title: Interpreting differences in quality of life: the FACT-H&N in laryngeal cancer patients.
abstract: Quality of life (QOL) scores can be difficult to interpret, because small statistically significant differences can be clinically unimportant. Our goal was to estimate the magnitude of difference in QOL that is noticeable to patients.
  
  
  METHODS
  Laryngeal cancer patients (n = 98, male = 83%, mean age = 65) completed a QOL questionnaire, FACT-H&N. Paired participants rated their own QOL as compared to each other. We estimated the smallest difference in QOL score that was associated with a noticeable difference in patients' subjective ratings.
  
  
  RESULTS
  Differences in FACT-H&N score were somewhat correlated with patients' ratings of their well-being relative to other patients (r = 0.195, p < 0.0001). The FACT-H&N score had to differ by 6.22 for patients to rate themselves as 'a little bit better' relative to other patients (95% CI: 1.42-11.02), and by 12.40 for patients to rate themselves as 'a little bit worse' relative to others (95% CI: 5.09-19.71). Results were consistent regardless of patient age, gender or laryngeal subsite but were imperfect predictors of individual judgements.
  
  
  CONCLUSIONS
  The minimal important difference for the FACT-H&N score is about 6-12 units, but laryngeal cancer survivors may be more sensitive to gains than losses.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada. jolie.ringash@rmp.uhn.on.ca
authors.forename: Jolie
authors.initials: J
authors.lastname: Ringash
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: Donald A
authors.initials: DA
authors.lastname: Redelmeier
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002173:Cancer Care Facilities; D002294:Carcinoma, Squamous Cell / Q000503:physiopathology / Q000523:psychology*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007822:Laryngeal Neoplasms / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires / Q000592:standards*