Health related quality of life following the treatment of oropharyngeal cancer by transoral laser.

Abstract

In 2006, our Institution changed the treatment strategy for small volume primary oropharyngeal tumours to transoral laser microsurgery (TOLM). The main aim of this cohort study was to report the health related quality of life (HRQOL) at around 2years following TOLM in consecutive patients treated from July 2006 through April 2013. The University of Washington Quality of Life (UW-QOL) questionnaire was administered annually up to Spring 2014 and adjusting for mortality the overall response rate was 71% (108/153). Tonsil primary site characterised 60% (98) of patients, base of tongue 25% (40), soft palate 13% (21) and others 2%, (3). Most patients had TOLM, neck dissection and adjuvant radiotherapy, with 21% (34) of tumours at stage 1 or 2, 25% (40) at stage 3 and 54% (88) at stage 4. Kaplan-Meier estimates of overall survival were 94% at 1year, 88% at 2years and 68% at 5years after TOLM. Three-quarters (76%) reported their overall QOL as being good, very good or outstanding, and by domain a clear majority of patients (range 57-94%, median 79%) reported none or only minor problems, most notably for swallowing, chewing and speech. The main dysfunction was in saliva (39%). In conclusion, the outcomes in TOLM for oropharyngeal squamous cell carcinoma are very encouraging. The data supports the current treatment strategy in the Unit. Further outcomes research is required to help refine patient selection to help optimise the survival and HRQOL benefit of TOLM.