title: Association between late effects assessed by physicians and quality of life reported by head-and-neck cancer survivors.
abstract: BACKGROUND
  Many survivors of head-and-neck cancer (HNC) suffer from late effects. Their overall quality of life deteriorates during treatment, followed by a slow recovery up to five years after treatment. We examined the association between the severity of physician-assessed late effects and the health-related quality of life (HRQoL) reported by survivors of HNC.
  
  
  METHODS
  The analysis was based on data collected during follow-up for 136 survivors of cancer in the oral cavity, pharynx, larynx, or salivary glands. Physicians' assessments of dysphagia, xerostomia, fibrosis, and hoarseness, derived from reports to of the Danish Head and Neck Cancer Group database and patient-reported overall quality of life and social, role, emotional, cognitive, and physical functioning reported on the European Organization for Research and Treatment of Cancer questionnaire. Linear regression models were used to examine the association between the severity of each late effect and HRQoL.
  
  
  RESULTS
  Quality of life was decreased among patients with moderate to severe dysphagia compared to patients without dysphagia (-16 points; 95% CI -21;-3). Also role functioning (-20 points; 95% CI -38;-2), emotional functioning (-19 points; 95% CI -34;-4) and social functioning (-27 points; 95% CI -41;-13) decreased compared with patients without dysphagia. Mild dysphagia was also associated with decreased overall quality of life (-12 points; 95% CI -21;-3). Moderate to severe hoarseness was significantly associated with poorer social functioning (-25 points; 95% CI -41;-10). There was no association between fibrosis or xerostomia and HRQoL.
  
  
  CONCLUSIONS
  Physician-assessed moderate to severe hoarseness and mild, moderate, or severe dysphagia are associated with clinically relevant decreases in patient-reported quality of life and functioning. Fibrosis and xerostomia of any severity were not associated with changes in any scale of functioning in this study population.
authors.affiliation: a Copenhagen Centre for Cancer and Health , Copenhagen , Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Daugaard
authors.affiliation: b Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Trille
authors.initials: T
authors.lastname: Kjaer
authors.affiliation: b Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.|c Department of Oncology , Rigshospitalet , Copenhagen , Denmark.
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.affiliation: d Department of Statistics, Bioinformatics and Registry , Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Jane
authors.initials: J
authors.lastname: Christiansen
authors.affiliation: e Department of Oncology , Herlev Hospital , Herlev , Denmark.
authors.forename: Elo
authors.initials: E
authors.lastname: Andersen
authors.affiliation: e Department of Oncology , Herlev Hospital , Herlev , Denmark.
authors.forename: Anni L
authors.initials: AL
authors.lastname: Nielsen
authors.affiliation: b Unit of Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.
authors.forename: Susanne O
authors.initials: SO
authors.lastname: Dalton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000523:psychology; D005260:Female; D005355:Fibrosis; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000523:psychology; D006685:Hoarseness / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D017741:Survivors / Q000523:psychology*; D014987:Xerostomia / Q000523:psychology