title: Head and neck specific Health Related Quality of Life scores predict subsequent survival in successfully treated head and neck cancer patients: a prospective cohort study.
abstract: To examine the survival prediction of head and neck (H&N) Health Related Quality of Life (HRQoL) scores among successfully treated and cognitive functioning H&N squamous cell carcinoma (HNSCC) patients. Through structured interviews, self-reported questionnaires were given to 139 successfully treated HNSCC patients, 67 ± 32 months following diagnosis. HRQoL-scores, measured with the EORTC QLQ-H&N35 inventory, self-reported levels of neuroticism, avoidance focused coping, coping by suppression of competing activity, alcohol consumption, smoking status, and heart and lung disease, as well as gender, age, TNM-stage, and tumor site were determined. The mean observation period was 75 ± 4 months among the survivors. Twenty-four deaths were observed. A EORTC QLQ-H&N 35 sum score, including a dichotomized version (HR 2.73-3.67), was predictive of survival, both directly and after adjustment for all of the above mentioned variables. The H&N HRQoL indices "feeling ill", "sexuality", "open mouth", "swallowing", and "pain" specifically predicted survival. The dichotomized H&N HRQoL sum score compared the 4th upper quartile to the three lower quartiles, and a cut off value of 28.5 was designated. Analyses demonstrated that a high risk group with 33% mortality may include only one quarter of the patient population as opposed to 12.5% mortality among the other patients. Our findings indicate a unique survival prediction from EORTC QLQ-H&N 35 sum scores in successfully treated HNSCC patients. HRQoL scores, in particular, related to oral health, predicted survival. Furthermore, HRQoL-scores may be a screening tool for identifying patients with high mortality risk.
authors.affiliation: Department of Surgical Sciences, University of Bergen, N-5021 Bergen, Norway.
authors.forename: Arild Andrè
authors.initials: AA
authors.lastname: Osthus
authors.forename: Anne K H
authors.initials: AK
authors.lastname: Aarstad
authors.forename: Jan
authors.initials: J
authors.lastname: Olofsson
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Aarstad
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000523:psychology / Q000628:therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000523:psychology / Q000628:therapy; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016019:Survival Analysis