title: Effect of comorbidity on quality of life and treatment selection in patients with squamous cell carcinoma of the head and neck.
abstract: OBJECTIVE
  Comorbidity is significantly associated with diminished survival and quality of life (QOL) after treatment of head and neck squamous cell carcinoma (HNSCC). We sought to determine whether comorbidity influenced pretreatment QOL scores and treatment selection in patients with HNSCC.
  
  
  METHODS
  The medical records of all patients diagnosed with HNSCC who participated in pretreatment QOL analysis over a 15-month period were retrospectively reviewed. Patients with a history of prior treatment for head and neck cancer, unresectable, or distant metastatic disease were excluded. The University of Washington (UW) QOL questionnaire, Performance Status Scale (PSS), and Karnofsky score were used to measure pretreatment QOL. Comorbidity was graded using the Modified Medical Comorbidity Index.
  
  
  RESULTS
  Of 75 patients who met study criteria, 33 underwent primary surgical therapy, and 42 underwent nonoperative (radiation or chemoradiation) therapy. Treatment groups did not differ with respect to patient demographics, UW QOL scores, PSS scores, Karnofsky score, or comorbidity. Treatment groups differed significantly by disease stage and primary site. Patients with advanced stage disease (III/IV) or oropharyngeal primary tumors were more likely to undergo nonoperative treatment, compared with patients with early stage disease (I/II) or oral cavity primary tumors (P < .005). No significant association was found between comorbidity and pretreatment QOL scores.
  
  
  CONCLUSIONS
  Comorbidity was not significantly associated with treatment selection or pretreatment QOL scores in patients with HNSCC. Location of the primary tumor and disease stage were significantly associated with treatment selection. Further studies are required to determine the effect of comorbidity on patient and tumor responses to treatment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912, U.S.A. cgourin@mcg.edu
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
authors.forename: William J
authors.initials: WJ
authors.lastname: McAfee
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Neyman
authors.forename: Jed W
authors.initials: JW
authors.lastname: Howington
authors.forename: Robert H
authors.initials: RH
authors.lastname: Podolsky
authors.forename: David J
authors.initials: DJ
authors.lastname: Terris
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D011336:Probability; D011379:Prognosis; D011788:Quality of Life; D011878:Radiotherapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018434:Sickness Impact Profile; D015996:Survival Rate; D016896:Treatment Outcome