Pretreatment quality of life as a prognostic factor for early survival and functional outcomes in patients with head and neck cancer.

Abstract

Quality of life (QOL) scores in cancer patients are associated with disease course and treatment outcomes. The aim of this study was to prospectively evaluate the associations between pretreatment QOL scores and survival or functional outcomes in patients with head and neck squamous cell carcinoma (HNSCC). This prospective study enrolled a total of 141 patients with previously untreated HNSCC who underwent curative treatments from October 2010 to March 2012. Patients completed questionnaires on QOL including the European Organization of Research and Treatment of Cancer 30-item Core QOL questionnaire (EORTC QLQ-C30) and EORTC QOL questionnaire Head and Neck Cancer module (QLQ-H&N35). Univariate and multivariate analyses were used to identify QOL scores significantly associated with overall survival (OS), disease-free survival (DFS), and functional outcomes of gastrostomy or tracheostomy dependence. The 2-year OS and DFS rates were 82.3 and 78.0%, respectively. The rates of gastrostomy and tracheostomy dependence were 9.2 and 14.9%, respectively. After controlling for clinical factors, specific QOL indices of 'dyspnea' (hazard ratio 1.023 [95% confidence interval 1.006-1.039]) and 'appetite loss' (1.020 [1.005-1.034]) were significantly associated with OS, while 'insomnia' (1.013 [1.002-1.025]) and 'appetite loss' (1.014 [1.001-1.026]) scores were significantly predictive of DFS (P < 0.05). Global health status score (0.967 [0.935-1.000]) and fatigue (1.048 [1.010-1.086]) were significantly associated with the dependence of tracheostomy (P < 0.05). There was no relationship between gastrostomy dependence and QOL indices. This study provides evidence of significant relationships between certain pretreatment QOL measures and survival or functional outcomes in HNSCC patients.