University Of Washington Quality Of Life Research Articles

Toxicities Affecting Quality of Life After Chemo-IMRT of Oropharyngeal Cancer: Prospective Study of Patient-Reported, Observer-Rated, and Objective Outcomes

To test the hypothesis that intensity modulated radiation therapy (IMRT) aiming to spare the salivary glands and swallowing structures would reduce or eliminate the effects of xerostomia and dysphagia on quality of life (QOL). In this prospective, longitudinal study, 72 patients with stage III-IV oropharyngeal cancer were treated uniformly with definitive chemo-IMRT sparing the salivary glands and swallowing structures. Overall QOL was assessed by summary scores of the Head Neck QOL (HNQOL) and University of Washington QOL (UWQOL) questionnaires, as well as the HNQOL "Overall Bother" question. Quality of life, observer-rated toxicities (Common Toxicity Criteria Adverse Effects scale, version 2), and objective evaluations (videofluoroscopy assessing dysphagia and saliva flow rates assessing xerostomia) were recorded from before therapy through 2 years after therapy. Correlations between toxicities/objective evaluations and overall QOL were assessed using longitudinal repeated measures of analysis and Pearson correlations. All observer-rated toxicities and QOL scores worsened 1-3 months after therapy andimproved through 12 months, with minor further improvements through 24 months. At 12 months, dysphagia grades 0-1, 2, and 3, were observed in 95%, 4%, and 1% of patients, respectively. Using all posttherapy observations, observer-rated dysphagia was highly correlated with all overall QOL measures (P<.0001), whereas xerostomia and mucosal and voice toxicities were significantly correlated with some, but not all, overall QOL measures, with lower correlation coefficients than dysphagia. Late overall QOL (≥6 or ≥12 months after therapy) was primarily associated with observer-rated dysphagia, and to a lesser extent with xerostomia. Videofluoroscopy scores, but not salivary flows, were significantly correlated with some of the overall QOL measures. After chemo-IMRT, although late dysphagia was on average mild, it was still the major correlate of QOL. Further efforts to reduce swallowing dysfunction are likely to yield additional gains in QOL.

The Korean version of the University of Washington Quality of Life Questionnaire for Patients with Head and Neck Cancer, and its use in an initial validation study of 56 patients

The University of Washington Quality of Life (UW-QOL) questionnaire is often used to assess health-related quality of life (HRQOL) of head and neck cancer patients. The aim of this study was to translate the UW-QOL version 4 into the Korean language and to carry out an initial validation study. A recognized methodology for translation of questionnaires was used. The validation study used the final Korean version between March and September 2009. Adult patients were recruited, with a confirmed diagnosis of head and neck cancer, therapy completed and disease-free for at least 1 year. The UW-QOL was successfully translated into Korean. 56 patients completed Korean versions of UW-QOL, the Beck Depression Inventory and the World Health Organization Quality of Life-BREF and various expected correlations were confirmed first between the two UW-QOL subscales (Spearman 0.54 p<0.001) and then of these subscales with the other concurrent measures. Lower (worse) UW-QOL scores were seen for later stage patients in all 12 domains. The Korean version of UW-QOL is ready for use in the assessment of HRQOL for Korean patients. Validation work needs to be continued to further establish psychometric properties of the questionnaire for use in this population.

Evaluation of the limitations of using the University of Washington Quality of Life swallowing domain alone to screen patients in the routine clinical setting

A broad patient-completed screening tool in routine clinical practice in head and neck oncology has merit, but clinicians should be aware that its simplicity could lead to some patients and the detail of their problems being missed. The purpose of this study was to compare the University of Washington Quality of Life (UWQoL) swallowing domain with the MD Anderson Dysphagia Inventory (MDADI) in relation to the need for interventions for swallowing around one year after treatment. The group comprised 112 consecutively referred patients to speech and language therapy between January 2007 and August 2009 after primary operation for previously untreated oral and oropharyngeal squamous cell carcinoma (SCC). A total of 78 patients completed questionnaires (median time of assessment 11.7 months, IQR 6.1–12.2). There were significant (p<0.001) and moderately strong correlations (rs=0.51–0.62) between the UWQoL swallowing domain score and MDADI subscales and total scores, and also with individual MDADI questions: taking a great deal of effort (rs=0.71); being upset (rs=0.61); and not going out (rs=0.62) were the strongest in regard to swallowing. Use of a gastrostomy tube was associated with worse UWQoL and MDADI scores. In conclusion, patients who score 100 on the UWQoL do not require swallowing to be evaluated further. Those who score 70 could benefit from the detailed MDADI to help to clarify the specific problem and the impact it has before being referred to speech and language therapy. Those who score less than 70 should be brought to the attention of speech and language therapists to confirm that appropriate support and intervention are in place.

Enhanced patient reported outcome measurement suitable for head and neck cancer follow-up clinics

BackgroundThe ‘Worse-Stable-Better’ (W-S-B) question was introduced to capture patient-perceived change in University of Washington Quality of Life (UW-QOL) domains.Methods202 head and neck cancer patients in remission prospectively completed UW-QOL and Patients Concerns Inventory (PCI). For each UW-QOL domain, patients indicated whether over the last month things had worsened (W), remained stable (S) or were better (B).Results202 patients at 448 attendances selected 1752 PCI items they wanted to discuss in consultation, and 58% (1024/1752) of these were not covered by the UW-QOL. UW-QOL algorithms highlighted another 440 significant problems that the patient did not want to discuss (i.e. the corresponding items on the PCI were not selected).After making allowance for UW-QOL algorithms to identify 'significant problems' and PCI selection of corresponding issues for discussion there remained clear residual and notable variation in W-S-B responses, in particular to identify patients with significant problems that were getting worse, and patients without significant problems that wanted to discuss issues that were getting worse. Changes in mean UW-QOL scores were notably lower for those getting worse on the W-S-B question, typically by 10 or more units a magnitude that suggests clinically important changes in score.ConclusionsThe W-S-B question adds little questionnaire burden and could help to better identify patients who might benefit from intervention. The results of this study suggest that the UW-QOL with the W-S-B modification should be used together with the PCI to allow optimal identification of issues for patient-clinician discussion during routine outpatient clinics.

Coping and Quality of Life after Total Laryngectomy

To investigate how ways of coping and traditional factors (age, sex, time postlaryngectomy, stage of disease, radiation, alaryngeal speech method) predict global quality of life, head and neck cancer-specific quality of life, and voice-related quality-of-life outcomes after total laryngectomy. Cross-sectional survey. University-based laboratory and speech clinic. Sixty-seven individuals who underwent total laryngectomy secondary to cancer were recruited from support groups and professional contacts. Individuals were at minimum 9 months postlaryngectomy. All outcomes were patient reported and included demographic data as well as a number of validated questionnaires: the Ways of Coping-Cancer Version (WOC-CV) scale, the Voice-Related Quality of Life (V-RQOL) scale, and the University of Washington Quality of Life (UW-QOL) composite and global QOL scores. Fifty-three individuals identified a stressful aspect of their laryngectomy. As a set, traditional variables (age, time postlaryngectomy, alaryngeal speech method) accounted for only 5% of global QOL scores but between 25% and 30% of the variance of composite UW-QOL and V-RQOL scores. Time postlaryngectomy was the strongest traditional predictor. Ways of coping accounted for 23% to 32% of all QOL scores. Avoidant coping strategies (both cognitive and behavioral escape) were among the strongest predictors of poorer QOL. When traditional variables were combined with ways of coping, they together accounted for 26% to 46% of the variance of QOL outcomes. Coping is important to consider when evaluating postlaryngectomy outcomes, above and beyond traditionally investigated factors.

Quality of life after treatment of laryngeal carcinoma: a single centre cross-sectional study

Laryngeal cancer treatment inherently affects life's most basic functions and significantly affects quality of life (QOL). We aimed to identify which aspects of QOL and which patients are most affected by the various treatment options. The University of Washington Quality of Life (UW-QOL) questionnaire was administered to all patients with laryngeal cancer treated at a single institution over a seven-year period (2003-2010). In total, 41 patients responded. All had been treated for squamous cell carcinoma of the larynx. Questionnaires were completed at a median of 18.5 months after treatment. The overall quality of life was 81.1/100 as assessed by the UW-QOL scale, with only 4.9% reporting 'poor' or worse QOL. Neither patient age nor time after treatment significantly affected any aspect of QOL. Patients undergoing primary radiotherapy reported the best QOL. Those undergoing chemoradiotherapy or combined surgical treatment and chemoradiotherapy reported the worst QOL, particularly in terms of social eating, taste and saliva production. Patients with a T stage ≥2 and those with nodal metastases reported a significantly worse QOL. Overall, QOL in our patients was good. This study highlights the aspects of QOL most affected by various treatments for laryngeal cancer and identifies areas in which therapeutic intervention may be focused. It also provides information to guide clinicians when assisting patients to make informed decisions regarding treatment of their head and neck cancer.

HPV+ Oral Cancer Patients Do Not Have Better QOL Trajectory

Objective: To determine the role of human papillomavirus (HPV) status on quality of life (QOL) in patients with oral cavity and oropharyngeal squamous cell carcinoma (OSCC). We hypothesized that high risk HPV (HPV-16, 18, 35, 45) tumors would be associated with better QOL trajectory. Method: Head and neck-specific QOL was determined using the University of Washington Quality of Life (UW-QOL) scale version 4 in patients with newly diagnosed invasive OSSC (n = 296). Results: Pre-treatment QOL was higher in patients with high risk HPV tumors compared with patients with HPV negative or low risk HPV (HPV-11, 32, 53, 66) tumors ( P = .004). This association remained in multivariate analysis. Patients with high risk HPV tumors had larger decreases in QOL from pre-treatment to immediate posttreatment compared with patients with HPV negative or low risk HPV tumors ( P = .032). There was no association between HPV status and QOL 1 year posttreatment. Conclusion: Among patients with OSCC, high risk HPV was independently associated with higher pretreatment QOL. The data did not support our hypothesis that patients whose tumors contain high risk HPV have better QOL trajectory. Research exploring patient expectations, treatment effects, and psychiatric comorbidity may provide insight into this finding.

Spanish validation of the University of Washington Quality of Life questionnaire for head and neck cancer patients

Objective The University of Washington Quality of Life (UW-QOL) questionnaire is one of the most widely used instruments to evaluate the quality of life of head and neck cancer patients. The aim of this study was to perform a Spanish translation and validation of the UW-QOL questionnaire. Study Design A cross-sectional study. Setting Three tertiary-care hospitals and a laryngectomee rehabilitation center. Subjects and Methods The translation and cultural adaptation of the questionnaire were performed following accepted international guidelines. The psychometric validation was performed on a consecutive series of patients treated for squamous cell carcinoma of the upper aerodigestive tract with no signs of relapse, recruited from May 2007 to December 2008. Eligible subjects were invited to complete the Spanish version of the UW-QOL questionnaire during routine clinical consultation, and complete it again within 15 days. Subjects also completed a validated Spanish version of the Goldberg Mental Health Survey and were evaluated by the use of the Karnofsky Index. Results A Spanish version of the questionnaire was developed in iterative fashion. In the psychometric validation process, a total of 76 patients were analyzed. Reliability was excellent, including both internal consistency (Cronbach's alpha of 0.84) and test-retest reliability (intraclass correlation coefficient between 0.91 and 0.97 with a confidence interval of 95%). Construct validity was supported by statistically significant relationships between the Karnofsky Index, the Goldberg Mental Health Survey, and the translated UW-QOL questionnaire. Conclusion The Spanish version of the UW-QOL questionnaire appears to be culturally appropriate and psychometrically valid.

Survival and quality of life of patients with oral and oropharyngeal cancer at 1-year follow-up of tumor resection

ObjectiveThis study aimed to assess the survival and life quality evolution of patients subjected to surgical excision of oral and oropharyngeal squamous cell carcinoma.Material and MethodsForty-seven patients treated at a Brazilian healthcare unit specialized in head and neck surgery between 2006 and 2007 were enrolled in the study. The gathering of data comprised reviewing hospital files and applying the University of Washington Quality of Life (UW-QOL) questionnaire previously and 1 year after the surgery. Comparative analysis used Poisson regression to assess factors associated with survival and a paired t-test to compare preoperative and 1-year postoperative QOL ratings.Results1 year after surgery, 7 patients were not found (dropout of the cohort); 15 had died and 25 fulfilled the UW-QOL again. The risk of death was associated with having regional metastasis previously to surgery (relative risk=2.18; 95% confidence interval=1.09-5.17) and tumor size T3 or T4 (RR=2.30; 95%CI=1.05-5.04). Survivors presented significantly (p<0.05) poorer overall and domain-specific ratings of quality of life. Chewing presented the largest reduction: from 74.0 before surgery to 34.0 one year later. Anxiety was the only domain whose average rating increased (from 36.0 to 70.7).ConclusionsThe prospective assessment of survival and quality of life may contribute to anticipate interventions aimed at reducing the incidence of functional limitations in patients with oral and oropharyngeal cancer.

Effect of temporal bone resection on temporomandibular joint function: A quality of life study

Objectives Temporal bone resection for carcinoma may affect quality of life (QOL) and result in temporomandibular joint (TMJ) disorders. The aims of this study were to 1) assess TMJ function after temporal bone resection, and 2) assess the impact of TMJ dysfunction on QOL. Study Design Chart and patient review and QOL study. Setting Tertiary referral center (Manchester Royal Infirmary). Subjects and Methods Thirty patients who had undergone temporal bone resection were identified. Thirteen patients were alive and were included in the study. All patients were submitted to a clinical examination to identify TMJ disorders and determine facial nerve function, and they all answered the University of Washington QOL (UW-QOL) questionnaire (version 4). Results Eight patients had TMJ disorders with reduced mobility in either direction and/or significant pain. Main factors affecting QOL were pain ( P = 0.001), appearance ( P = 0.001), and anxiety ( P = 0.000). Neither facial nerve palsy nor TMJ disorders affected QOL. The responses to the UW-QOL questionnaire showed that 69 percent of our patients had a good QOL. A total of 61.53 percent of our patients had TMJ dysfunction presenting as restriction of jaw mobility with or without pain. Conclusion TMJ dysfunction is present in a significant number of patients after temporal bone resection, resulting in longstanding problems, which should be addressed accordingly. Poor QOL results from ongoing pain and psycho-social disturbance.

Assessment of functioning in patients with head and neck cancer according to the International Classification of Functioning, Disability, and Health (ICF): A multicenter study

To assess the level of functioning in patients with head and neck cancer (HNC) using the the International Classification of Functioning, Disability, and Health (ICF). Multicenter study at nine different study centers in four European countries. Data collection included structured interviews according to the extended ICF checklist with 145 HNC patients and completion of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaires (EORTC-QLQ). The generic ICF checklist was extended by additional HNC-specific categories identified in six HNC-specific questionnaires: EORTC, University of Washington Quality of Life (UW-QOL), Functional Assessment of Cancer Therapy scale (FACT), Performance Status Scale for Head and Neck cancer patients (PSS-HN), Head and Neck Quality of Life instrument (HN-QOL), and Voice Handicap Index (VHI). The ICF qualifier system was applied on a scale from 0 (not impaired) to 4 (completely impaired), as well as "ns, na" (not specified, not applicable) and "c" (impaired due to comorbidity). ICF categories impaired due to HNC (1-4) in > or = 10% of patients were reported. One hundred fifteen (80%) of 144 categories of the extended ICF checklist were identified to be at least mildly impaired or restricted in > or = 10% of patients. The four areas that were relevant to most of the patients were "immediate family" (91%), "friends" (86%), "health services and policies" (85%) and "health professionals" (85%), all belonging to the ICF component of environmental factors. The most often identified categories were "ingestion" (75%) for body functions and "speaking" (76%) for activities and participation. The summary score of all answers correlated well with the overall level of health and quality of life as assessed in the EORTC questionnaires (0.59, 0.61, respectively). The ICF identifies problems in functioning in patients with HNC comprehensively. The results emphasize the importance of contextual environmental factors. In particular, environmental factors referring to interpersonal support should be more strongly included in rehabilitation plans for HNC.

Dysphagia Following a Total Laryngectomy: The Effect on Quality of Life, Functioning, and Psychological Well-Being

The aim of this study was to investigate the effect that dysphagia has on quality of life (QoL), functioning, and psychological well-being of people who have undergone a total laryngectomy. A questionnaire battery was sent to all members (N = 197) of the Laryngectomee Association of NSW, Australia. QoL and functioning were assessed using the World Health Organisation Quality of Life-Bref (WHOQoL-Bref) and the University of Washington QoL (UW-QoL) measures. Psychological well-being was measured using the Depression Anxiety and Stress Scale (DASS). One hundred ten questionnaires (56%) were completed and returned. There were no significant differences in QoL, as measured by the WHOQoL-Bref, between those laryngectomees with and without dysphagia. Laryngectomees with dysphagia, however, had significantly impaired functioning and markedly reduced social participation as measured by the UW-QoL. Significantly higher levels of depression and anxiety were also documented in those laryngectomees who had dysphagia. Dysphagia may not necessarily determine QoL following a total laryngectomy. However, it may have a negative impact on functioning and on psychological well-being.

Speech and voice outcomes in oropharyngeal cancer and evaluation of the University of Washington Quality of Life speech domain

Radical treatment of oropharyngeal cancer can have significant impact on speech & voice outcomes. (i) To assess the extent of speech & voice handicap in disease-free survivors of oropharyngeal squamous cell cancer. (ii) To assess the validity of the speech domain of UWQOL as a screening tool. (iii) To identify clinical characteristics associated with worse speech/voice outcome. Cross-sectional survey. University Hospital Aintree, a university teaching hospital and tertiary referral centre. All who were treated for oropharyngeal cancer between 1 January 1999 and 31 May 2005, were alive, disease free and willing to participate. Three patient-based questionnaires: University of Washington Quality of Life (UWQOL), voice handicap index (VHI) and voice related quality of life (VRQOL). Three expert-based assessments: GRBAS rating, speech intelligibility and dysarthria rating. Sixty-six per cent of patients participated. Median VHI score (29) & VRQOL score (15) imply mild to moderate voice impairment. 20% of patients had severe handicap (VHI score >60). Forty-eight per cent had normal voice ratings. Speech was normal in 26%, mildly impaired in 62% and significantly impaired in 12% patients (UWQOL). Correlation between UW-QOL speech domain with speech intelligibility rating was 0.52 (P < 0.001). There were clear demarcations between UW-QOL scores of 30, 70 and 100 on the voice questionnaires. Adverse speech and voice function were associated with tumour stage, radiotherapy (RT) & free-flap surgery. Voice & speech impairment is prevalent in >70% of oropharyngeal cancer patients. There is moderate correlation between UWQOL speech domain and speech intelligibility assessment & voice tools making it a quick and easy screening instrument. The main clinical correlates associated with adverse patient and observer rated speech and voice outcomes were tumour stage, RT and free-flap reconstruction.

A Randomized, Placebo-Controlled Trial of Citalopram for the Prevention of Major Depression During Treatment for Head and Neck Cancer

To determine whether prophylactic treatment with the antidepressant citalopram hydrobromide, compared with placebo, could prevent major depressive disorder in patients undergoing therapy for head and neck cancer (HNC). Prospective, randomized, placebo-controlled trial. Academic medical center. Thirty-six subjects were randomized, and 23 completed the study. Subjects were randomized to receive 40 mg of citalopram hydrobromide or matching placebo (herein after, citalopram group and placebo group, respectively) for 12 weeks with a final visit at 16 weeks. The Hamilton Depression Rating Scale, psychiatric interview, and the University of Washington Quality of Life (UW-QOL) and Clinician Global Impression-Severity (CGI-S) scales. The numbers of subjects who met predefined cutoff criteria for depression during the 12 weeks of active study were 5 of 10 (50%) taking placebo and 2 of 12 (17%) taking citalopram (Fisher exact test, P = .17). No patients in the citalopram group became suicidal, compared with 2 in the placebo group. Global mood state at the conclusion of the study as measured by the CGI-S scale was rated as at least mildly ill in 15% of those receiving citalopram compared with 60% in the placebo group (Fisher exact test, P = .04). Quality of life, measured by the UW-QOL, deteriorated in both groups from baseline but less so in the citalopram group. This study reports data from the first depression prevention trial in HNC and suggests that prophylactic treatment may decrease the incidence of depression during HNC therapy. The clinical significance of the reduction in depression was best demonstrated by the CGI-S scale, which showed a notable difference in global psychiatric and physical well-being.

The patients' account of outcome following primary surgery for oral and oropharyngeal cancer using a ‘quality of life’ questionnaire

The purpose of this study was to collate all the University of Washington quality of life (UW-QOL) data collected in the Unit since 1995 and to summarize it in a patient-friendly format that can be used when discussing treatment outcomes. The sample of cancer patients consisted of 561 consecutive patients undergoing primary surgery for previously untreated oral and oropharyngeal squamous cell carcinoma presenting to the Regional Maxillofacial Unit Liverpool, between the years 1995 and 2004. Follow-up was on May 2006. Information sheets were constructed based on the UW-QOL, summarizing the patients at around 2 years (median 28 months). The response to each statement in all 12 domains, domains as important, and the general health-related QOL/QOL questions are given. Data has been summarized for six common groups based on the clinical presentation and treatment. The data show big differences by tumour size, free-flap surgery and adjuvant radiotherapy. Information presented in this format is potentially extremely useful when counselling patients and their families regarding the likely outcomes of treatment.

An evaluation of the University of Washington Quality of Life swallowing domain following oropharyngeal cancer

Oropharyngeal cancer and its treatment have debilitating effect on swallowing function which can impact on quality of life. The aims of this study were to assess swallowing dysfunction in patients treated for oropharyngeal cancer by both patient and observer assessed tools and to assess the suitability of University of Washington Quality of Life (UW-QOL) swallowing domain as a potential screening tool in routine clinic practice. This was a cross-sectional study of disease free survivors following radical treatment for oropharyngeal squamous cell carcinoma at a tertiary care centre between 1999 and May 2005. Evaluation included three questionnaires--the M. D. Anderson Dysphagia Inventory (MDADI), the SWALQOL, the University of Washington Quality of Life (UWQOL) and Fibreoptic Endoscopic Evaluation of Swallowing (FEES). Of 117 patients 77 (66%) participated. On the UW-QOL, 18% could only swallow liquids whilst 11% could not swallow at all. There is a clear demarcation between UW-QOL levels and food consistency and texture as measured by the SWALQOL (r= -0.86, P<0.001). There was a graduation in respect to function with correlations of r=0.61 with overall MDADI and SWALQOL and r= -0.45 for FEES. Patients scoring 70 or better in the UW-QOL were notably better in MDADI and the SWALQOL hence a cut off of below 70 could be regarded as a quick screening tool for swallowing dysfunction.

Quality of Life following Total Laryngectomy: Assessment Using the UW-QOL Scale

Objectives: To determine the quality of life (QOL) in patients using valved speech following total laryngectomy with a validated patient self-report scale. Study Design: Cross-sectional cohort study. Patients: 63 patients following total laryngectomy using valved speech. Intervention: University of Washington Quality of Life (UW-QOL) questionnaire. Main Outcome Measures: Patient perception of the QOL over the last 7 days following total laryngectomy in response to specific questions and correlated with sociodemographic and treatment factors. Results: Responses were received from 44 males and 11 females (response rate: 87.3%) with a median age of 66 years (range: 40–84). The mean (SD) composite score of the QOL in our series of patients with total laryngectomy was 81.3 (10.9). As regards the overall QOL, 80% of our patients cited it as very good (45.5%) to good (34.5%). Patients identified speech, appearance, and activity as the most important issues following total laryngectomy. Only age and pharyngo-oesophageal segment closure were significant predictors of QOL scores (Student t test, p < 0.05) and not other demographic and treatment variables. Conclusions: The composite score and overall QOL were high in our series of total laryngectomy patients and this possibly reflects adequate multidisciplinary management. We strongly urge the use of prospective longitudinal studies that will adequately identify any QOL changes over time. Although the UW-QOL questionnaire is a simple and brief scale, it has limitations that can curtail its effective use in laryngectomy patients and we advise supplementing it with the use of domain-specific questionnaires.

An evaluation of the shoulder domain of the University of Washington quality of life scale

The aim of this study was to compare the shoulder domain in the University of Washington quality of life (UW-QoL) scale with two shoulder-specific questionnaires. Methods We did a cross-sectional survey of 100 consecutive outpatients who had had operations on the head and neck for cancer using the UW-QoL, the neck dissection impairment index, and the shoulder disability questionnaire. Results The types of neck dissection were none ( n = 12), unilateral selective ( n = 63), bilateral selective ( n = 17), and radical or modified radical ( n = 8). There were significant correlations among the three questionnaires. The worst scores were found in the group who had modified radical or radical neck dissection. Although responses were similar between those who had no neck dissection and those who had unilateral level 3 neck dissection, a few patients reported considerable dysfunction after selective neck dissection. Conclusion Although the UW-QoL shoulder domain is limited to one of four responses, our results support the conclusion that it is sufficiently sensitive to screen for dysfunction of the shoulder.

Investigation of QOL after laryngectomy using the UW-QOL questionnaire with chinese patients

OBJECTIVE To assess the postoperative QOL(Quality of Life) of Chinese laryngeal cancer patients who have undergone a partial or total laryngectomy, and to analyze their prognostic factors, as well as to assess the feasibility of using the University of Washington Quality of Life (UW-QOL) questionnaire in QOL studies of laryngeal cancer patients. METHODS Using the UW-QOL questionnaire, a survey was conducted in patients treated by a partial or total laryngectomy for laryngeal cancer. RESULTS Questionnaires were sent to 142 patients who were diseasefree for more than half a year after surgery. Replies were received from 130 patients (91% response rate) with 118 patients completing the questionnaire. These patients were divided into 2 groups: a partial-laryngectomy group (n=81; excluding cordectomy) and a total-laryngectomy group (n=37). The composite QOL scores of the partial-laryngectomy group (692.3±127.9) were higher than those of total-laryngectomy group (636.4±140.0), showing a statistically significant difference (P<0.05). The partial-laryngectomy group (74.3±23.8; 80.9±20.3) was better than the total-laryngectomy group (40.3±25.8; 69.6±27.1) in speech and appearance (P<0.001; P<0.05); but the total-laryngectomy group (92.6±13.0) was superior to the partial-laryngectomy group (83.0±20.5) in pain (P<0.01). Six factors including cancer stage, operative modality, complications, postoperative radiotherapy or chemotherapy, living partners and chronic disease before or after operation were related to postlaryngectomy QOL. CONCLUSION Partial laryngectomy is superior to total laryngectomy in speech, appearance and overall QOL. Besides operative modality, cancer stage, complications, postoperative radiotherapy or chemotherapy, living partners and chronic diseases before or after operation are factors influencing postlaryngectomy QOL. As a whole, the UW-QOL questionnaire is a good instrument for studying QOL of laryngeal cancer patients in China, and it can be used to explore the QOL outcomes obtained from different reconstructive techniques.

Brazilian–Portuguese validation of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer

The University of Washington Quality of Life (UW-QOL) questionnaire is an English-language survey instrument used worldwide to assess the quality of life of patients with head and neck cancer. To be used in other cultures, such instruments require careful translation and psychometric validation in other languages. The translation and cultural adaptation of the questionnaire were performed following accepted international guidelines. The psychometric validation was performed on a consecutive series of patients with at least 1 year of disease-free survival after treatment for squamous cell carcinoma of the upper aerodigestive tract, recruited from October 2004 to January 2005 from a tertiary cancer center hospital. Eligible subjects were invited to complete the Portuguese version of the UW-QOL questionnaire during routine clinical consultation and complete it again within 15 days. They also completed a validated Portuguese version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and a questionnaire to evaluate anxiety and depression symptoms (Hospital Anxiety and Depression Scale [HADS]). A Portuguese version of the questionnaire was developed in iterative fashion. In the psychometric validation process, a total of 109 patients were analyzed. Reliability was excellent, including both internal consistency (Cronbach's alpha [alpha] of 0.744) and test retest reliability (intraclass correlation coefficient [ICC] of 0.882). Construct validity was supported by statistically significant relationships between the SF-36 and HAD questionnaires and the translated UW-QOL questionnaire. The Brazilian-Portuguese version of the UW-QOL questionnaire appears to be culturally appropriate and psychometrically valid. This version is a valuable tool to evaluate accurately the quality of life of Brazilian patients with head and neck cancer.