Health-related Quality of Life in Head and Neck Cancer. A Five-year Prospective Multicenter Study

Abstract: The aim of this prospective longitudinal multicenter study was to evaluate the health-related quality of life (HRQL) in patients with head and neck cancer at diagnosis, after one and five years in relation to tumour location, stage, sub site, treatment modality, gender and age. The first part of the study, lasting for one year, consisted of 357 patients (mean age 63 years; 72% males) that were included between 1993 and 1995. Their health-related quality of life (HRQL) was evaluated repeatedly with standardized HRQL questionnaires; the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and the EORTC Head and Neck Cancer Module (EORTC QLQ-H&N35). A follow-up was performed 1998-2000 on the 192 surviving patients after five years, and 167 (87%) of them answered the same questionnaires once more. The results, i.e. the mean score for the entire study population showed no improvements in HRQL. Deterioration was found already after 3 months for treatment related symptoms, such as problems with teeth, opening of the mouth, dryness in the mouth and sticky saliva. These problems persisted or worsened over time. Similar results were found regardless of tumour location, stage, sub site, most treatment modalities, gender and age. Patients who died during the study, reported worse HRQL both at diagnosis and at the one-year follow-up compared to the survivors. The HRQL at diagnosis was associated with survival and with quality of life after five years. When the data were analyzed individually, 40% of the patients reported improved score on the global quality of life scale from diagnosis to the five-year follow-up. In addition, 11% had a high quality of life at both assessment points. This pattern also applied for most of the other function and symptom scales, except for treatment related symptoms. The side-effects of treatment were noteworthy even in those patients that showed stable or improved global quality of life. In conclusion, treatment of head and neck cancer often result in side-effects for at least five years, and problems with dry mouth, teeth and sticky saliva are considerable. The HRQL at diagnosis for patients with head and neck cancer seems to be an important factor for the prognosis of both HRQL over time and survival.