Health-related quality of life and overall survival: a prospective study in patients with head and neck cancer treated with radiotherapy

A J Van Nieuwenhuizen,J Voortman,C R Leemans,I M Verdonck-De Leeuw,L M Buffart,J A Langendijk,M R Vergeer

doi:10.1007/s11136-020-02716-x

A J Van Nieuwenhuizen, J Voortman + Show 5 more

Open Access

https://doi.org/10.1007/s11136-020-02716-x

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Journal: Quality of Life Research	Publication Date: Dec 8, 2020
Citations: 15	License type: open-access

Affiliation: Amsterdam University Medical Centers

Abstract

PurposeWe aimed to examine whether pre-treatment, post-treatment and change in health-related quality of Life (HRQoL) is associated with survival, in patients with head and neck cancer (HNC).MethodsWe included 948 newly diagnosed HNC patients treated with primary or adjuvant (chemo)radiotherapy with curative intent. The EORTC QLQ-C30 questionnaire was assessed pre-treatment and at 6 weeks, 6 months and 12 months post-treatment. Multivariable Cox regression analyses were performed to examine whether HRQoL at all time points and changes in HRQoL over time were associated with survival, after adjusting for demographic, clinical and lifestyle-related variables.ResultsHigher HRQoL scores were significantly associated with improved 5-year overall survival at all time points, except for the subscale global QoL at 6 weeks. Changes in HRQoL at 6 weeks post-treatment compared to pre-treatment were not significantly associated with survival. Changes in physical (HR: 0.88 95% CI: 0.82–0.96) and emotional functioning (HR: 0.90 95% CI: 0.85–0.96) from pre-treatment to 6 months post-treatment and changes in global QOL, and physical, emotional, and social functioning from pre-treatment to 12 months post-treatment were significantly associated with survival.ConclusionHigher HRQoL reported pre-treatment and post-treatment (6 weeks, 6 months and 12 months) are significantly associated with improved survival, as well as changes in HRQoL at 6 and 12 months compared to pre-treatment. Our results highlight the value of monitoring HRQoL and to identify those patients that report decreased or deteriorated HRQOL. This may help to further improve cancer care in a timely and efficient manner.

Highlights

Many patients with head and neck cancer (HNC) have to deal with severe physical and psychosocial problems because of the disease and its treatment
Deterioration in global quality of life (QoL), physical, emotional and social functioning at 12 months after treatment compared to pre-treatment was significantly associated with shorter survival
A negative mean change score indicates worsening of health-related quality of life (HRQoL) after treatment compared to pre-treatment. This comprehensive study among a large group of patients with HNC showed that better HRQoL was significantly associated with longer survival, adjusted for demographic, lifestyle-related and clinical factors

Summary

Introduction

Many patients with head and neck cancer (HNC) have to deal with severe physical and psychosocial problems because of the disease and its treatment They are often confronted with HNC-specific problems, such as oral dysfunction, swallowing and speech impediments [1,2,3,4,5,6,7,8,9,10]. These disorders have a distinct impact on the health-related quality of life (HRQoL) of patients with HNC. 63% of the studies included in that review did not consider relevant confounders (e.g. 11 studies did not assess comorbidity, and seven studies did not assess smoking and alcohol consumption) [21]

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