplinary providers who care for patients across the cancer care continuum. Additionally, the recent Coronavirus Disease 2019 (COVID-19) pandemic has necessitated adaptations to head and neck cancer care to accommodate the mitigation of COVID-19 risk and ensure timely treatment. This review explores advances in diagnostic criteria, prognostic factors, and management for subsites including head and neck squamous cell carcinoma and the various forms of skin cancer (basal cell carcinoma, cutaneous squamous cell carcinoma, Merkel cell carcinoma, and melanoma). Then, this review summarizes emerging developments in immunotherapy, radiation therapy, cancer survivorship, and the delivery of care during the COVID-19 era.

Nasopharyngeal Cancer: Prevalence, Outcome, and Impact on Health-Related Quality of Life at Princess Norah Oncology Center, Jeddah, Saudi Arabia

Introduction

Head and neck malignancies are considered among the most common cancers that arise from different anatomical sites in the region. The number of new cases diagnosed worldwide each year is estimated to be more than 550,000 resulting in about 380,000 deaths. One of these head and neck cancers that may affect patient quality of life is the nasopharyngeal carcinoma (NPC). The purpose of our study is to assess the outcome, and the quality of life of these patients. Our study reviews NPC patients treated at Princess Norah Oncology Center, Jeddah, retrospectively over the past 15 years to provide additional information on this disease in Saudi Arabia.

Methods

We included all histologically confirmed cases of NPC seen at National Guard Hospital in Jeddah between 2002 and 2017. The data was collected retrospectively from the BestCare system, hospital information system, and the medical records. The created table included demographics, comorbidities, and first symptoms. The research table also contained stage at presentation and treatment modalities. Moreover, 25 patients were asked to complete the Arabic versions of European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC HN-35) module questionnaire to assess the quality of life. All results were computed using IBM SPSS version 23 (IBM Corp., Armonk, NY), which was provided by College of Medicine at KSAU.

Results

A total of 107 patients with adequate documentation were identified. There were 72.9% males and 27.1% females; 81.3% of patients were alive and in remission and 18.7% were dead. Neck mass was the most common clinical manifestation present in 84.1% of patients. Radiotherapy and chemotherapy were the most used modality by 96.3%. The five-year survival rate year was 81.3%. Moreover, the H&N-35 questionnaire showed that the NPC survivors suffered mostly poor social contact.

Conclusion

A large proportion of the identified patients were in remission. Quality of life assessment shows that the main impact of the disease and treatment was on social contact.

Palliative chemotherapy in head and neck cancer: balancing between beneficial and adverse effects

Introduction: Head and neck squamous cell cancer (HNSCC) is the sixth most common cancer in the world. Almost 2/3rds of patients have recurrent or metastatic (R/M) HNSCC. Treatment options for R/M HNSCC have evolved, with relatively little change in survival. Thus, it is imperative that management decisions must balance efficacy with toxicity and emphasize the importance of maintaining the patient's quality of life (QOL).Areas covered: We cover the various chemotherapeutic options available for R/M HNSCC including single agent chemotherapy, platinum-based doublets and triplet options. The role of cetuximab, immunotherapy and oral metronomic chemotherapy (OMCT) is also reviewed. We discuss the management of patients with platinum-refractory disease.Expert opinion: In all patients with R/M HNSCC, we recommend assessment of extent of disease, patient symptomatology, performance status, affordability and availability of logistic and social support. In patients with PD-L1 CPS =/> 20, pembrolizumab is an option. In patients with PD-L1 CPS < 20, pembrolizumab/cisplatin/5FU or cisplatin/5FU/cetuximab (EXTREME) may be considered based on affordability and availability. Options available that have a lower toxicity and can help to maintain the patient's QOL include; single agent chemotherapy, carboplatin/paclitaxel combination chemotherapy, sequential combination chemotherapy followed by cetuximab, replacing 5FU with docetaxel (TPEx regime) and OMCT.

Patients' experience of recurrent/metastatic head and neck squamous cell carcinoma and their perspective on the EORTC QLQ-C30 and QLQ-H&N35 questionnaires: a qualitative study

Background

Head and neck squamous cell carcinoma (HNSCC) and its associated treatments may affect all aspects of patients’ health-related quality of life (HRQoL). Although the EORTC QLQ-H&N35 is regularly administered to patients with HNSCC, there is a paucity of studies re-assessing the conceptual relevance of this patient-reported outcome (PRO) measure from a patient perspective. Furthermore, the content validity of the EORTC QLQ-C30 has not been widely documented in patients with recurrent and/or metastatic HNSCC. The objectives of this study were to understand patients’ experiences of recurrent/metastatic HNSCC and its treatments, and to evaluate the conceptual relevance and acceptability of the EORTC QLQ-C30 and QLQ-H&N35 from a patient perspective for use in clinical trials.

Methods

A literature review and clinician interviews were conducted to inform in-depth semi-structured telephone interviews with US patients who had received treatment for recurrent and/or metastatic HNSCC in the preceding 12 months. Interview transcripts were analysed thematically using ATLAS.ti v7; patient quotes were coded to identify concepts and themes to develop a conceptual model of HNSCC experience.

Results

Fourteen patients were interviewed (71% male, aged 35–84 years). Patients reported few symptoms pre-diagnosis including neck lump/swelling (n = 7/14, 50%) and/or difficulty swallowing (n = 3/14, 21%). Treatments generally comprised surgery and chemotherapy and/or radiotherapy. A number of side effects from all treatments were reported. Numbness, difficulty speaking and pain were the most reported side effects of surgery (n = 4/8, 50%); weight loss and fatigue were the most reported side effects of chemotherapy and/or radiotherapy (n = 8/13, 61%). All side effects negatively impacted patients’ HRQoL. Patients generally found the QLQ-C30 and QLQ H&N35 content to be understandable and conceptually relevant; excessive mucous production and neuropathic symptoms were among the suggested additions.

Conclusions

HNSCC and its diverse symptoms and treatments have a negative impact on many aspects of patients’ lives. A number of reported symptoms including difficulty speaking and swallowing, localised pain and fatigue may be important for treatment benefit evaluation in clinical trials from a patient perspective. The QLQ-C30 and QLQ-H&N35 are generally relevant and suitable for use in clinical trials. However, some items could be amended/added to ensure conceptual comprehensiveness of these measures.

Electronic supplementary material

The online version of this article (10.1186/s41687-018-0060-7) contains supplementary material, which is available to authorized users.

Effects of Minimally Invasive Surgery for Patients With OSA on Quality of Life

OBJECTIVE

To retrospectively study the effects of minimally invasive single-stage multilevel surgery (MISS MLS) for treating patients with obstructive sleep apnea/hypopnea syndrome (OSA) on quality of life (QOL).

METHODS

All OSA patients with multilevel obstruction who failed or refused continuous positive airway pressure (CPAP) treatment and then underwent Pillar implants and temperature-controlled radiofrequency of the base of tongue (RFBOT) were enrolled. The subjective symptoms and QOL (SF-36 Taiwan Standard Version 1.0) parameters were collected preoperatively and a minimum of 3 months postoperatively. Postoperative morbidity and complications were also recorded.

RESULTS

Thirty-seven patients (30 men, 7 women; mean age = 46.8 years; mean BMI = 23.9 kg/m²) were enrolled. The mean Epworth Sleepiness Scale changed from 12 ± 4.3 to 10.6 ± 4.3 ( P = .004, Wilcoxon signed-rank test). The mean snoring visual analog scale reduced from 9.5 ± 1.3 to 4.0 ± 2.0 ( P < .0001). The mean score of SF-36 increased from 65.5 ± 19.6 to 75.2 ± 16.7 ( P = .001). The SF-36 subscales showed statistically significant changes, especially in bodily pain, role-emotional, and general health.

CONCLUSION

The study demonstrated that MISS MLS was effective on QOL in selected patients for treating OSA patients who are unresponsive to conservative OSA therapy.

Exploratory Factor Analysis of NRG Oncology's University of Washington Quality of Life Questionnaire-RTOG Modification

CONTEXT

The 15-item University of Washington Quality of Life questionnaire-Radiation Therapy Oncology Group (RTOG) modification (UW-QOL-RTOG modification) has been used in several trials of head and neck cancer conducted by NRG Oncology such as RTOG 9709, RTOG 9901, RTOG 0244, and RTOG 0537.

OBJECTIVES

This study is an exploratory factor analysis (EFA) to establish validity and reliability of the instrument subscales.

METHODS

EFA on the UW-QOL-RTOG modification was conducted using baseline data from NRG Oncology's RTOG 0537, a trial of acupuncture-like transcutaneous electrical nerve stimulation in treating radiation-induced xerostomia. Cronbach α coefficient was calculated to measure reliability; correlation with the University of Michigan Xerostomia Related Quality of Life Scale was used to evaluate concurrent validity; and correlations between consecutive time points were used to assess test-retest reliability.

RESULTS

The 15-item EFA of the modified tool resulted in 11 items split into four factors: mucus, eating, pain, and activities. Cronbach α ranged from 0.71 to 0.93 for the factors and total score, consisting of all 11 items. There were strong correlations (ρ ≥ 0.60) between consecutive time points and between total score and the Xerostomia Related Quality of Life Scale total score (ρ > 0.65).

CONCLUSION

The UW-QOL-RTOG modification is a valid tool that can be used to assess symptom burden of head and neck cancer patients receiving radiation therapy or those who have recently completed radiation. The modified tool has acceptable reliability, concurrent validity, and test-retest reliability in this patient population, as well as the advantage of having being shortened from 15 to 11 items.

Comparison of quality of life outcomes in laryngeal cancer patients following chemoradiation vs. total laryngectomy

OBJECTIVE: To evaluate quality of life issues in patients with laryngeal cancer after treatment with either chemoradiation or total laryngectomy and radiation therapy.

METHODS: Forty-nine patients with a history of stage II-IV laryngeal squamous cell carcinoma treated primarily with either chemoradiation or by total laryngectomy with postoperative radiation completed the University of Washington Quality of Life instrument, version 4. Patients were identified on a volunteer basis in an academic university head and neck clinic setting. Each patient completed the above instrument, and statistical analysis was performed by Wilcoxon and X 2 , tests.

RESULTS: Instruments were completed by all 49 patients: 15 patients who underwent primary chemoradiation and 34 patients who underwent a total laryngectomy followed by radiation. Domains reported in both treatment groups without significant differences were appearance, activity, recreation, moods, taste, saliva, anxiety, and general questions. However, there were significant differences between the 2 groups in the domains of pain, swallowing, chewing, speech, and shoulder function. The laryngectomy patients reported greater impairment of speech ( P = 0.001), and shoulder function ( P = 0.018), whereas the chemoradiation patients suffered from greater pain, difficulty swallowing ( P = 0.061), and problems chewing ( P = 0.027).

CONCLUSIONS: Most patients with laryngeal cancer, whether treated primarily with chemoradiation or total laryngectomy, reported excellent functional outcomes and health-related quality of life. Pain, swallowing, chewing, saliva, and shoulder function were recorded as significant factors affecting their daily quality of life.

Quality of life associated factors in head and neck cancer patients in a developing country using the FACT-H&N

Health-related quality of life (HRQoL) associated factors are vital considerations prior to treatment decision-making for head and neck cancer patients. The study aimed to identify potential socio-demographic and clinical prognostic value of HRQoL in head and neck cancer patients in a developing country. The Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N)-V4 in Urdu language was administered among 361 head and neck cancer patients. Data were statistically tested through multivariate analysis of variance (MANOVA) and regression modeling to identify the potentially associated factors. Treatment status, tumor stage and tumor site had the strongest negative impact on patients HRQoL, with a statistically significant decrement in FACT summary scales (effect size >0.15). Moderate associated factors of HRQoL included treatment type, marital status, employment status and age (effect size range 0.06-0.15). Weak associated factors of HRQoL with a small effect size (>0.01-0.06) included tumor size and type, gender, education level and ethnicity. This study reports 12 socio-demographic and clinical variables that have a significant impact on HRQoL of head, and neck cancer patients, and that should be considered during treatment decision-making by multidisciplinary teams and also in future HRQoL studies conducted in other developing countries.

Impact of late toxicities on quality of life for survivors of nasopharyngeal carcinoma

BACKGROUND

To investigate the impact of physician-assessed late toxicities on patient-reported quality of life (QoL) for nasopharyngeal carcinoma (NPC) patients with long-term survival.

METHODS

A cross-sectional survey of QoL and late toxicities was conducted in 242 NPC patients with disease-free survival of more than 5 years after treatment. The QoL was assessed by the European Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Late toxicities including neuropathy, hearing loss, dysphagia, xerostomia, and neck fibrosis were recorded based on the criteria of Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v.4.0). The general linear model multiple analysis of variance (GLM-MANOVA) was performed to predict factors associated with the QoL.

RESULTS

In the multifactor model of GLM-MANOVA, of the five late toxicities of CTCAE scales, neuropathy, hearing loss, and xerostomia were observed to be significantly associated with the overall outcome of the fifteen QLQ-C30 scales. A statistically significant trend (p <0.05) was observed, indicating that NPC survivors with more severe neuropathy, hearing loss or xerostomia had a worse outcome on global QoL, all five functional scales, and a variety of symptomatic scales.

CONCLUSIONS

To improve QoL outcome for NPC survivors, the development of a modern radiotherapeutic technique should not only focus on reduction of the dose to the salivary glands, but also on anatomical structures that are involved in neuropathy and hearing loss.

Outcomes of xerostomia-related quality of life for nasopharyngeal carcinoma treated by IMRT: based on the EORTC QLQ-C30 and H&N35 questionnaires

The aim of this study was to review the published literature addressing the question of whether intensity-modulated radiotherapy (IMRT) resulted in an improvement of quality of life (QoL), especially xerostomia-related QoL of all nasopharyngeal carcinoma patients as time progressed. A literature search of PubMed, Embase and Google Scholar was performed, only reports containing original data of the QoL scores after treated by IMRT were included. Two independent reviewers extracted information of study design, study population, interventions, outcome measures and conclusions for each article. The inclusion criteria were met by 14 articles covering outcomes based on the questionnaires treated by IMRT. Data from same questionnaires (European Organization of Research and Treatment of Cancer QLQ-C30 and H&N35 questionnaires) were exacted and we analyzed four items (global health status, dry mouth and sticky saliva, swallowing, social eating and social contact), which have a close relationship with xerostomia-related QoL. Results indicated that a maximal deterioration of most QoL scales including global health status developed during treatment or at the end of the treatment course and then followed by a gradual recovery to 1 year, 1-2 years after IMRT, compared with their baseline level, some specific head and neck items, most in the EORTC QLQ H&N35, remained worse for the surviving patients. In conclusion, the published data reasonably support the benefits of IMRT in improving QoL, but xerostomia-related items still had a significantly negative effect in 2 years to impact a survivor's QoL.

Psychological distress in patients and caregivers over the course of radiotherapy for head and neck cancer

OBJECTIVES

Head and neck cancer patients and their caregivers report high rates of psychological distress. High rates of physical symptom burden and the increased need for family members to provide caregiving during treatment may contribute to this distress.

METHODS

This study examined trajectories of patient and caregiver distress over the course of radiotherapy for head and neck cancer as well as how patients and caregivers influence each other's distress. Forty-nine head and neck cancer patient-caregiver dyads completed 6 weekly assessments of physical symptoms (MDASI-HN) and distress (e.g., NCCN distress thermometer) over the course of radiotherapy.

RESULTS

Patient and caregiver distress increased steadily over the course of treatment, peaking at week 5; patients (82% male; 69% Stage 4) and caregivers (90% female) reported significant distress in 77% of cases. Linear mixed models with the patient-caregiver dyad as the unit of analysis showed that increases in patient-rated head and neck specific physical symptoms had a significant (p<.05) time-varying effect on both patient and caregiver distress. Increases in one dyad member's distress levels were also significantly associated with decreases in the other's distress levels over time.

CONCLUSION

Findings highlight the adverse impact of patient physical symptoms during radiotherapy on both patient and caregiver distress. They also support a dyadic coping model whereby patients and caregivers manage their distress together as a unit. Overall, dyadic supportive care interventions that focus on controlling patient physical symptoms and that address both patient and caregiver distress are sorely needed in head and neck cancer.

Quality of life in patients with chordomas/chondrosarcomas during treatment with proton beam therapy

INTRODUCTION

Health-related quality of life (HQL) parameters have never been tested in patients having chondromas/chondrosarcomas who are being treated with protons. The aim of this study was to document changes in HQL of chordoma/chondrosarcoma patients treated with proton beam radiotherapy. Treatments commenced in September 2011 at CNAO, and HQL studies were initiated in January 2012 for all patients undergoing treatment.

METHODS

The validated Italian translation of the EORTC QLQ-C30 version 3.0 was used for HQL evaluation. The HQL assessments were made prior to starting radiation and at completion of treatment. Scoring was as per the EORTC manual. As per standard norms, a difference of >10 points in the mean scores was taken to be clinically meaningful.

RESULTS

Between January and September 2012, 17 patients diagnosed with chordoma or chondrosarcoma, with a mean ± SD age of 49.5 ± 16.4 years, had completed treatment. The involved sites were skull base (n = 12) and sacral/paraspinal (n = 5). The prescribed dose was 70-74 GyE at 2 GyE per fraction, 5 days/week. When comparing pre- and post-treatment scores, neither a clinically meaningful nor a statistically significant change was documented.

CONCLUSIONS

During treatment, HQL is not adversely affected by protons, allowing normal life despite the long course of treatment. This is an ongoing study and more long-term assessment will help evaluate the actual impact of proton therapy on HQL for these slow-responding tumours.

The validity and reliability of the Turkish version of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer

PURPOSE

The University of Washington Quality of Life Questionnaire (UW-QOL) is an English-language survey used to assess the quality of life of patients with head and neck cancer. The present study aimed to translate this widely used questionnaire into Turkish according to international guidelines and to statistically determine its validity and reliability by administering it to native Turkish-speaking patients.

MATERIALS AND METHODS

This prospective study was performed at Hacettepe University, Faculty of Medicine, Turkey. The study included patients newly diagnosed as having head and neck cancer. Translation and cultural adaptation of the questionnaire were performed first. Then, the translated version was tested on a consecutive series of patients seen in the department of otorhinolaryngology head and neck surgery and the department of radiation oncology between September 2006 and February 2008. The patients were asked to complete 3 sets of questionnaires. The first set was completed 1 day before the beginning of treatment, the second 3 months after the completion of treatment, and the third 10 days after the second questionnaire was completed. The first and second sets included the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire-Turkish version and UW-QOL-Turkish version. The third set included the Turkish UW-QOL only. Performance status was assessed and rated by a physician using the Karnofsky and ZEW (Zubrod/The Eastern Cooperative Oncology Group (ECOG)/World Health Organization) performance scales, synchronous with the first and second sets of questionnaires.

RESULTS

The original English version of UW-QOL was carefully translated into Turkish, and a final Turkish version of UW-QOL was developed in an iterative fashion. To determine its validity and reliability, 67 patients were included in the study. Internal consistency (Cronbach α = .757) was adequate, and test-retest reliability (interclass correlation coefficient, 0.941) was excellent. The composite scores of the translated UW-QOL were compared statistically with the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire scores, Karnofsky and ZEW performance scales, T stage of the disease, and UW-QOL global questions scores to support the scale's construct validity, and statistically significant associations were observed.

CONCLUSIONS

The Turkish UW-QOL appears to be a valid and reliable tool for use with Turkish patients with head and neck cancer; it can also be used in clinical investigations and routine clinical practice in Turkey.

A systematic review of head and neck cancer quality of life assessment instruments

Although quality of life (QOL) is an important treatment outcome in head and neck cancer (HNC), cross-study comparisons have been hampered by the heterogeneity of measures used and the fact that reviews of HNC QOL instruments have not been comprehensive to date. We performed a systematic review of the published literature on HNC QOL instruments from 1990 to 2010, categorized, and reviewed the properties of the instruments using international guidelines as reference. Of the 2766 articles retrieved, 710 met the inclusion criteria and used 57 different head and neck-specific instruments to assess QOL. A review of the properties of these utilized measures and identification of areas in need of further research is presented. Given the volume and heterogeneity of QOL measures, there is no gold standard questionnaire. Therefore, when selecting instruments, researchers should consider not only psychometric properties but also research objectives, study design, and the pitfalls and benefits of combining different measures. Although great strides have been made in the assessment of QOL in HNC and researchers now have a plethora of quality instruments to choose from, more work is needed to improve the clinical utility of these measures in order to link QOL research to clinical practice. This review provides a platform for head and neck-specific instrument comparisons, with suggestions of important factors to consider in the systematic selection of QOL instruments, and is a first step towards translation of QOL assessment into the clinical scene.

Current strategies in reconstruction of maxillectomy defects

OBJECTIVE

To outline a contemporary review of defect classification and reconstructive options.

DESIGN

Review article.

SETTING

Tertiary care referral centers.

RESULTS

Although prosthetic rehabilitation remains the standard of care in many institutions, the discomfort of wearing, removing, and cleaning a prosthesis; the inability to retain a prosthesis in large defects; and the frequent need for readjustments often limit the value of this cost-effective and successful method of restoring speech and mastication. However, flap reconstruction offers an option for many, although there is no agreement as to which techniques should be used for optimal reconstruction. Flap reconstruction also involves a longer recovery time with increased risk of surgical complications, has higher costs associated with the procedure, and requires access to a highly experienced surgeon.

CONCLUSION

The surgeon and reconstructive team must make individualized decisions based on the extent of the maxillectomy defect (eg, the resection of the infraorbital rim, the extent of palate excision, skin compromise) and the need for radiation therapy.

Early self-care rehabilitation of head and neck cancer patients

Conclusions: No positive effects of early preventive rehabilitation could be identified. The results do not contradict the proposition that rehabilitation based on self-care can be effective but it is important to establish evidence-based training programs and identify proper instruments for selection of patients and evaluation of intervention. Objectives: Patients with head and neck cancer suffer from functional impairments due to intense treatment. In this study, we investigated the effectiveness of an experimental early preventive rehabilitation using hard, objective end points in a nonselective, longitudinal, prospective cohort study. Methods: In all, 190 patients were included in the program and received instructions for training before the start of treatment with the aim of reducing swallowing problems and reducing mouth opening and stiffness in the neck. A control group of 184 patients was recruited. Results: There was no difference in weight loss and 2-year survival between the two groups. No positive effects concerning functional impairments were found in patient-reported outcome measures.

Health-related quality of life in 640 head and neck cancer survivors after radiotherapy using EORTC QLQ-C30 and QLQ-H&N35 questionnaires

Background

With the advances in modern radiotherapy (RT), many patients with head and neck cancer (HNC) can be effectively cured, and their health-related quality of life (HR-QoL) has become an important issue. In this study, we evaluated the prognosticators of HR-QoL in a large cohort of HNC patients, with a focus on the result from technological advances in RT.

Methods

A cross-sectional investigation was conducted to assess the HR-QoL of 640 HNC patients with cancer-free survival of more than 2 years. Among them, 371 patients were treated by two-dimensional RT (2DRT), 127 by three-dimensional conformal RT (3DCRT), and 142 by intensity-modulated RT (IMRT). The EORTC QLQ-C30 questionnaire and QLQ-H&N35 module were used. A general linear model multivariate analysis of variance was used to analyze the prognosticators of HR-QoL.

Results

By multivariate analysis, the variables of gender, annual family income, tumor site, AJCC stage, treatment methods, and RT technique were prognosticators for QLQ-C30 results, so were tumor site and RT technique for H&N35. Significant difference (p < 0.05) of HR-QoL outcome by different RT techniques was observed at 2 of the 15 scales in QLQ-C30 and 10 of the 13 scales in H&N35. Compared with 2DRT, IMRT had significant better outcome in the scales of global QoL, physical functioning, swallowing, senses (taste/smell), speech, social eating, social contact, teeth, opening mouth, dry mouth, sticky saliva, and feeling ill.

Conclusions

The technological advance of RT substantially improves the head-and-neck related symptoms and broad aspects of HR-QoL for HNC survivors.

Functional outcomes related to the prevention of radiation-induced xerostomia: oral pilocarpine versus submandibular salivary gland transfer

BACKGROUND

Xerostomia has a devastating impact on oral function and quality of life in patients who receive radiation treatment for head and neck cancer. The purpose of this study was to examine functional outcomes related to 2 saliva-sparing treatments: (1) oral pilocarpine during radiotherapy; or (2) the submandibular salivary gland transfer (SGT) before radiotherapy.

METHODS

Sixty-nine patients were recruited (SGT = 36; pilocarpine = 33). Speech intelligibility, swallowing outcomes, and quality of life were assessed at 4 points in time (pretreatment, and 1 month, 6 months, and 12 months after the pretreatment assessment).

RESULTS

There were no differences between groups in speech outcomes; however, significant between-group differences existed in swallowing and quality of life outcomes. In all cases, patients who received the SGT procedure had better swallowing outcomes and quality of life scores than the patients who received oral pilocarpine.

CONCLUSION

The SGT should be the treatment of choice between the 2 treatments offered to prevent xerostomia in the present study.

Quality of life after different treatment modalities for carcinoma of the oropharynx

OBJECTIVES

To assess the long-term posttreatment quality of life of patients with carcinoma of the oropharynx treated with different treatment modalities.

STUDY DESIGN

Retrospective chart review and patient response to EORTC quality of life core questionnaire QLQ-C30 and EORTC quality of life core head and neck cancer module QLQ-H&N35 questionnaires.

METHODS

Two hundred and seventeen patients with carcinoma of the oropharynx were treated with curative intent between 1990 and 1998. In January 2001, a total of 111 disease-free survivors were identified and included in this study. The questionnaires were completed by 99 patients (89% completion rate).

RESULTS

Of 99 patients, 31 patients were treated with surgery alone, 19 with radiation therapy alone and 49 with surgery followed by postoperative irradiation. Median follow-up for the entire study group was 71 months. Physical, role, emotional, cognitive and social functioning reflected in the functional scale scores of the global EORTC QLQ-C30 were generally good and showed no significant differences for the different treatment modalities. Comparison of the head and neck specific EORTC QLQ-H&N35 scores revealed significantly less troubles with swallowing (P = 0.006), social eating (P = 0.007) and social contact (P = 0.008), dry mouth (P < 0.0001), sticky saliva (P = 0.0001) and mouth opening (P = 0.001) in non-irradiated patients versus those treated with any either primary or postoperative radiation therapy. Patients undergoing surgery (with and without postoperative irradiation) had less pain (P = 0.04), less problems with social eating (P = 0.009) and less restricted mouth opening (P = 0.03) than the nonsurgically treated patients.

CONCLUSIONS

Quality of life after curative treatment of oropharyngeal carcinoma is generally good. Differences regarding quality of life between the different treatment modalities manifest themselves in the head and neck specific EORTC QLQ-H&N35 module, not in the global core questionnaire EORTC QLQ-C30.

Psychometric properties of the EORTC head and neck-specific quality of life questionnaire in disease-free Greek patients with cancer of pharynx and larynx

PURPOSE

The purpose of our study was to formally translate to and determine the psychometric properties of QLQ-H&N35 in a group of Greek patients who had been successfully treated for laryngeal or pharyngeal cancer.

METHOD

The Greek translation of the questionnaire was performed according to the instructions of EORTC Quality of Life group as described in the translation manual. The procedure included forward and backward translations followed by a pilot study and was reported and accepted by the EORTC Quality of Life group. In a cross-sectional study, the translated EORTC QLQ-H&N35 in conjunction with the core EORTC QLQC30 questionnaire was given to 116 patients who had been successfully treated for cancer of larynx or pharynx.

RESULTS

The compliance was high, and the QLQ-H&H35 demonstrated acceptable reliability (internal consistency) and construct validity. The questionnaire had the ability to distinguish between patients with different performance status, site, treatment modality, and disease stage.

CONCLUSION

The Greek version of EORTC H&N35 in conjunction with the EORTC C30 is a valid and informative tool in assessing quality of life in Greek patients with cancer of larynx and pharynx.

Changes in quality of life of head-and-neck cancer patients following postoperative radiotherapy

The purpose of this study was to investigate the longitudinal changes in quality of life (QoL) for 77 head-and-neck squamous cell cancer (HNSCC) patients receiving postoperative radiotherapy (RT). The data pertaining to their QoL were collected using the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) and the EORTC Head and Neck Module (QLQ-H&N35) before and two years after postoperative RT. The differences in all the QLQ-C30 scales between the two time points were not statistically (p<0.01) or clinically (difference > or =+10 points) significant. Of all the scales in the QLQ-H&N35, only problems in social eating, teeth, dry mouth, and sticky saliva became worse with both statistical and clinical significance. Clinical cancer stage and marital status were the only variables significantly associated with the change in global QoL. The subjects with stage IV disease (5.0-fold) and those with a spouse (5.5-fold) had a lower risk of reporting negative changes in global QoL. The study indicates that some individual HNSCC patients, after receiving postoperative RT, suffered from a deterioration of QoL scales, especially in some specific head-and-neck symptoms. Meanwhile, we found some patients, especially those with more advanced HNSCC, might have developed somewhat tougher coping abilities to deal with the adverse effects of adjuvant RT on their global QoL.

Quality of life and survival outcome for patients with nasopharyngeal carcinoma receiving three-dimensional conformal radiotherapy vs. intensity-modulated radiotherapy-a longitudinal study

PURPOSE

To investigate the changes of quality of life (QoL) and survival outcomes for patients with nasopharyngeal carcinoma (NPC) treated by three-dimensional conformal radiotherapy (3D-CRT) vs. intensity-modulated radiotherapy (IMRT).

METHODS AND MATERIALS

Two hundred and three newly diagnosed NPC patients, who were curatively treated by 3D-CRT (n = 93) or IMRT (n = 110) between March 2002 and July 2004, were analyzed. The distributions of clinical stage according to American Joint Committee on Cancer 1997 were I: 15 (7.4%), II: 78 (38.4%), III: 74 (36.5%), and IV: 36 (17.7%). QoL was longitudinally assessed by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-H&N35 questionnaires at the five time points: before RT, during RT (36 Gy), and 3 months, 12 months, and 24 months after RT.

RESULTS

The 3-year locoregional control, metastasis-free survival, and overall survival rates were 84.8%, 76.7%, and 81.7% for the 3D-CRT group, respectively, compared with 84.2%, 82.6%, and 85.4% for the IMRT group (p value > 0.05). A general trend of maximal deterioration in most QoL scales was observed during RT, followed by a gradual recovery thereafter. There was no significant difference in most scales between the two groups at each time point. The exception was that patients treated by IMRT had a both statistically and clinically significant improvement in global QoL, fatigue, taste/smell, dry mouth, and feeling ill at the time point of 3 months after RT.

CONCLUSIONS

The potential advantage of IMRT over 3D-CRT in treating NPC patients might occur in QoL outcome during the recovery phase of acute toxicity.

Developing core sets for patients with head and neck cancer based on the International Classification of Functioning, Disability and Health (ICF)

Problems in functioning are frequently seen in survivors of head and neck cancer (HNC) and proof to have increasing impact on their quality of life. With the approval of the International Classification of Functioning, Disability and Health (ICF) by the World Health Assembly in May 2001, we can now rely on a globally accepted framework and classification system based on a bio-psycho-social mode to assess and compare functional outcome. To make the ICF-classification with more than 1.400 categories applicable to every-day clinical practice, ICF core sets are established. The objective of this paper is to outline the proposed development process for the ICF core set for HNC and to invite international experts to participate in this process. The ICF core set will be defined at a Consensus conference, which will integrate evidence from preparatory studies, namely: (a) a systematic literature review regarding the outcome measures of clinical trails and observational studies, (b) semi-structured patient interviews, (c) international experts participating in a internet-based survey and (d) cross-sectional, multi-center studies for clinical applicability. To validate the ICF core set field-testing will follow. The ICF provides useful standards of clinical rehabilitation practice, research and teaching. Its application stimulates comparability of outcome parameters, eventually improving understanding of functioning and disability. The ICF can function as a new language, simplifying communication and cooperation between various professional backgrounds and between health professionals and their patients eventually leading to a more effective and economic rehabilitation. The ICF core set for HNC is designed to translate the benefits of the ICF into clinical routine. The development of ICF core sets is an inclusive and open process. Anyone who wishes to actively participate is invited to contact the project coordinator (Uta.Tschiesner@med.uni-muenchen.de). Individuals, institutions and associations can be formally associated as partners of the project.

Changing Quality of Life in Patients with Advanced Head and Neck Cancer after Primary Radiotherapy or Chemoradiation

OBJECTIVE

The purpose of this study was to investigate the longitudinal changes in quality of life (QoL) for patients with advanced stage (stage III or IV) head and neck squamous cell carcinoma (HNSCC) following primary radiotherapy (RT) or concomitant chemoradiotherapy.

METHODS

From January 2001 to January 2003, 149 patients with advanced HNSCC were enrolled. The data pertaining to their QoL were collected using the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) and the EORTC Head and Neck Module (QLQ-H&N35) before and 1 year after RT.

RESULTS

Sixty-eight (46%) patients dropped out during the study period. Thirty-nine (57%) of them died of cancer. Those who were older, stage IV, treated by RT alone, or had worse pretreatment EORTC QoL scales were significantly more likely to drop out. For those completing the study, only the problems of swallowing, dry mouth, and sticky saliva were found to become more serious with both statistical (p < 0.05) and clinical (difference >10 points) significance 1 year after RT. Those subjects with cancer at the hypopharynx/larynx had a 3.3-fold higher probability to report an improvement in global QoL (95% confidence interval, CI: 1.11-6.82) than those with cancer at the oral cavity/oropharynx. Those alive without cancer 1 year after RT had a 3.6-fold higher probability to report an improvement in global QoL (95% CI: 1.32-7.13) than those alive with cancer.

CONCLUSION

The study showed a high dropout rate in this longitudinal QoL study for patients with advanced HNSCC. Pretreatment cancer sites and living with cancer or not after treatment significantly affected the change in global QoL 1 year after RT.

Quality of life, mucositis, and xerostomia from radiotherapy for head and neck cancers: A report from the NCIC CTG HN2 randomized trial of an antimicrobial lozenge to prevent mucositis

BACKGROUND

The National Cancer Institute of Canada Clinical Trials Group undertook a multicenter, randomized, double-blind controlled trial of an oral antimicrobial versus placebo to prevent and treat mucositis. We present the quality of life (QOL) analysis for this trial.

METHODS

One hundred thirty-eight patients were randomly assigned. QOL data were collected every 2 weeks before, during, and after radiotherapy. The European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ-C30) and a Trial Specific Checklist (TSC) were used.

RESULTS

The antimicrobial lozenge did not impact QOL. The principal acute side effect of radiotherapy is oral pain, affecting more than 90% of patients. Role function is impacted during treatment, and patients experience fatigue. Appetite was reported to markedly increase during radiotherapy. There was a dramatic and persistent increase in dry mouth.

CONCLUSIONS

This study highlights the benefits of combining the EORTC QLQ-30 with an "oral" TSC in a randomized controlled trial and provides valuable baseline data for their use with an objective mucositis scoring system.

A qualitative study of head and neck cancer

The findings presented contribute to quality of life (QOL) research by highlighting the significance of factors affecting the communication by patients with primary-stage squamous cell carcinoma of the head and neck cancer (SCCHN) of their experiences of suffering after treatment to their clinicians. Qualitative research methodology based on open-ended interviews with 18 survivors of American Joint Committee on Cancer primary stage I and II SCCHN were used. The interviews were transcribed verbatim and thematically analyzed. Three important themes emerged: (1). a diminished self (2). fears of addiction, and (3). hopelessness and the loss of meaning in life after SCCHN. The findings indicate that SCCHN patients under-report their experiences mainly due to fear. As a consequence, and perhaps due to a failure on the part of clinicians and patients to adequately address such fears, SCCHN patients may experience greater psychological morbidity, becoming increasingly fatalistic about biomedicine's ability to restore them to health after cancer despite being "cured", or to relieve related symptoms. This qualitative study provides a perspective as to why such under-reporting occurs, thereby potentially enhancing clinician-patient communication and the QOL of SCCHN patients who present with curable disease.

Communicating suffering in primary stage head and neck cancer*

The findings presented in this discussion seek to make a contribution to quality of life (QOL) research, by highlighting the import of factors affecting the communication of primary stage head and neck cancer patient's experiences of suffering after treatments by their clinicians. Qualitative research methodology based on open-ended interviews with 18 survivors of American Joint Committee on Cancer (AJCC) Stage I and Stage II, squamous cell carcinoma of the head and neck (SCCHN) were used. The interviews were transcribed verbatim and thematically analysed. In this preliminary analysis, three important themes emerged: (1) a self diminished by cancer; (2) the fear of addiction to pain medications; and (3) hopelessness and the loss of meaning in life after SCCHN. Our present findings indicate that SCCHN patients understand their experiences of cancer and under-report their experiences of suffering mainly because of fear. These include fears of: being further diminished by SCCHN, fears of addiction, and an inability to cope with the additional losses associated with SCCHN. As a consequence, and perhaps, because of a failure the part of clinicians and patients to adequately address these fears, SCCHN patients may also experience greater psychological morbidity, becoming fatalistic about biomedicine's ability to restore them to health after cancer, or related symptoms, including pain, despite being 'cured.' This study provides a perspective on why this under-reporting occurs, thereby potentially enhancing clinician-patient communication and the QOL of SCCHN patients who present with curable disease.

Quality of life in long-term survivors of oropharynx carcinoma

PURPOSE

To collect data on the health-related quality of life (QOL) of long-term survivors and to determine to what extent QOL might be an appropriate end point in the comparison of treatment options in oropharyngeal carcinoma.

METHODS AND MATERIALS

All patients treated between 1992 and 1998, in two French comprehensive cancer centers, by brachytherapy (BT) +/- external beam radiotherapy (EBRT) or surgery plus RT, or exclusive EBRT for T1-T3 (International Union Against Cancer staging system) oropharynx squamous cell carcinoma, were included. QOL was measured once in disease-free patients at least 2 years after treatment initiation. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire and the specific H&N35 module were self-administered by all participating patients. Sociodemographic data were collected using a questionnaire specifically designed for the study. The association between the QOL scores of the various treatment-, disease-, and patient-related variables was performed through bivariate analysis and then by multivariate analysis. The mean QOL scores of the EORTC QLQ-C30 questionnaire were compared with the mean scores in the general population.

RESULTS

Of the 159 eligible patients, 113 agreed to participate (97 men and 16 women, median age 61 years, range 41-83). The initial treatment was EBRT plus BT in 49 patients, surgery plus RT in 27, and EBRT alone in 37. The median follow-up time was 62 months (range 24-110). Compared with the general population, the three scores indicating the most impaired QOL were emotional and social functioning and fatigue. The clinical significance of global QOL impairment was borderline. The physical functioning, role functioning, and pain scores did not significantly differ from those of the general population. In multivariate analysis, the initial treatment had no significant influence on any dimension of QOL, except global QOL and emotional functioning. Surprisingly, surgery plus RT, as the initial treatment, favorably influenced the emotional functioning score and EBRT plus BT negatively influenced the global QOL score. None of these treatment modalities influenced any symptom scales. Patient selection was, at least partially, responsible for these paradoxical results.

CONCLUSION

The results of this study bring original and useful data about the QOL of long-term survivors of oropharynx carcinoma. In these patients, the QOL was significantly impaired, particularly in its psychosocial dimensions. The level of symptoms and functioning (except global QOL and emotional) was similar whatever the initial treatment. These results suggest the importance of coping processes. In a trial comparing treatment options from a long-term perspective, survival remains the most relevant end point, and a QOL evaluation should be a secondary end point. More prospective studies on QOL in head-and-neck cancer patients are needed to determine new strategies for rehabilitation management.

Health-related quality of life for nasopharyngeal carcinoma patients with cancer-free survival after treatment

PURPOSE

To evaluate the health-related quality of life (HR-QOL) of nasopharyngeal cancer (NPC) patients with cancer-free survival after treatment and to investigate the factors correlated with their HR-QOL.

METHODS AND MATERIALS

One hundred eighty-two NPC patients with cancer-free survival of more than 2 years after treatment were enrolled in the study. Data from the same number of people without a history of cancer, who had come to the hospital for health checkups, were also collected for comparison. The Chinese SF-36 questionnaire and nine items about head-and-neck functional impairments (HNFI) were self-reported by all participants at the clinics. Data relating to sociodemographic factors, cancer stage, and treatment of NPC survivors were analyzed.

RESULTS

Psychometric tests revealed the excellent internal reliability (Cronbach's alpha: 0.87-0.96) and discriminative validity of the Chinese SF-36 used in Taiwan. Most functional domains of the Chinese SF-36 and all nine HNFI items were significantly worse in NPC survivors than in control subjects. No cancer or treatment-related variables significantly correlated with any functional domains of SF-36 or any items of HNFI for NPC survivors. Economic status, educational level, occupational status, and the number of comorbidities were the variables that significantly correlated with most functional domains of SF-36 for NPC survivors. Patients with more sufficient economic status, higher educational levels, with employment, or without comorbidity tended to enjoy better HR-QOL as detected by the SF-36. Salivation, hearing, and swallowing dysfunctions were the top three HNFI that disturbed NPC survivors. Economic status remained the most significant variable correlated with HNFI, including salivation, swallowing, neck stiffness, taste, and phonation. Survivors with better economic status reported less severe HNFI.

CONCLUSIONS

NPC survivors had worse HR-QOL than healthy control subjects in the study. Socioeconomic status was the most significant variable that correlated with the HR-QOL of NPC survivors. This result might indicate that patients' superior individual characteristics and financial resources are important variables determining their ability to cope with cancer and treatment complications affecting their HR-QOL.

An exploration of the pretreatment coping strategies of patients with carcinoma of the head and neck

BACKGROUND

Patients with head and neck carcinoma (HNC) often face exhaustive and debilitating treatment as well as physical and functional residual effects, such as disfigurement, compromised speech, dry mouth, and difficulties swallowing. Understanding how patients cope with these challenges is important in comprehensive care of patients with HNC.

METHODS

Seventy-nine patients with HNC were assessed for quality of life (QOL) and coping strategy. Measures included the Functional Assessment of Cancer Therapy-Head and Neck, the Performance Status Scale for Head and Neck Cancer Patients, and the Ways of Coping-Cancer Version. Coping strategies were summarized and related to patient demographics and QOL.

RESULTS

The results suggested that patients with HNC used a wide range of coping strategies, with social support seeking behaviors representing the greatest proportion of total coping effort (25%). The use of avoidant coping strategies (both cognitive and behavioral escape) was associated with poorer overall QOL.

CONCLUSIONS

Although further examination of these issues in larger groups of patients with HNC is warranted, the current findings suggest the adaptability of this group of patients and the potential benefit of social support-based assistance or intervention.

Quality of life in long term survivors of colorectal cancer

OBJECTIVES

We aimed to determine the quality of life (QOL) for long term survivors of colorectal cancer.

METHODS

Persons with colorectal cancer who had survived at least 5 yr from diagnosis were recruited from a local cancer registry to answer questions about general QOL and colon cancer-specific issues. Before the general survey, focus group interviews with long term survivors were conducted to select survey questions from a pool of general and cancer-specific QOL questionnaires. The survey included the Health Utilities Index, the Center for Epidemiological Studies Depression Scale, and questions from the Short Form 36 and Functional Assessment of Cancer Therapy-Colorectal Cancer. After permission was obtained from their primary physicians, long term survivors from the registry were mailed invitation letters, then telephoned. Those agreeing were mailed self-administered questionnaires with stamped return envelopes.

RESULTS

Two hundred twenty-seven respondents (average age = 74 yr, 46% female) completed the survey. Survivors reported a relatively uniform and high QOL, irrespective of stage at diagnosis and time from diagnosis. Non-cancer related comorbid conditions and low income status had more influence on overall QOL than initial stage of colorectal cancer or time since diagnosis. Compared to age-matched populations, long term survivors reported higher overall QOL, but had higher rates of depression. Sixteen percent reported three or more bowel movements a day; 49% reported chronic recurrent diarrhea.

CONCLUSIONS

Those who achieve long term remission from colorectal cancer may experience a relatively high QOL, although physical symptoms such as diarrhea and depressive symptoms remain a problem.