title: A systematic review of quality of life in head and neck cancer treated with surgery with or without adjuvant treatment.
abstract: Quality of life (QoL) is an important consideration in the management of head and neck cancers (HNC). We systematically reviewed the literature to assess the impact of curative surgical resection (+/- adjuvant therapy) of HNC on QoL. Eligible studies (participants>age 18 years, reported fully in English, and prospectively assessed QoL) were filtered using quality criteria, and classified according to the added value, using a published taxonomy. MEDLINE and EMBASE searching yielded 302 distinct reports, 49 met eligibility, and 26 met quality criteria. Among the eligible studies, achievement of certain quality criteria was poor: a priori hypothesis (8%), statistical accounting of missing data (8%), reporting of assessment interval (35%) and rationale for chosen measure (53%). The most frequent ways QoL added value were: understanding of treatment benefit and risk (100%), comparing treatments for QoL effect (92%) and advancing QoL research methodology (50%). QoL (physical/social functioning and various symptom domains) deteriorated with treatment, gradually recovering to baseline (cancer diagnosis) level. Swallowing, chewing, saliva, taste, eating disruption, and aesthetic deficits may persist. Advanced tumors, extensive surgical resection, need for flap reconstruction, neck dissection, and postoperative radiation are associated with worse QoL outcomes. Knowledge of these trends can be applied in shared decision making, identification of commonly faced QoL issues, and to develop and provide survivorship resources. Future research should focus on routinely incorporating QoL in randomized studies, reporting the result according to guidelines, and following knowledge translation principles to maximize the clinician's and patient's ability to use QoL data.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre and the University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
authors.forename: Shrinivas
authors.initials: S
authors.lastname: Rathod
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre and the University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Livergant
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre and the University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Klein
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Witterick
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre and the University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9, Canada. Electronic address: jolie.ringash@rmp.uhn.on.ca.
authors.forename: Jolie
authors.initials: J
authors.lastname: Ringash
mesh_terms: D000368:Aged; D006258:Head and Neck Neoplasms / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life
keywords: Evidence based medicine; Head and Neck Neoplasm; Postoperative radiation; Quality of life; Radiotherapy; Squamous cell cancer; Squamous cell carcinoma; Surgery; Systematic review