Quality of Life Measures in Head and Neck Cancer

Abstract

Quality of life (QOL) is an important patient reported outcome (PRO) in head and neck cancer (HNC) where survival rates remain at approximately 50% overall. HNC specific Health Related Quality of Life (HR-QOL) instruments typically measure aspects of communication, swallowing, chewing, nutrition and cosmesis. Nine disease specific HR-QOL instruments have been published for patients with HNC focusing on a range of treatments and outcomes. Treatment for HNC results in medium term morbidity and depression, much of which has been shown to improve within 1 year. There is no clear evidence for the impact of disease and treatment on PROs such as QOL. The emotional sequelae and perception of physical limitations may be more important to the patient than the actual limitations resulting from HNC and treatment. This chapter highlights the insensitivity of general measures of HR-QOL to accurately illustrate HNC specific problems or treatment related effects. The majority of published studies do not interpret HR-QOL scores in terms of clinical relevance. Using a global or total score for examining effects of treatment induced change may not be appropriate for this patient group. Further research is needed into the potentially modifiable aspects of QOL or modifiable factors related to PROs in order to design appropriate interventions.