Impact of Family Caregiver and Patient Related Factors on Quality of Life in Head Neck Cancer Patients

Abstract

To study an impact of family caregiver and patient related factors on quality of life in head- neck squamous cell carcinoma (HNC) patients. A descriptive cross-sectional study was conducted in department of radiation oncology at a rural tertiary cancer center from August 2019 to January 2022. Marathi speaking, newly diagnosed, non-metastatic, histopathology proven HNC patients who consented for study were included. Marathi version of an updated head neck specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-H&N43) was used. Indigenously prepared and validated interviewer administered questionnaire (IAQ) for patients and respective family caregiver (FCG) were used to understand attitude towards HNC(ATHNC) and FCG's attitude as a caregiver (ATC). Total score was directly proportional to ATHNC and inversely proportional to ATC. Graph-Pad, Instat-3 (California Inc) was used for statistical analysis. A total of 210 patients and respective FCG were interviewed. Subgroup analysis of QOL was done for 201 radically treated patients (RTP) with respect to age, sex, education, socioeconomic status, place of residence, duration of symptoms, stage and disease sub-site. QOL of palliative treatment group (N = 9) was compared with RTP. All these parameters had impact on QOL with medium to large effect size difference and minimum important difference/change. ATHNC was significantly better for young (p = 0.022), literate (p = 0.004) and upper socioeconomic class (USC) (p = 0.043) FCGs. It was significantly better for male (p = 0.003), literate (p = 0.001), USC (p = 0.004) patients presenting in early stage of disease (p = 0.013). Though it was not significant on multivariate analysis. ATHNC score of FCGs had significant effect on QOL of patients with respect to role function (RF) (p = 0.032), financial difficulties (FI) (p = 0.017) and sexuality (SX) (p = 0.048). Patients with higher ATHNC score had significantly better QOL with respect to social function (SF) (p = 0.0004), FI (p = 0.0002), body image (BI) (p = 0.0033) and social contact (SC) (p = 0.0057). QOL of patients having FCGs with lower ATC score was significantly better. QOL of patients with younger FCGs was significantly better with respect to FI (p = 0.0244) while it was significantly better for pain (PA) (p = 0.0462) and emotional function (EF) (p = 0.0144) if FCG was male. Suboptimal literacy and accountability level were few short comings of this study. Informer bias cannot be ruled out CONCLUSION: Age, sex, place of residence, educational level, socioeconomic status, duration of symptoms, stage, and site of lesion affects different QOL parameters differently and hence an individual QOL needs to be addressed. FCGs parameters affect QOL of patients. Understanding the determinants and its pattern of effect on QOL of patients will guide us to offer timely care and interventions in a pragmatic mode.