A prospective quality of life study of patients with laryngeal carcinoma by tumor stage and different radiation therapy schedules

Demographic differences in early vs. late-stage laryngeal squamous cell carcinoma

PURPOSE

This study aims to evaluate how various demographic factors impact the stage at diagnosis and, therefore, prognosis of laryngeal cancer.

MATERIALS AND METHODS

Using the National Cancer Database, 96,409 patients were diagnosed with laryngeal squamous cell carcinoma between 2004 and 2020. Early (stage 0 or I) vs. late-stage (stage IV) cancers were compared based on demographic variables utilizing Chi-square and multivariate analysis with a significance of p < 0.05.

RESULTS

Female, Black, and generally older patients were more likely to have late-stage cancer than their counterparts. When compared with a community cancer program, patients treated at other facility types were more likely to be diagnosed late. Patients with private insurance, Medicare, or other government insurance were all less likely to have late-stage cancer compared to patients without insurance. Compared to patients in the lowest median household income quartile, patients in the third quartile and fourth quartile were diagnosed earlier. Patients living in an area with the lowest level of high school degree attainment were most likely to be diagnosed late. Living in a more populous area was associated with a lower chance of being diagnosed late. Increasing Charlson-Deyo Score was associated with a stronger likelihood of being diagnosed at a later stage.

CONCLUSION

Patients who are female, Black, uninsured, have a low household income, live in less populated and less educated areas, are treated at non-community cancer programs, and have more comorbid conditions have later stage diagnoses. This data contributes to understanding inequities in healthcare.

Low Post-Treatment Quality of Life and the High Incidence of Pain Are Common and Significantly Exacerbated in Depressed Head and Neck Patients Treated with Definitive Accelerated Radiotherapy

(1) Background: The goal of this study is to evaluate psychological tolerance and health-related quality of life (QOL) in head and neck (HN) cancer patients treated with definitive accelerated radiotherapy (DART). (2) Methods: 76 recurrence-free patients eligible for the study, who were treated with DART in the CAIR-2 phase III clinical study (median of follow-up = 47 months), completed EORTC QLQ-C30 with the H&N35 module, Hospital Anxiety and Depression Scale (HADS) and Visual-Analog Scales (VAS) of pain in HN and the neck/arm areas. (3) Results: The most dominant symptoms measured with QLQ-C30 were as follows: fatigue (44/100), sleeplessness (39/100), financial problems (38/100) and pain (32/100). Within the H&N35, the highest scores were reported on the subscales of sticky saliva (60/100), mouth dryness (65/100) and increased intake of painkillers (50/100). Pain (VAS) was reported by 87% (HN area) and 78% (shoulder area) of the patients, with a mean score of 3/10. One-third of the patients reported depressive moods (HADS ≥ 15 points) with an average score of 12.5/42 p. The depressed group, who smoked more as compared to the non-depressed group before DART (96% vs. 78%) and required steroids treatment (85% vs. 58%) during DART, also scored significantly worse on 23 of the 35 subscales of QLQ-C30 and H&N35 and experienced more intense pain (VAS). Women and less-advanced patients scored better in several aspects of quality of life. (4) Conclusions: Patients treated with DART struggle with low quality of life and persistent treatment-related symptoms including constant pain. HNC survivors, especially those who are depressed, may require additional psychosocial, rehabilitation and medical intervention programmes.

Quality of Life in Non-Ventilated Tracheostomised Patients

Introduction: Tracheostomy is a lifesaving procedure, often done at short notice to the patient and his kin. Living with a tracheostomy plays a significant role in the psychological and social aspect of the patient's life. Methods: In this study, fifty-two patients who underwent elective tracheostomy and did not depend on assisted ventilation were included. Three international standerized indices namely the Satisfaction with Life Scale, Karnofsky Performance Scale and Living with Tracheostomy Index Scale were used to assess the Quality of Life (QOL). Social, Psychological and Functional domains were assessed by means of questionnaire and specific scoring was allotted. Paired sample T-test was applied to find the level of significance across all domains. A p value of less than 0.05 was considered as the level of significance. Results: Most of the patients fell in the age group of 41-50 years. Domain wise analysis showed, high significant increase in quality of life at final administration of questionnaire with regard to all three domains. The indications of tracheostomy for all the patients in this study was long term mechanical ventilation. The effect of tracheostomy on swallowing and feeding was also noted. A significant amount of patients reported difficulty in communication and strained inter-personal communications. It was observed that patients who could perform their tracheostomy care independently had better self-image and quality of life. Conclusion: All tracheostomy patients had poor quality of life with compromise in Quality of Life across various domains. The functional, psychological and social aspects of quality of life improved over a period of time. Psychological assistance therefore should serve as a prerequisite to the comprehensive management of all patients undergoing tracheostomy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03162-6.

Nurse-led telephone follow-up according to the revised nursing outcomes classification for laryngeal carcinoma surgery patients: a randomized controlled trial

BACKGROUND

This study used the revised nursing outcomes classification (NOC) outlined in our previous study, "Core nursing outcomes for otorhinolaryngology head-neck," for telephone follow-up of patients who had laryngeal carcinoma surgery in China. This randomized controlled trial aimed to compare nurse-led telephone follow-up according to the revised NOC with traditional telephone follow-up.

METHODS

A total of 100 postoperative patients were recruited from March 2018‒March 2020. Patients were randomly assigned to nurse-led telephone follow-up groups as either revised NOC follow-up (n = 51) or traditional follow-up (n = 49). The investigated outcomes included nursing outcomes, quality of life, and self-care abilities.

RESULTS

The baseline characteristics of patients were well balanced. We noted that improvements in nursing outcomes in the intervention group were significantly better than for those in the control group (P = 0.018), primarily regarding psychosocial health (P < 0.001) and health knowledge and behavior (P < 0.001). Moreover, patient outcomes in the intervention group were associated with greater improvements in quality of life than those in the control group (P < 0.001), especially for social conditions (P < 0.001), emotional health (P < 0.001), functional status (P < 0.001), and additional attention (P = 0.001). Finally, compared with the control group, significant improvements were observed in self-care abilities in the intervention group (P = 0.002), mainly regarding general self-care abilities (P = 0.016) and development self-care abilities (P < 0.001).

CONCLUSION

This study found that nurse-led telephone follow-up according to the revised NOC improved nursing outcomes, quality of life, and self-care abilities.

TRIAL REGISTRATION

ChiCTR2100045941.

Resilience and its associated factors in head and neck cancer patients in Pakistan: an analytical cross-sectional study

INTRODUCTION

The study aimed to assess resilience and its associated factors in head and neck cancer patients, post-treatment in a low middle income country (LMIC) such as Pakistan.

METHODS

An analytical cross-sectional study was conducted from November 2019 to May 2020 among head and neck cancer patients aged at least 18 years at the largest private tertiary care hospital, in Karachi, Pakistan. Information regarding their resilience scores was collected through Wagnild and Young's Resilience scale that comprises of 14 items (RS-14). Moreover, depression and anxiety were also assessed via Hospital Anxiety and Depression Scale (HADS) and social support was assessed by Enriched Social Support Instrument (ESSI).

RESULTS

The data was analyzed by linear regression modeling. Unadjusted and adjusted beta coefficients with 95% CI were reported. A total of 250 head and neck cancer patients were recruited, 79% of them were males. Mean age of the patients was 51.59 years with 93% having high social support and only 8% having severe depression and 3% having severe anxiety. After adjusting for the covariates in multivariable analysis resilience was associated with severe depression (- 17[- 20.98,-12.93]) or borderline depression (- 4[- 8.41,-0.39]), severe anxiety (- 11 [- 17.88,-4.18]), low social support (- 6[- 9.62,-1.71]), having family members of > 6 in the household (- 2[- 4.31,-0.29), smokeless tobacco users post- treatment (10[5.79, 14.45]), and those who underwent tracheotomy (- 4[- 7.67,-0.21]). There was a significant interaction between education and role in the family (decision maker).

CONCLUSION

In Pakistan, a South Asian LMIC, collectivist culture prevails, family ties are greatly promoted thus resilience and social support is highly prevalent in head and neck cancer patients resulting in lower prevalence of depression and anxiety. Our study highlights that higher resilience is prevalent among small families less than six members, as the welfare of the individual is prioritized over multiple needs of the family. Formal Education and role in household/decision making power are effect modifiers in our study, demonstrating its protective effect on the mental health of head and neck cancer patients. High resilience scores were reported among current smokeless tobacco users as compared to quitters post treatment. Resilience-building interventions should be formulated to aid head and neck cancer patients to cope with the disease and its sequel.

Multidimensional evaluation of voice outcomes following total laryngectomy: a prospective multicenter cohort study

Purpose

The purpose of this study is to assess the general course of acoustic, patient rated, and clinician-rated voice outcomes from pre- up to 12 months post total laryngectomy.

Methods

Patients admitted to a total laryngectomy in five participating hospitals in Australia and The Netherlands were included. Assessments took place at pre-, 3 months, 6 months, and 12 months post-surgery. Voice outcomes are evaluated with the Acoustic Voice Quality Index (AVQI), perceptual scales, and patient-reported outcome measures including VHI-10 and EQ-5D-5L. Statistical analyses include descriptive statistics, t tests (pre- to 6 months post-surgery), Linear Mixed Effect models.

Results

The study included 43 participants. A significant worsening of AVQI is seen from pre- to post-surgery evaluated with t test (p < 0.001). The Linear Mixed Effect model confirmed Time as a significant factor in predicting AVQI score (p ≤ 0.001), as well as perceptual rated voice quality by the clinician (p = 0.015) and patient-reported perceptual rated voice quality (p = 0.002). No statistical significance was found in VHI-10 scores over time.

Conclusion

Successful TE-speech was achieved in most participants, some had to rely on augmentative alternative communication methods. Patient-reported outcomes indicate acceptance of the condition and sufficient coping in the long term. However, acoustic rated voice quality is abnormal at all post-surgery time-points. AVQI proved to be a useful instrument to evaluate TE-speech. There is a need for validation and determination of cut-off values for VHI-10 and AVQI for use in TE-speech.

Voice Quality, Function, and Quality of Life for Laryngeal Cancer: A Prospective Longitudinal Study Up to 24 Months Following Radiotherapy

OBJECTIVE

To study the potential changes of health-related quality of life (HRQL), voice quality, and communicative function up to 24 months following radiotherapy for patients with laryngeal cancer.

METHODS

A total of 28 patients with laryngeal cancer, treated by curatively intended radiotherapy were included in this prospective longitudinal descriptive study. Patients were followed pre-radiotherapy, 12 months, and 24 months post-radiotherapy. At each time point, voice recordings and patient-reported outcome instruments (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core30, Head and Neck35, Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer) were completed. Perceptual analysis using the Grade-Roughness-Breathiness-Asthenia-Strain was performed using the voice recordings.

RESULTS

Voice quality remains inferior to the voices of healthy controls both before and up to 24 months post-radiotherapy, demonstrating no statistically significant changes during the study period. Self-perceived communicative function revealed a trend toward improvement. Health-related quality of life remains mostly at stable levels, however, with statistically significant deterioration regarding dry mouth and sticky saliva. Generally, patients reported inferior scores compared to a normal population.

CONCLUSION

This study demonstrated no statistically significant changes over time in HRQL and perceptual voice quality at pre-radiotherapy compared to 24 months post-radiotherapy. However, the values remain inferior to the voices of healthy controls or a normal population.

Patients with adenoid cystic carcinomas of the salivary glands treated with lenvatinib: Activity and quality of life

BACKGROUND

The treatment of patients with recurrent and/or metastatic (R/M) salivary gland adenoid cystic carcinoma (ACC) remains an unmet need.

METHODS

Patients with R/M disease with a history of clinical or symptomatic disease progression within 6 months and a maximum of 1 previous line of chemotherapy or a multiple kinase inhibitor received oral lenvatinib at a dose of 24 mg/day. The primary endpoint was the objective response rate; secondary endpoints included quality of life (QOL) (according to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 Items [EORTC QLQ-C30] and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core Module Head and Neck Module [EORTC QLQ-H&N35]), progression-free survival and overall survival, duration of response, and toxicities.

RESULTS

Twenty-eight patients with R/M ACC were enrolled. Among 26 evaluable patients, 3 partial responses (11.5%) were reported. Target lesion reductions between 23% to 28% were observed in 4 of 20 patients with stable disease. Treatment-related adverse events were frequent (all grades, 96%; grade≥3 in 50% of cases according to version 4.03 of the National Cancer Institute Common Terminology Criteria for Adverse Events). The dose of lenvatinib was reduced in 24 patients, whereas in 21 patients the dose was reduced within the first 12 weeks and 4 patients maintained the full dose throughout treatment. The QOL deteriorated between baseline and 6 months with regard to Fatigue and Dry Mouth. There was no evidence of changes in Swallowing and Physical Functioning. At a median follow-up of 29 months, 2 patients remained on treatment, 10 patients were off protocol for disease progression and were alive with disease, and 14 patients had died of disease progression. The median overall survival, progression-free survival, and duration of response were 27 months, 9.1 months, and 3.1 months, respectively.

CONCLUSIONS

Lenvatinib appears to have modest activity in ACC. Toxicities are common but manageable and QOL was found to deteriorate in some domains.

Objective and subjective hyposalivation after treatment for head and neck cancer: Long-term outcomes

OBJECTIVES/HYPOTHESIS

This study examined saliva weight over time and its association with diet and patient-rated swallowing, dry mouth, sticky saliva, and dysgeusia quality of life in head and neck cancer (HNCA) patients treated with surgery plus adjuvant chemoradiotherapy (CRT), or primary CRT.

STUDY DESIGN

Prospective cohort study in an outpatient HNCA center setting.

METHODS

Patients were seen pretreatment, and 1, 3, 6, 12, 24, and 36 + months post-treatment. All had newly diagnosed oral, oropharynx, nasopharynx, larynx/hypopharynx cancer from 2010 to 2016 and were to undergo surgery + CRT or primary CRT. Stimulated saliva weight was assessed with the Saxon test. Diet, eating, dry mouth, and dysgeusia quality of life were assessed and correlated with saliva weight, treatment modality, and tumor site.

RESULTS

Saliva weight decreased the most within the first 3 months across treatment groups, except for the surgery + CRT group, which continued to decline. Similar trends were seen by tumor site. Performance Status Scale (PSS) Normalcy of Diet and all quality-of-life scores declined following treatment. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck-35 (EORTC QLQ-H&N35); Eating Assessment Tool (EAT-10); M. D. Anderson Dysphagia Inventory (MDADI) Composite, Global, and subdomain scores; and PSS Diet were significantly correlated with saliva weight.

CONCLUSIONS

Saliva weight worsened post-treatment across groups and tumor site, with improvement by 36 + months. Saliva weight correlated with diet, eating quality of life and perception of dysgeusia across time points. Despite dose-sparing intensity-modulated radiation therapy, newer technologies are needed to preserve saliva production and maintain higher quality of life.

LEVEL OF EVIDENCE

2b Laryngoscope, 128:2732-2739, 2018.

Evidence-Based Medicine in Otolaryngology Part 9: Valuing Health Outcomes

Decisions about resource allocation are increasingly based on value trade-offs between health outcomes and cost. This process relies on comprehensive and standardized definitions of health status that accurately measure the physical, mental, and social well-being of patients across disease states. These metrics, assessed through clinical trials, observational studies, and health surveys, can facilitate the integration of patient preferences into clinical practice. This ninth installment in the Evidence-Based Medicine in Otolaryngology Series is a practical overview of health outcome valuation, as well as the integration of both quality and quantity of life into standardized metrics for health research, program planning, and resource allocation. Tools for measuring preference-based health states, measures of effectiveness, and the application of metrics in economic evaluations are discussed.

Quality of life during the first year after partial laryngectomy: Longitudinal study

BACKGROUND

This prospective study was conducted to assess changes in quality of life (QOL) of patients who undergo a partial laryngectomy.

METHODS

The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires Core and Head and Neck (EORTC-QLQ-C30, QLQ-H&N35) were used preprocedure (n = 218), 1 week (n = 159), 3 months (n = 122), and 1 year after partial laryngectomy (n = 88). Changes over time were analyzed with the Wilcoxon signed rank test and the Holm-Bonferroni method, and interpreted regarding clinical relevance.

RESULTS

Most subscales worsened 1 week postprocedure, but many recovered to baseline level after 1 year. Dyspnea and cognitive functioning deteriorated over time, with worst scores recorded after 1 year. Financial difficulties and fatigue increased after surgery and maintained that level throughout the follow-up period; sticky saliva remained worse than at baseline, despite some improvements over time.

CONCLUSION

The discovered limitations of QOL should be observed more closely during follow-up treatment, and patients should be informed about these potential effects before partial laryngectomy.

Impact of Oral Cancer on Quality of Life

The clinical manifestations of oral cancer and the effects of treatment can have a negative impact on a patient's quality of life. Physiologic functions, cosmetic appearance, and psychological well-being can become compromised during the diagnosis, treatment, and survivorship of patients with oral cancer. This article addresses the relationship of oral cancer and quality of life, as well as the different aspects affected by this condition.

Voice rehabilitation after laryngeal cancer: Associated effects on psychological well-being

Purpose

Psychological distress after laryngeal cancer treatment is prevalent. Although voice rehabilitation has shown to improve functional outcomes and positively affect health-related quality of life, to date, there has been limited study of the associated effect of behavioural voice intervention on psychological well-being/distress post laryngeal cancer.

Method

Sixty-three patients with Tis-T4 laryngeal cancer treated with (chemo)radiotherapy were prospectively recruited and randomised to either a voice rehabilitation (VR, n = 31) or control group (n = 32). The VR group received 10 speech pathology sessions consisting of both direct and indirect voice intervention post (chemo)radiotherapy. The control group received general voice education but not specific intervention. As part of a multidisciplinary assessment battery, psychological well-being/distress was measured using the Hospital Anxiety and Depression Scale (HADS) pre, six and 12 months post VR.

Results

Within-group analysis revealed a significant (p = 0.03) reduction in the proportion of patients with anxiety in the VR group between baseline and 12 months. No change over time was observed in controls. Between-group analysis revealed a trend for fewer VR cases demonstrating anxiety (p = 0.06) or depression (p = 0.08) at 6 months and significantly fewer demonstrating anxiety (p = 0.04) and depression (p = 0.04) at 12 months, compared to controls. Significant correlations were observed between patients’ voice perceptions and reduced anxiety (r_pb = −0.38) and depression (r_pb = −0.66) within the VR group at 12 months.

Conclusions

The positive correlations and between-group analyses indicate a positive effect on psychological well-being associated with completing voice rehabilitation. Results highlight potential additional benefits of behavioural voice intervention beyond achieving direct change to voice function.

Predictors affecting quality of life in patients with upper aerodigestive tract cancers: a case-control study from India

OBJECTIVE

The aim of this study was to measure quality of life (QOL) in patients with upper aerodigestive tract (UADT) cancer in comparison with hospital-based controls. We also assessed the impact of various clinical predictors at time of diagnosis of disease/cancer on QOL in these patients.

STUDY DESIGN

A case-control study was conducted (N = 480) with 240 UADT cancer cases and 240 controls matched by gender and age (≥5 years) from 2 different hospitals in Pune, India. The University of Washington Quality of Life Questionnaire was used to measure QOL and was administered through face-to-face interviews. Various QOL domains were analyzed by using one-way analysis of variance and Bonferroni adjustments for post hoc comparisons.

RESULTS

Cases had significantly lower scores across all domains of QOL compared with controls. Overall, the most affected domains were anxiety and mood. Cancer site significantly influenced QOL, with patients with cancers of the oropharynx and hypopharynx having the worst mean scores across all domains. Patients with stage IV cancer had the worst mean scores across the majority of the QOL domains. Our findings highlight the complex interactions between individual and clinical predictors that have an impact on QOL.

CONCLUSIONS

QOL needs to be incorporated as an important outcome measure in an individualized approach to therapeutic and palliative care planning to enable a better quality of survival of patients with UADT cancers.

Study protocol for a randomized controlled trial: tongue strengthening exercises in head and neck cancer patients, does exercise load matter?

BACKGROUND

Reduced tongue strength is an important factor contributing to early and late dysphagia in head and neck cancer patients previously treated with chemoradiotherapy. The evidence is growing that tongue strengthening exercises can improve tongue strength and swallowing function in both healthy and dysphagic subjects. However, little is known about the impact of specific features of an exercise protocol for tongue strength on the actual outcome (strength or swallowing function). Previous research originating in the fields of sports medicine and physical rehabilitation shows that the degree of exercise load is an influential factor for increasing muscle strength in the limb skeletal muscles. Since the tongue is considered a muscular hydrostat, it remains to be proven whether the same concepts will apply.

METHODS/DESIGN

This ongoing randomized controlled trial in chemoradiotherapy-treated patients with head and neck cancer investigates the effect of three tongue strengthening exercise protocols, with different degrees of exercise load, on tongue strength and swallowing. At enrollment, 51 patients whose dysphagia is primarily related to reduced tongue strength are randomly assigned to a training schedule of 60, 80, or 100% of their maximal tongue strength. Patients are treated three times a week for 8 weeks, executing 120 repetitions of the assigned exercise once per training day. Exercise load is progressively adjusted every 2 weeks. Patients are evaluated before, during and after treatment by means of tongue strength measurements, fiber-optic endoscopic evaluation of swallowing and quality-of-life questionnaires.

DISCUSSION

This randomized controlled trial is the first to systematically investigate the effect of different exercise loads in tongue strengthening exercise protocols. The results will allow the development of more efficacious protocols.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN14447678.

Evaluation of the quality of life of patients before treatment of squamous cell carcinoma of the head and neck by means of chemoradiotherapy

Aim of the study

To identify predictors of quality of life (QOL) in head and neck cancer patients prior to cisplatin chemotherapy and radiotherapy treatment.

Material and methods

A cross-sectional study at a Clinical Oncology department of a teaching hospital in the state of São Paulo, Brazil, from September 2011 to October 2012 was performed. QOL was assessed using the University of Washington QOL Questionnaire. Demographic and clinical characteristics were obtained through interviews with patients and collected from medical records. Multivariate linear regression was used to determine the association between QOL scores and patient-related factors.

Results

We studied 48 head and neck cancer patients, who were mostly white (77.1%), males (83.3%), with pharyngeal cancers (66.7%), cancers with stage T4 (45.8%) and N1 (31.2%) tumours, and classified with a Karnofsky Performance Status (KPS) of 90% (37.5%). Patients had excellent scores for saliva (96.2 ±13.5) and shoulder (93.6 ±17.9), with pain and anxiety being the most affected domains (59.6 ±32.4 and 57.5 ±39.2, respectively). A significant relationship of KPS and T stage with overall QOL score was noted. The population with lowest overall QOL score was those who had low KPS scores and T4 tumours.

Conclusions

Head and neck cancer patients prior to cisplatin chemotherapy and radiotherapy treatment, with a low KPS and staged as T4 tumours, have worse overall QOL, and special attention should be given to these patients.

Measuring psychosocial functioning in the radiation oncology clinic: a systematic review

BACKGROUND

This paper aimed to systematically review the (1) prevalence, (2) risk factors, (3) interventions, and (4) measurement instruments associated with psychosocial function decline in radiation therapy (RT) patients.

METHODS

A MEDLINE systematic literature review was performed to identify studies monitoring psychosocial function among RT patients as a primary endpoint.

RESULTS

Fifty-seven and 22 risk factors for RT-related psychosocial function decline were identified and refuted, respectively, in 93 eligible studies representing 12,808 patients. Median prevalences of psychosocial function decline prior to, during, and following RT were 20%, 36%, and 25%. Prior to RT, anxiety was more prevalent than depression (20% vs 15%), but dropped following completion of RT, whereas median depression levels remained elevated (17% vs. 27%). Of the 79 identified risk factors, 17 were reported as predictive of psychosocial decline by two or more more studies, and five had robust support: (1) physical symptoms, (2) time point during RT, (3) chemotherapy reception, (4) female gender, and (5) younger age. Three interventions were consensually reported to improve psychosocial function: psychotherapy, nursing consultation/patient education, and self-management training. Eighty-six different assessment tools were used to monitor RT-related psychosocial function decline with the Hospital Anxiety and Depression Scale (25.8%) and the psychiatric interview (22.6%) being the most utilized. The distress thermometer has been used in 5 studies (5.4%) to date.

CONCLUSION

Psychosocial function declines in approximately one-third of RT patients. Anxiety can dissipate after initiation of RT, whereas depression can persist throughout and after RT. Severe physical symptoms and time-related factors most robustly predict psychosocial function decline, which can be improved by psychotherapy and interventions aimed to improve patient education.

Prospective evaluation of health-related quality of life in long-term oral and oropharyngeal cancer survivors and the perceived need for supportive care

PURPOSE

To evaluate long-term changes in health related quality of life (HRQOL) in oral/oropharyngeal cancer survivors and their need for and use of supportive care.

METHODS

Between 1999 and 2001, 80 advanced oral or oropharyngeal cancer patients treated with free-flap reconstruction and postoperative radiotherapy were included in a prospective study of whom 27 patients were long-term survivors (mean 9.2 years, range 8-11 years). The HRQOL of 26 patients (response rate 96%) was assessed with the EORTC QLQ-C30 and QLQ-H&N35 questionnaires at four points in time: pretreatment (baseline), and at 6 months, 12 months (short term) and 8-11 years (long-term) follow up. A study specific questionnaire was developed to evaluate the need for and use of supportive care (allied health services, peer contact, psychosocial care, and complementary care) and was completed at the period of treatment and at long-term follow up.

RESULTS

A number of HRQOL domains worsened significantly (p < 0.01) in the long-term: emotional functioning, social functioning, swallowing, speech, taste/smell, dry mouth, sticky saliva and coughing assessed by the mixed effects statistical model. At time of treatment, the need for supportive care was the highest for a dental hygienist (77%), a physical therapist (73%), a speech therapist (42%), a dietician (38%), and a special diet (62%). At long-term follow up, the need for supportive care was limited to a dental hygienist (46%) and a physical therapist (23%). Only small differences were observed between the perceived need for and actual use of supportive care.

CONCLUSION

A range of HRQOL domains in head and neck cancer survivors were deteriorated in the long-term compared to baseline and to the first year after treatment. At time of treatment and less frequently at long-term follow up, patients reported needing and using a variety of supportive care services.

Mental adjustment to cancer and its relation to anxiety, depression, HRQL and survival in patients with laryngeal cancer - a longitudinal study

Background

Using a longitudinal design, aim of this study was to investigate the relation between mental adjustment to cancer and anxiety, depression, health-related quality of life (HRQL) and survival in patients treated for laryngeal cancer.

Methods

95 patients with Tis-T4 laryngeal cancer were assessed at one and 12 months after start of treatment, respectively, using the Mini-Mental Adjustment to Cancer Scale (Mini-MAC), the European Organisation for Research and Treatment of Cancer (EORTC) Study Group on Quality of Life core questionnaire (EORTC QLQ-C30) supplemented with the Head and Neck cancer module (QLQ-H&N35) and the Hospital Anxiety and Depression (HAD) Scale. For survival analyses patients were followed up for a median time of 4.22 years from inclusion.

Results

The most commonly used adjustment response at both occasions was Fighting Spirit. The use of adjustment responses was relatively stable over time. Correlation analyses showed that patients using Helpless-Hopeless and Anxious Preoccupation responses reported more anxiety and depression, as well as decreased HRQL. Tumour site and stage showed no effect on adjustment response. Survival analysis indicated that use of a Helpless-Hopeless response was related to poorer survival (HR 1.17, p 0.001).

Conclusion

The relation between adjustment responses Helpless-Hopeless and Anxious Preoccupation and anxiety, depression, HRQL and possibly poorer survival indicate that assessment of mental adjustment should be considered when planning treatment and rehabilitation in laryngeal cancer patients.

[Quality of life evolution in patients after surgical treatment of laryngeal, hypopharyngeal or oropharyngeal carcinoma]

INTRODUCTION

The assessment of quality of life in patients with head and neck cancer is dependent on many variables.

OBJECTIVE

The aim of this study was to evaluate the differences in quality of life among patients treated with conservative or radical surgery for laryngeal, oropharyngeal or hypopharyngeal cancer, evaluated before and at 3 and 6 months after definitive therapy.

MATERIAL AND METHOD

Prospective study between November 2008 and June 2009 on 53 patients diagnosed and treated for head and neck carcinoma with surgery: partial (n=32) and radical (n=21). Quality of life was evaluated using the European Organization of Research and Treatment of Cancer (EORTC) general questionnaire EORTC QLQ-C30 and its specific head and neck EORTC QLQ-H&N35 before treatment, and at 3 and 6 months afterwards.

RESULTS

No significant differences were found in overall health. Patients experienced the greatest changes in functional scale. There were no changes in swallowing problems or feeling of disease, while evident phonation problems were present in both groups.

DISCUSSION AND CONCLUSIONS

The routine application of quality of life questionnaires in cancer patients improves information regarding how and to what extent patients feel that treatment and its sequelae modify it, making it possible to adapt rehabilitation and support programs to their real needs. This data helps in choosing between different options depending on the results, delivering improved care to patients.

The impact of total laryngectomy: the patient's perspective

PURPOSE/OBJECTIVES

To describe the experiences of patients who had total laryngectomy from their perspective.

RESEARCH APPROACH

Descriptive, qualitative study.

SETTING

Participants' homes or investigator's hospital office.

PARTICIPANTS

10 patients after total laryngectomy.

METHODOLOGIC APPROACH

Data were collected by semistructured, open-ended interviews during a period of six months, with an interview topic guide built on the framework of the literature review. Data were analyzed with descriptive content analysis. Trustworthiness of the study was enhanced through the use of verbatim quotations, audible data analysis trail, and a reflexive approach.

MAIN RESEARCH VARIABLES

Patients' experiences of undergoing total laryngectomy.

FINDINGS

Patients who have undergone a total laryngectomy report difficulties and concerns that are largely functional and psychological. The functional difficulties reported included descriptions of altered swallow, excess phlegm, speech difficulties, weak neck muscles, and altered energy levels. The psychological concerns reported included descriptions of depression, regrets, and personal resolve.

CONCLUSIONS

As a group, patients experience a broad range of problems well after completion of treatment, reinforcing the need for rehabilitation management for prolonged periods after surgery.

INTERPRETATION

Nurses are suitably positioned to support this group of patients across the disease management trajectory, from the initial preoperative period to the postoperative period and through to the rehabilitative period and beyond.

Effects of chemoradiotherapy on voice and swallowing

PURPOSE OF REVIEW

Chemotherapy has been found to result in comparable survival rates to surgery for head and neck cancer. However, toxicity can often be worse after chemoradiotherapy, with impairment in voice, swallowing, nutrition, and quality of life. Investigators are attempting to modify radiotherapy treatment regimens to spare organs that have an impact on swallowing. This review will highlight voice and swallowing impairment seen after chemoradiotherapy, as well as treatment for voice and swallowing disorders in this population. Results of newer radiotherapy regimens will also be highlighted.

RECENT FINDINGS

Specific oropharyngeal swallowing motility disorders after chemoradiotherapy have been identified. Damage to specific structures has been correlated with specific pharyngeal phase swallow impairment. Swallowing function and quality of life have been examined over time, with improvement seen in both. Preventive/prophylactic swallow exercise programs have been encouraging. Chemoradiotherapy effects on voice have been identified in terms of acoustic, aerodynamic, and patient and clinician-rated perception of function. Improvement in voice has also been observed over time after chemoradiotherapy. Voice therapy has been found to have a positive impact on voice and perceptual measures in this population.

SUMMARY

Current studies show some improvement in swallow function after swallow and voice therapy in patients treated with chemoradiotherapy. Further, there is a suggestion of improved swallow function with sparing of organs with specific radiotherapy protocols. Future research needs to focus on specific voice and swallow treatment regimens in the head and neck cancer patient treated with chemoradiotherapy, specifically, timing, frequency, duration, and specific treatment types.

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.

Validation of the EORTC QLQ-C30 and EORTC QLQ-H&N35 in patients with laryngeal cancer after surgery

BACKGROUND

The aim of this study was to test the validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Module (QLQ-C30) and Head and Neck Module (QLQ-H&N35) for patients who have undergone surgery due to laryngeal cancer.

METHODS

A total of 323 patients from 6 different centers in Germany who had been operated on completed the QLQ-C30 and the QLQ-H&N35 in addition to being surveyed in a personal interview.

RESULTS

Multitrait scaling analysis confirmed the proposed scale structure of both questionnaires. Cronbach's alpha of the QLQ-C30 scales ranged from 0.64 (Cognitive Functioning) to 0.94 (Global Health Status); the alpha of the QLQ-H&N35 ranged from 0.55 (Speech) to 0.90 (Sexuality). Known-groups comparisons showed multiple differences in sociodemographic and clinical variables.

CONCLUSION

It can be concluded that the QLQ-H&N35, in conjunction with the QLQ-C30, is a reliable instrument that is able to differentiate between diverse groups of patients with laryngeal cancer after surgery.

Self evaluation of communication experiences after laryngeal cancer - a longitudinal questionnaire study in patients with laryngeal cancer

Background

Aim of this longitudinal study was to investigate the sensitivity to change of the Swedish Self Evaluation of Communication Experiences after Laryngeal Cancer questionnaire (the S-SECEL), addressing communication dysfunction in patients treated for laryngeal cancer. Previous studies have highlighted the need for more specific questionnaires for this purpose.

Methods

100 patients with Tis-T4 laryngeal cancer were included prior to treatment onset. Patients answered four questionnaires at six occasions during one year; the S-SECEL, the European Organisation for Research and Treatment of Cancer (EORTC) Core Quality of Life Core Questionnaire (QLQ-C30) supplemented by the Head and Neck cancer module (QLQ-H&N35) and the Hospital Anxiety and Depression (HAD) scale. In addition, performance status was assessed. Differences within groups were tested with the Wilcoxon paired signed ranks test and between-group analyses were carried out using the Mann-Whitney U test. Magnitude of group differences was analyzed by means of effect sizes.

Results

The S-SECEL was well accepted with a response rate of 76%. Communication dysfunction increased at 1 month, followed by a continuous decrease throughout the year. Changes were statistically significant at most measurement, demonstrating the sensitivity of the S-SECEL to changes in communication over time. The S-SECEL and the EORTC QLQ-C30 with the QLQ-H&N35 demonstrated similar results; however the S-SECEL was more sensitive regarding communication dysfunction. The largest changes were found in the most diagnose specific items concerning voice and speech.

Conclusion

The S-SECEL was investigated in the largest Scandinavian longitudinal study concerning health-related quality of life (HRQL) in laryngeal cancer patients. The questionnaire was responsive to change and showed convergent results when compared to established HRQL questionnaires. Our findings also indicate that the S-SECEL could be a more suitable instrument than the EORTC QLQ-C30 with QLQ-H&N35 when measuring communication experiences in patients with laryngeal cancer; it is more sensitive, shorter and can be used on an individual basis. As a routine screening instrument the S-SECEL could be a valuable tool for identifying patients at risk for psychosocial problems and to help plan rehabilitation. It is therefore recommended for clinical use in evaluation of communication dysfunction for all patients with laryngeal cancer irrespective of treatment.

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.

A cross-sectional comparison study of cognitive and emotional well-being in oral cancer patients

The main aim of this study was to establish whether oral cancer patients were at risk of long-term problems with adaptation, whilst investigating contributory factors using a framework of Subjective Well-Being. Three samples of patients treated for either oral cancer (n=115); throat cancer (n=47), or benign conditions of the salivary gland (n=33) were recruited into a cross-sectional, postal questionnaire study. A gender and age matched healthy normative sample (n=115) was recruited for comparison purposes. Measures included The Satisfaction with Life Scale, the General Health Survey (SF-12), Life Orientation Test and the Hospital Anxiety and Depression Scale. Patients with oral cancer demonstrated similar levels of cognitive and emotional well-being as the other samples. Time since treatment and the majority of clinical and treatment related factors had no effect on cognitive and emotional adaptation in any of the patient samples.

The relationship between the Patient Generated Index (PGI) and measures of HR-QoL following diagnosis with head and neck cancer: are illness and treatment perceptions determinants of judgment-based outcomes?

OBJECTIVES

The primary objectives of this study were to examine the relationship between factors specified in the extended Self-Regulation Model (SRM) (illness and treatment perceptions and coping strategy) and three types of QoL outcome. Secondary objectives were to examine the relationships between outcome measures (general and cancer-specific HR-QoL and the Patient Generated Index (PGI)).

DESIGN

Cross-sectional questionnaire study.

METHODS

Eighty-two newly diagnosed patients with head and neck cancer (HNC) completed the Illness Perception Questionnaire--Revised (IPQ-R), the Beliefs about Medicines Questionnaire (BMQ), the Hospital Anxiety and Depression Scale (HADS), the Brief COPE and the Life Orientation Test (LOT-R). Patient outcomes were assessed using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, MOS Short Form Health Survey (SF-12v2) and the Patient Generated Index (PGI).

RESULTS

These pre-treatment cross-sectional results have shown that key components of the SRM (beliefs and coping) were explanatory factors of HR-QoL outcomes. The PGI was not associated with any of the components of the SRM. The PGI was partially correlated with HR-QoL measures; in particular, Global QoL/health status (EORTC) and Mental Component Summary scores (SF-12).

CONCLUSIONS

Our findings suggest that the illness perceptions approach may be a useful method for eliciting and understanding patients' beliefs regarding HNC. In order to maximize outcomes, simple interventions could address particular patient beliefs and coping styles.

Quality of Life Correlates After Surgery for Laryngeal Carcinoma

OBJECTIVES

To assess the correlation of operation mode, postoperative radiotherapy, and disease stage factors with the health-related quality of life (HRQL) measures after surgery for laryngeal carcinoma.

STUDY DESIGN

Reanalysis of data of two multi-institutional cross-sectional studies.

PATIENTS AND METHODS

We interviewed 218 laryngectomees and 153 partial laryngectomy patients in and near Leipzig, Germany, in two cross-sectional studies, using the general and the head- and neck-specific quality of life questionnaires of the European Organization for the Research and Treatment of Cancer (EORTC QLQ-C30 and EORTC QLQ-H&N35). Multifactorial univariate and multivariate models were calculated, with laryngectomy vs. partial laryngectomy, radiotherapy (irradiated or not), and disease stage (International Union Against Cancer [UICC] stages I/II vs. III/IV) as influencing factors and the HRQL scales and items as dependent variables. Analyses were adjusted for the patient's age and the time elapsed since the operation.

RESULTS

Laryngectomees were more affected in their sense of smell (P < or = .000). Among irradiated patients, functioning levels and many symptom scales showed worse results (P < or = .05). Both operation mode and postoperative radiotherapy were independently associated with head- and neck-specific HRQL in multivariate analysis. Differences between disease stage groups, however, were not significant. Patient's age was an influencing factor on HRQL, but time since operation was not.

CONCLUSIONS

: Postoperative radiotherapy seems to have the greatest impact on patients' HRQL independent of other clinical factors following surgery for laryngeal carcinoma. Aftercare of irradiated laryngeal carcinoma patients should focus more on the patient's quality of life.

Is there a difference in quality of life, comparing summer and winter, in patients who have undergone total laryngectomy?

Introduction:

Several studies have implied that patients' quality of life stabilises six months after undergoing total laryngectomy. However, these studies may well have overlooked persistent short term variations in patients' quality of life. The aim of this study was to assess the impact of seasonal change (i.e. summervswinter) on the quality of life of patients following total laryngectomy.

Methods:

A prospective, cross-sectional study of recurrence-free laryngectomy patients was performed, using the European Organization for Research and Treatment of Cancer (version three) QLQ-C30 questionnaires (EORTC QLQ-C30), during January 2004 (i.e. winter), August 2004 (summer) and January 2005 (winter).

Results:

Thirty-six patients were entered into the study. The response rate was 70.3 per cent. Patient's time elapsed since surgery varied from six months to 12 years. In all questionnaire domains, responses seemed remarkably consistent over time.

Conclusion:

No statistically significant differences were found between summer and winter scores in all the domains analysed by the EORTC QLQ-C30.

Illness and treatment beliefs in head and neck cancer: is Leventhal's common sense model a useful framework for determining changes in outcomes over time?

OBJECTIVE

The main aim of this prospective study was to examine the utility of Leventhal's common sense model in predicting longitudinal judgement-based outcomes in patients with head and neck cancer (HNC). The study is of potential importance as it focuses on the relations between personality factors, coping styles, informational needs, illness representations, and outcomes using a longitudinal study design. This has particular value as the trend in similar research is to focus on concurrent relations between variables. In addition, the prediction of numerous outcomes from illness perceptions has received relatively scant attention in the field of HNC.

METHODS

Fifty patients completed the following measures prior to treatment, 1 month and 6-8 months after treatment: IPQ-R, BMQ, Brief COPE, LOT-R, SCIP, EORTC QLQ-C30, SF-12, Patient Generated Index (PGI), and HADS.

RESULTS

Baseline illness and treatment beliefs were not predictive of HR-QoL, individualized QoL, or anxiety 6-8 months after treatment; however, beliefs about the chronicity of the disease (timeline beliefs) were predictive of depression after treatment. Coping strategies employed and levels of satisfaction with information before treatment were significant predictors of several outcomes.

CONCLUSIONS

Our findings suggest that a common sense model may be a useful framework for eliciting and understanding patients' beliefs regarding HNC; however, there are concerns regarding the use of a 'dynamic' model to predict longitudinal outcomes from baseline factors that may change over the course of an illness.

Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross-sectional study in a community hospital outpatient centre

The purpose of the present study is to determine the impact of illness characteristics and psychopathological comorbidity on the quality of life (QoL) of radio-oncological patients in health-related and individual dimensions. Sixty-three of 93 eligible patients (40 women and 23 men) were included in the study during their radiation therapy visit to an outpatient centre annexed to a community hospital in Southern Bavaria, Germany. In a semi-structured interview, we elicited individually relevant life domains rated by the patients according to the 'Schedule for the Evaluation of Individual Quality of Life - Direct Weighting'. In addition, the participants completed the 'European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire Core 30' and the 'Hospital Anxiety and Depression Scale'. We also assessed the demand for psychotherapy and utilization of psycho-oncological services. In total, 9.5% of the examined patients suffer from clinically relevant anxiety and/or depression [total Hospital Anxiety and Depression Scale (HADS) score >19]. There was a weak positive correlation between Karnofsky's Performance Status and QoL. Anxiety and depression were significantly correlated with impaired QoL, especially with impaired individual QoL. There was no association between psychopathological comorbidity and the requirement for psycho-oncological support. Conversely, patients who report difficulties in accepting help had a significantly lower QoL. Psychopathological comorbidity has a considerable influence on QoL of patients undergoing radiotherapy. Measuring the individual QoL appears as an adapted needs assessment and helps the psychotherapist in focusing on the patient's problems and desires. Furthermore, the patient's QoL is a main target in providing or planning mental health care in non-university oncological services.

Defining the stenotic post-laryngectomy tracheostoma and its impact on the quality of life in laryngectomees: development and validation of a stoma function questionnaire

OBJECTIVES

The aims of this study were to identify if: (i) size of stoma contributes to quality of life (QoL) in laryngectomees; (ii) stoma size has an impact on routine stoma care and function; and (iii) an optimal stoma size exists below which patients experience stoma problems.

DESIGN

Cross-sectional study of laryngectomees.

SETTING

Two tertiary care centres.

PARTICIPANTS

Fifty-seven patients who had undergone total laryngectomy one to five years ago and using tracheo-oesophageal speech as their primary communication means.

MAIN OUTCOMES MEASURES

Three main measures were studied: 1 a new study specific questionnaire designed to assess problems with function and care of the end tracheosto- ma; 2 QoL as assessed by the head and neck QoL instrument; 3 a precision custom designed sizer to measure the minimum stoma diameter.

RESULTS

The final study-specific questionnaire contained four items assessing different aspects of stomal function. From raw total scores an overall stomal score was generated. The stoma score was moderately correlated to emotion and speech domains in head and neck Quality of Life questionnaire, indicating that different concepts were being measured. The mean minimum stoma diameter was 15.9 +/- 2.9 mm. There was a significant increase in the area under the receiver operating characteristic curve beyond a threshold value of > or 15 mm; smaller sizes were associated with a poorer stoma score (Mann-Whitney test, P < 0.001). No patient found the stoma sizer use distressing.

CONCLUSIONS

Size of stoma significantly contributes to QoL in laryngectomees and stomas with minimum diameters of 14 mm or less are associated with adverse effects on routine stoma function. The study-specific stoma function questionnaire appears to be a useful instrument.

Deterioration in quality-of-life of late (10-year) survivors of head and neck cancer

OBJECTIVES

To determine 10-year quality-of-life (QOL) in head and neck cancer patients and to examine the potential predictors of late QOL.

DESIGN

Prospective 10-year (QOL) assessment in a cohort of head and neck cancer patients.

SETTING

Tertiary referral head and neck cancer centre in Auckland, New Zealand.

PARTICIPANTS

Two hundred patients diagnosed and were treated for head and neck cancer. Exclusion criteria were blindness, learning difficulties or inability to understand or read English.

MAIN OUTCOME MEASURES

Quality-of-life at 10 years measured by Auckland QOL questionnaire, and analysed for associations with the following co-variates: age, gender; co-morbidities (alcohol intake and smoking), type and stage of disease; treatment modality; and QOL measures.

RESULTS

At 10 years following diagnosis, overall QOL (life satisfaction), decreased significantly by an average of 11% (95% CI: -5, -17) compared with before treatment, and by 15% when compared with years 1 and 2. Pre-treatment QOL significantly predicted late QOL, whilst QOL 1 year after treatment did not. None of the socio-demographic, disease- or treatment-related factors predicted long-term QOL on univariate analysis, but this may be due to the small sample size.

CONCLUSIONS

This observed, late drop in the QOL of head and neck cancer patients requires further corroboration and investigation. Due to small sample sizes associated with long-term studies in head and neck cancer cohorts, studies of predictors of long-term QOL will only be likely to succeed if done as multi-centre studies. As there is some evidence to suggest that psychosocial interventions improve the QOL of head and neck cancer patients, it may be appropriate to consider screening for risk of a late deterioration in QOL in order to plan appropriate psycho-social intervention.

Matched case-control study of quality of life and xerostomia after intensity-modulated radiotherapy or standard radiotherapy for head-and-neck cancer: initial report

PURPOSE

To compare quality of life (QOL) and xerostomia between head-and-neck cancer patients who received standard radiotherapy (RT) and patients matched by factors known to affect QOL who received intensity-modulated RT (IMRT).

METHODS AND MATERIALS

This was a prospective, longitudinal study of patients with head-and-neck cancer requiring bilateral neck irradiation who received IMRT at the University of Michigan and patients who received standard RT at affiliated clinics. Each patient received a validated head-and-neck cancer-related QOL questionnaire (HNQOL) consisting of four multi-item domains--Eating, Communication, Pain, and Emotion--and a validated patient-reported xerostomia questionnaire (XQ). In both questionnaires, the answers were scored 0-100, with higher scores denoting worse QOL or xerostomia. The questionnaires were given before therapy and at 1, 3, 6, 12, 18, and 24 months after the completion of therapy. Each standard RT patient was matched with several IMRT patients according to tumor site, stage, RT status (postoperative or definitive), and age. A linear mixed-effects model was fit to compare outcomes between the two treatment groups and to model trends over time. To account for matching, the differences in scores between the matched sets of patients were fit as a random intercept. Also, matching was taken into account in the model by using the standard error of the within-paired-groups differences.

RESULTS

Between 1997 and 2002, 10 patients who had received standard RT and answered the XQ and HNQOL through at least 1 year were included in the study. Each of these patients was matched with a subgroup of 2-5 patients (median, 3) who had received IMRT, had similar patient and tumor characteristics, and answered the same questionnaires. A total of 30 patients were included in the IMRT group. During the initial months after therapy, the XQ and HNQOL summary scores worsened significantly in both groups compared with the pretherapy scores. Starting at 6 months, improvements of both XQ and HNQOL scores were found over time in the IMRT patients (p = 0.01 and 0.04, respectively), compared with no trend of improvement in the standard RT patients (p = 0.5 and 0.9, respectively). The trend of improvement over time in QOL in the IMRT patients was noted in most of the HNQOL domains (Eating: p = 0.07, Pain: p = 0.05, Emotion: p = 0.04, and Communication: p = 0.13), compared with no trend of improvement in most of the domains in the standard RT patients. As the scores of the IMRT (but not the standard RT) patients improved over time, the differences between the groups in the mean XQ and HNQOL summary scores widened. At 12 months, median XQ and HNQOL scores were lower (better) in the IMRT compared with the standard RT patients by 19 and 20 points, respectively, adjusted for the pretherapy values (p = 0.2). In both groups, the pretherapy XQ and HNQOL summary scores were significantly related to the respective posttherapy scores (p = 0.02 and p < 0.01, respectively).

CONCLUSIONS

After initial posttherapy declines in both groups, xerostomia and QOL improved over time after IMRT but not after standard RT. The potential benefits gained from IMRT in xerostomia or in QOL, compared with standard RT, are best reflected late (> or = 6 months) after therapy.

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.

Physical and psychosocial correlates of head and neck cancer: an update of the literature and challenges for the future (1996-2003)

An update of the literature on physical and psychosocial aspects of head and neck cancer, with special emphasis on effects of treatment, patient-related factors and psychosocial intervention on quality of life (QoL). QoL deteriorates during and directly after treatment and returns only slowly to pre-treatment values. Organ preservation, gender and coping-strategies are factors related to QoL after treatment. As prognosis and survival were found to be comparable under different treatment regimes, we noticed a gradual shift in therapy towards organ preservation. Systematic care, using specific instruments is important for improving the QoL. We feel that more attention should be given to improving support, in order to optimize the QoL of patients during the palliative stage.

Evaluations of quality of life and organ function

For advanced head and neck cancer (HNC) patients, aggressive radiation and chemoradiation treatments offer new therapy options. The aims of these regimens are increased survival and organ preservation, with the goals of preserving organ function, minimizing late effects, and improving quality of life (QOL). At the same time, the toxicities of these regimens are acknowledged as is the potential for long-term dysfunction. Thus, particularly now, with the increasing use of aggressive chemoradiation therapy (CRT) regimens, documentation of the QOL and functional outcomes of these treatments is critical. The implications for speech and swallowing are widely recognized and the broader effects of these impairments on overall QOL have received some attention. This article presents data on the performance, functional, and QOL results of radiation therapy (RT) and various CRT regimens in HNC.

Health-related quality of life five years after diagnosis of laryngeal carcinoma

PURPOSE

To evaluate the health-related quality of life (HRQL) of patients with laryngeal carcinoma in a prospective longitudinal multicenter study at diagnosis, after 1 and 5 years in relation to tumor location and treatment modality.

SUBJECTS AND METHODS

Eighty-six patients (mean age 66 years; 84% males) with laryngeal carcinoma were evaluated with standardized HRQL questionnaires: the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core-30 (EORTC QLQ-C30), the EORTC QLQ-Head and Neck Cancer Module (EORTC QLQ-H&N35), and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Some significant changes in HRQL were found between diagnosis and 5 years after diagnosis, depending on the treatment given. The patients' ability to speak improved whereas some general functions deteriorated and treatment-related side effects increased. When comparing HRQL at 1 and 5 years after diagnosis, it appears that most values at the 1-year follow-up assessment persist until 5 years, but a few deteriorate. The HRQL at diagnosis seems to be associated with survival rate after 5 years, and the global quality of life scale at diagnosis tends to predict HRQL after 5 years.

CONCLUSIONS

The use of HRQL questionnaires is valuable when comparing different treatments and as an aid in predicting treatment side effects. Evaluation of HRQL at diagnosis for patients with laryngeal carcinoma seems to be of value for the prognosis of HRQL over time and for the prognosis of survival.