title: Level of distress predicts subsequent survival in successfully treated head and neck cancer patients: a prospective cohort study.
abstract: CONCLUSIONS
  Our findings indicate a unique survival prediction from general health questionnaire (GHQ) sum scores in successfully treated head and neck squamous cell carcinoma (HNSCC) patients and also to some extent with inclusion of health-related quality of life (HRQoL) scores.
  
  
  OBJECTIVE
  To examine the survival prediction from the level of distress, measured by GHQ scores obtained from at inclusion successfully treated HNSCC patients.
  
  
  METHODS
  Structured interviews were conducted for 135 successfully treated cognitive functioning HNSCC patients 67 ± 31 (mean ± SD) months after diagnosis following a regular follow-up visit. GHQ scores, alcohol consumption history, smoking status, present comorbidities, level of neuroticism, choice of psychological coping with the cancer disease, and HRQoL scores (EORTC QLQ-C30 and -H&N35) were determined. The TNM stage, treatment provided and tumour site were obtained from the hospital records. Forty-three deaths were noted during a minimum 8.5 years of observation.
  
  
  RESULTS
  The GHQ sum scores predicted survival in univariate (p < 0.05) and multivariate analyses with the above-mentioned covariates included (p < 0.01). Using clinically relevant cut-off levels, GHQ scores predicted survival in both univariate (hazard ratio (HR) 1.9; p = 0.05) and multivariate Cox regression analyses (HR 3.8; p = 0.001). We also demonstrated survival prediction from GHQ scores when adjusted by HRQoL scores.
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen.
authors.forename: Hans Jørgen
authors.initials: HJ
authors.lastname: Aarstad
authors.forename: Arild Andrè
authors.initials: AA
authors.lastname: Osthus
authors.forename: Jan
authors.initials: J
authors.lastname: Olofsson
authors.forename: Anne K H
authors.initials: AK
authors.lastname: Aarstad
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D001008:Anxiety Disorders / Q000523:psychology; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000523:psychology / Q000628:therapy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000523:psychology* / Q000628:therapy; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000075384:Neuroticism; D010555:Personality Inventory; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012907:Smoking / Q000453:epidemiology; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires