title: Does quality of life predict long-term survival in patients with head and neck cancer?
abstract: OBJECTIVE
  To assess whether pretreatment and posttreatment quality of life (QOL) is associated with long-term survival in patients with head and neck cancer.
  
  
  METHODS
  Ten-year follow-up of an inception cohort.
  
  
  METHODS
  Regional tertiary referral center.
  
  
  METHODS
  The study included 200 consecutive patients with primary epithelial head and neck cancer.
  
  
  METHODS
  Quality of life and several recognized risk factors for death were assessed prospectively using the Auckland QOL questionnaire before treatment and 12 months after treatment; survival was determined at 10 years.
  
  
  METHODS
  Survival and odds of death (hazards ratio) were measured.
  
  
  RESULTS
  At 10 years, 136 patients (68%) were deceased, 48 patients (24%) were alive, and the status of 16 patients (8%) was unknown. Median survival was 6 years (interquartile range, 4.4-7.7). Before treatment, patients with low QOL had no significantly increased odds of death (hazard ratio, 1.4; 95% confidence interval, 0.8-2.4). In contrast, after treatment, patients with low QOL at 1 year had significantly increased odds of death (2.5; 95% confidence interval, 1.4-4.3; P = .001) even after adjustment for covariates.
  
  
  CONCLUSIONS
  Findings suggest potential survival benefits from improvements in QOL. However, the observed associations between survival benefit and QOL at 1 year may be confounded by comorbidity, which was not measured and deserves further investigation.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Coventry and Warwickshire, Coventry, England.
authors.forename: Hisham M
authors.initials: HM
authors.lastname: Mehanna
authors.forename: Randall P
authors.initials: RP
authors.lastname: Morton
mesh_terms: D000368:Aged; D001293:Attitude to Death; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013997:Time Factors