title: Studies in the quality of life of head and neck cancer patients: results of a two-year longitudinal study and a comparative cross-sectional cross-cultural survey.
abstract: OBJECTIVE
  To examine quality-of-life (QL) changes that occur over time among patients treated for head and neck cancer and to compare QL outcomes in two geographically separate and culturally distinct populations.
  
  
  METHODS
  A prospective, observational longitudinal study was made of QL changes over time in head and neck cancer patients, and a matched-pairs cross-sectional study was conducted for comparison of QL outcomes between groups of head and neck cancer patients from two different sociocultural environments.
  
  
  METHODS
  Patients attending a tertiary head and neck cancer center in Auckland, New Zealand, were interviewed using a validated questionnaire before treatment and at 3, 12, and 24 months after treatment. Changes over time were assessed according to gender, site and stage of primary tumor, and type of treatment received. A second group of patients from Toronto, Ontario, Canada, were matched to the first group for age, gender, site and stage of tumor, and time since treatment and interviewed using the same questionnaire. The group comparison was followed by a matched-pairs analysis for the 12-month follow-up interval.
  
  
  RESULTS
  In the longitudinal study, combined modality treatment resulted in greater physical and somatic dysfunction than single modality treatment. Patients learned to cope well with dysfunction and disability and with adjusting their lifestyle so that overall QL was not related to treatment received. Even so, pain scores and measures of psychological distress were related to overall QL. Otherwise there was no consistent correlation between specific symptoms and QL. An illustration of patients' adaptation to dysfunction was evident in scores for perceived difficulty swallowing, which decrease despite the ongoing need for a soft or liquid diet. In the comparative study, significantly different global QL scores were evident in the two clinical groups studied, despite similar social, somatic, and physical functioning. There was also a significant but inconstant difference in emotional functioning. Although the clinical groups received significantly different treatment regimens, the observed differences in global QL were independent of treatment received.
  
  
  CONCLUSIONS
  Patients with head and neck cancer generally managed well despite disability and dysfunction after treatment. Patients' expectations, emotional responses, and desired outcomes seemed to be determined by sociocultural factors, causing different patient groups to view their overall QL outcome somewhat differently.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Green Lane Hospital, Green Lane West 3, Auckland, New Zealand. RPMorton@middlemore.co.nz
authors.forename: Randall P
authors.initials: RP
authors.lastname: Morton
mesh_terms: D000223:Adaptation, Psychological; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D009520:New Zealand; D009864:Ontario; D010039:Otorhinolaryngologic Neoplasms / Q000150:complications / Q000523:psychology / Q000628:therapy; D010146:Pain / Q000209:etiology; D011788:Quality of Life; D012120:Respiration Disorders / Q000209:etiology; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires