Effect of comorbidity on post‐treatment quality of life scores in patients with head and neck squamous cell carcinoma

Abstract

To determine the effect of comorbidity on 1-year post-treatment quality of life (QOL) in patients with head and neck squamous cell cancer (HNSCC). One hundred twenty-five previously untreated HNSCC patients participated in longitudinal QOL analysis over a 28-month period. The University of Washington QOL questionnaire, Performance Status Scale, and Karnofsky score were used to measure QOL. Generalized estimating equations were used to analyze the effects of patient variables and their interaction with time. The majority of patients (74%) had advanced stage (III/IV) disease; advanced comorbidity was present in 30%. Early tumor, node, metastases (TNM) stage was associated with significantly greater decreases in 1-year chewing and swallowing scores (P < .0001) than advanced stage disease. Nonoperative treatment was associated with significantly poorer 1-year shoulder and taste scores for early TNM stage, in contrast to advanced stage disease (P = .01). Comorbidity alone did not affect any of the QOL indices, but showed an interaction with treatment and primary site for appearance and chewing scores, respectively. Patients with high-grade comorbidity had poorer 1-year survival (80% for early stage disease, 55% for advanced stage disease) than patients with low-grade comorbidity (100% for early stage disease, 69% for advanced stage disease). These data suggest that patient perception of disability, rather than the extent and severity of disease, influences the majority of head and neck disease-specific QOL indices. Analysis of the effects of comorbidity on post-treatment QOL is limited by increased mortality in patients with advanced comorbidity.