Level of distress predicts subsequent survival in successfully treated head and neck cancer patients: a prospective cohort study

Abstract

Conclusion: Our findings indicate a unique survival prediction from general health questionnaire (GHQ) sum scores in successfully treated head and neck squamous cell carcinoma (HNSCC) patients and also to some extent with inclusion of health-related quality of life (HRQoL) scores. Objective: To examine the survival prediction from the level of distress, measured by GHQ scores obtained from at inclusion successfully treated HNSCC patients. Methods: Structured interviews were conducted for 135 successfully treated cognitive functioning HNSCC patients 67 ± 31 (mean ± SD) months after diagnosis following a regular follow-up visit. GHQ scores, alcohol consumption history, smoking status, present comorbidities, level of neuroticism, choice of psychological coping with the cancer disease, and HRQoL scores (EORTC QLQ-C30 and -H&N35) were determined. The TNM stage, treatment provided and tumour site were obtained from the hospital records. Forty-three deaths were noted during a minimum 8.5 years of observation. Results: The GHQ sum scores predicted survival in univariate (p < 0.05) and multivariate analyses with the above-mentioned covariates included (p < 0.01). Using clinically relevant cut-off levels, GHQ scores predicted survival in both univariate (hazard ratio (HR) 1.9; p = 0.05) and multivariate Cox regression analyses (HR 3.8; p = 0.001). We also demonstrated survival prediction from GHQ scores when adjusted by HRQoL scores.