Treatment of Head and Neck Cancer, Effects on Health-Related Quality of Life and Nutrition

Abstract: The aim of this thesis was to explore the impact of treatment on health-related quality of life (HRQoL), fatigue and nutrition in head and neck cancer (HNC) patients. The tumour locations often induce problems with swallowing and nutrition. Curative treatment, in-cluding surgery and/or radiotherapy (+/- chemotherapy), aggravates these problems, and worsened HRQoL is common. The thesis is based on three cohort studies and one random-ized controlled trial comparing radiotherapy combined with cetuximab or cisplatin. HRQoL was assessed with validated questionnaires from the European Organization for Research and Treatment of Cancer (EORTC). The GLIM criteria were used to diagnose mal-nutrition. Results: Paper I evaluated HRQoL in patients with cancer of the base of the tongue (CBT) one year after treatment. Their HRQoL was significantly worse than that of the general population, especially local symptoms such as pain, swallowing problems and dry mouth. When CBT patients were compared to patients with tonsil cancer, only a minimal differ-ence in HRQoL was observed. Paper II aimed to explore the impact of treatment on HRQoL depending on age. The HRQoL at diagnosis and repeatedly measured up to one year after treatment were similar or even better for older patients (>70 years) than for younger pa-tients. After treatment, older patients did not regain their physical function to the same level as the younger patients did. In Paper III, fatigue was evaluated for 5 years in the same cohort. Physical fatigue was significantly worse after 3 months, whereas emotional and cognitive fatigue were the worst at diagnosis and at 3 months. All fatigue domains were significantly better after one year and remained stable to five years after treatment. There were no long-term differences in fatigue for age or treatment modality. A few predictors for developing chronic fatigue were found. In Paper IV, radiotherapy with concomitant cetux-imab was equal to concomitant cisplatin regarding the number of malnourished patients according to the GLIM criteria. However, at 6 weeks, patients receiving cisplatin had lost significantly more weight. Conclusions: HRQoL is persistently decreased compared to general population scores, and malnutrition is common after treatment of HNC. Rehabilitation and nutritional support before, during and after cancer treatment are important in the management of HNC patients. These findings may also help to affirm to patients and caregivers regarding the natural progress of symptoms associated with HNC and its treatment.