Abstract
BackgroundNew medicinal and surgical oncological treatment strategies not only improve overall survival rates but continually increase the importance of Health-Related Quality of Life (HRQOL). The purpose of this retrospective cross-sectional study was to analyze HRQOL of patients with oral squamous cell carcinoma after ablative surgery and to evaluate predictive factors for HRQOL outcome.MethodsThe study included 88 patients with histologically confirmed oral squamous cell carcinoma of whom 42 had undergone local reconstruction (LR) and 46 microvascular reconstruction (MVR). During follow-up, all patients completed the University of Washington Quality of Life Questionnaire (UW-QOL) containing 12 targeted questions about the head and neck. Descriptive analyses were made for the tumor site, the T-stage, and adjuvant therapies. HRQOL was compared between the LR and the MVR group with parametric tests. Further analyses were impact of the tumor site, the T-status, and the time from surgery to survey on HRQOL. Statistics also included multivariate correlations and different interaction effects.ResultsHRQOL in the LR group was ‘very good’ with 84.3 ± 13.7 and ‘good’ in the MVR group with 73.3 ± 16.5 points. The physical domains swallowing (p = 0.00), chewing (p = 0.00), speech (p = 0.01), taste (p = 0.01), and pain (p = 0.04) were significantly worse in the MVR group. An increase in the T-status had a significant negative effect on swallowing (p = 0.01), chewing (p = 0.01), speech (p = 0.03), recreation (p = 0.05), and shoulder (p = 0.01) in both groups. Regarding the tumor site and subsequent loss of HRQOL, patients with squamous cell carcinoma on the floor of the mouth had significantly worse results in the categories pain (p = 0.002), speech (p = 0.002), swallowing (p = 0.03), activity (p = 0.02), and recreation (p = 0.01) than patients with tumors in the buccal mucosa. Speech (p = 0.03) and pain (p = 0.01) had improved 1 year after surgery.ConclusionPatients with flap reconstruction because of oral squamous cell carcinoma showed very good overall HRQOL. Outcomes for microvascular reconstruction were good, even in the case of larger defects. The T-status is a predictor for HRQOL. Swallowing, chewing, speaking, taste, and pain were the most important issues in our cohort.Implementing HRQOL questionnaires for the assessment of quality of life could further increase the treatment quality of patients with oral cancer.
Highlights
New medicinal and surgical oncological treatment strategies improve overall survival rates but continually increase the importance of Health-Related Quality of Life (HRQOL)
1 patient had been treated for a T3-tumor. 80 patients (90.9%) underwent neck dissection, and 17 patients (19.3%) received adjuvant therapy. 46% of the patients had University of Washington Quality of Life Questionnaire (UW-QOL) scores
The comparison of the mean scores of the local reconstruction (LR) and microvascular reconstruction (MVR) groups showed that the domains swallowing (p = 0.001), chewing (p = 0.000), speech (p = 0.011), taste (p = 0.014), and pain (p = 0.036) were significantly worse in the MVR group
Summary
New medicinal and surgical oncological treatment strategies improve overall survival rates but continually increase the importance of Health-Related Quality of Life (HRQOL). The purpose of this retrospective cross-sectional study was to analyze HRQOL of patients with oral squamous cell carcinoma after ablative surgery and to evaluate predictive factors for HRQOL outcome. Over the past few years, functional and psychosocial rehabilitation has progressively become an essential secondary outcome [1,2,3,4,5] In this regard, the model of Health-Related Quality of Life (HRQOL) was developed to assess patient function and well-being after oncological therapy and to gain structured insight into disease- and therapy-derived problems [2, 6, 7] HRQOL needs certainly to be seen as a complex multidimensional construct with a very individual character [1, 7, 8]. Further aspects of HRQOL have to be identified in the future to be able to use quality of life as a standardized outcome parameter after flap reconstruction and to enhance oncological outcome while minimizing postoperative handicaps [8, 10, 13]
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