Dynamics of quality of life of head and neck cancer patients after treatment. Clinical significance

The study objective is to evaluate the quality of life as one of the main parameters that determines the effectiveness of treatment of patients with head and neck squamous cell carcinoma.Materials and methods. Thirty-three stage III—IV oral cancer patients aged between 39 and 70 years were asked to fill EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer quality of life questionnaire core 30-questions) and QLQ-H&N35 (head and neck cancer-specific module) before and 12—18 months after completion of the treatment that consisted of surgery followed by radiation with or without chemotherapy. Surgery included neck dissection with removal of the primary tumor via transoral (n = 5) or combined (n = 28) approach. Reconstruction was performed by primary closure (n = 5), with pedicled (n = 8) or free (n = 20) flaps.Results. According to EORTC QLQ-C30 questionnaire only positive shifts turned out to be statistically significant: general health, emotional function, pain, insomnia and diarrhea. Site-specific EORTC QLQ-H&N35 questionnaire revealed several positive (pain in the head and neck, feeling ill, use of painkillers and weight gain) and negative (public eating, problems with taste and smell, sticky saliva and dry mouth) changes. Applying algorithms for determining clinical significance changed the number and value of several scales and domains. Changes in general health, emotional function, pain, insomnia, pain in the head and neck, taste and smell disorders, mouth opening, sticky saliva, dry mouth, painkillers and weight gain were found to have some clinical relevance. Moreover, for one of them (mouth opening) statistical significance was not reached.Conclusions. Further research of clinical significance of changes and differences in scales and domains that determine and affect quality of life are needed. They will allow to understand more fully problems that every patient with oral cavity cancer tries to cope with.

Health-related quality of life in oropharyngeal cancer survivors – a population-based study

Objective: The aim of this study was to compare QoL of oropharyngeal cancer survivors who had received different treatments. Subjects and methods: We contacted 954 survivors. Each survivor received the QoL questionnaires EORTC QLQ-C30 and EORTC QLQ-H&N35. Results: A total of 263 survivors completed the questionnaires (28% responses). Forty-five of them had undergone surgery, 20 had received definitive radiotherapy or chemo-radiotherapy, 85 surgery plus adjuvant radiotherapy, and 111 surgery plus adjuvant chemo-radiotherapy. Survivors who had received adjuvant radiotherapy and surgery reported significantly more problems with swallowing (B=13.43 [95% Confidence Interval (CI) 1.83-25.03]), senses (B=24,91 [CI 11.86-37.97]), eating (B=16.91 [CI 3.46-30.36]), dry mouth (B=26.42 [CI 12.17-40.67]), sticky saliva (B=22.37 [CI 6.23-38.50]) and nutritional supplements (B=18.59 [CI 0.62-36.56]) than those who had received surgery only. Survivors who had received adjuvant chemo-radiotherapy and surgery reported significantly many more problems with dry mouth (B=34.15 [CI 18.91-49.39]) and sticky saliva (B=22.90 [CI 5.65-40.16]), and fewer problems with physical functioning (B=-12.07 [CI 0.49-23-64]). Conclusion: Survivors who participated in this survey and who had undergone surgery alone reported in some head- and neck-specific domains a better health-related quality of life than patients who had undergone multi-modal treatment or adjuvant radiotherapy.