Patient reported outcomes in head and neck cancer: selecting instruments for quality of life integration in clinical protocols.
BACKGROUND
Health Related Quality of Life has been used in medical research for more than twenty years, being progressively accepted during the last decade as an important patient reported outcome. Considering the multidimensional approach involved in Health Related Quality of Life assessment, instrument applicability and cultural adaptation must be tested for each population. In order to select the most appropriate instrument for Head and Neck cancer patients, two major Health Related Quality of Life specific questionnaires for Head and Neck cancer patients were compared. Conceptual differences, psychometric characteristics, scores, reliability, construct validity and sensitivity to symptomatology, tumour location, tumour size were analyzed.


METHODS
102 consecutive Head and Neck cancer patients completed two different Health Related Quality of Life questionnaires: EORTC QLQ-C30 and its specific head and neck module QLQ-H&N35 and the Functional Assessment of Cancer Therapy Scales (FACT-H&N). Patients completed the questionnaires, immediately before consultation as a part of the routine evaluation.


RESULTS
A greater variability was always found in the EORTC QLC-C30 questionnaire's scores for all comparable domains. Both instruments revealed a good internal consistency and demonstrated to be good tools to distinguish symptomatic patients. The EORTC questionnaires still demonstrated sensitivity to distinguish T3 and T4 staging. Conceptual differences and the psychometric characteristics are discussed. Our results suggest that these two instruments assess different aspects of Health Related Quality of Life - the questionnaires should be used separately and chosen according to the study objectives and methodology.


CONCLUSIONS
This study emphases the importance in selecting the appropriate tool as a critical success factor in implementing routine Health Related Quality of Life assessment in clinical practice. This decision assumes particularly importance when utilization of results in real time and integration into clinical protocols are considered.
Oral Anatomy and Oral Histology- Health Sciences Department, Fernando Pessoa University, Rua Carlos da Maia, 296, 4200-150 Porto, Portugal.|Institute for Biomedical Sciences Abel Salazar- Porto University, Lg. Prof. Abel Salazar no. 2. 4099-003 Porto, Portugal.|The Centre of Health Studies and Research of the Coimbra University, Av. Dias da Silva, 165, 3004-512, Coimbra, Portugal.
Augusta P
AP
Silveira
Math Department, Polytechnic Institute of Cávado and Ave, Campus do IPCA - Lugar do Aldão 4750-810 Vila Frescainha S. Martinho Barcelos, Portugal.
Joaquim
J
Gonçalves
Oral Anatomy and Oral Histology- Health Sciences Department, Fernando Pessoa University, Rua Carlos da Maia, 296, 4200-150 Porto, Portugal.|Institute for Molecular and Cell Biology, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal.
Teresa
T
Sequeira
Health Sciences Department, Portuguese Catholic University, Campus Viseu Estrada da Circunvalação; 3504-505, Viseu, Portugal.|Santiago de Compostela University - Facultad De Medicina Y Odontologia Rua San Francisco, S/N, 15704, Santiago De Compostela, Espanha.
Cláudia
C
Ribeiro
Health Sciences Department, Institute for Biomedical Sciences Abel Salazar- Porto University, Lg. Prof. Abel Salazar no. 2. 4099-003 Porto, Portugal.
Carlos
C
Lopes
Fernando Pessoa University, Rua Carlos da Maia, 296, 4200-150 Porto, Portugal.|Portuguese Institute for Oncology - Porto, Otorhinolaringology service (IPO-Porto, ORL). Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.
Eurico
E
Monteiro
Aveiro University, Secção Autónoma Ciências da Saúde; Campus Universitário de Santiago, Aveiro, Portugal Infante D. Pedro Hospital, Aveiro, Av. Artur Ravara, 3814-501, Aveiro, Portugal.
Francisco L
FL
Pimentel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis* / Q000628:therapy; D002755:Choice Behavior; D002985:Clinical Protocols; D019937:Diagnostic Techniques and Procedures; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012107:Research Design; D057566:Self Report; D011795:Surveys and Questionnaires; D016896:Treatment Outcome