Free flaps – Are they a boon? A quality of life analysis

Abstract

Background We always assess the treatment being administered to the cancer patients in terms of 5-year survival often ignoring the quality of life which the patient has. Life is not something to be quantified without making it better. It is not just about prolonging the duration of survival. This study is being carried out in our institution to emphasize on this aspect of patients' life rather than just counting the years he lives after being diagnosed and treated for cancer. During this study all the University of Washington quality of life (UWQOL) data collected in the institute since July 2014 of the patients who underwent free flap microvascular reconstruction after ablative oral cavity cancer surgery was analyzed. Methods This ongoing study comprises of 51 patients who underwent surgery for oral cavity squamous cell carcinoma followed by free flap reconstruction at SMS Medical College and Hospital since July 2014. The patients were asked to complete the UW-QOL questionnaire (validated Hindi version). The questionnaire represents the patient's own perception of their level of QOL. Version 4 of the UW QOL, in use since 2000, has 12 domains, a question that asks patients to choose up to three domains of most importance to them and three global questions about their health-related and overall QOL. Overall QOL includes not only physical and mental health, but also many other factors, such as family, friends, spirituality or personal leisure activities that are important to the enjoyment of life. Results and discussion The cohort comprised 51 patients. Mean age was 56.6 years. 82.35% were men and 17.65% were women. T3/T4 advanced tumors were present for 35.29%. All the patients had free-flap surgery and 41 patients (80.4%) had adjuvant radiotherapy. The patients rated swallowing, speech and chewing as top 3 domains of concern. Overall, when asked what their HRQOL had been like during the previous 7 days, patients replied as: 2(3.92%) outstanding, 17(33.33%) very good, 20(39.21%) good, 9(17.64%) fair, 2(3.92%) poor and 1(1.96%) very poor. Overall, QOL not only includes physical and mental health but also many other important factors, and the patients rated their overall QOL in the previous 7 days as: 3.92% outstanding, 33.33% very good, 33.33% good, 23.53% fair, 3.92% poor and 1.96% very poor. Conclusion UW QOL provides an important tool to assess the quality of life a patient leads after he is cured of the disease. The study pins the importance to the patient's aspect of the treatment outcome. Stage of the disease and radiotherapy were seen to affect domain scores. Studies have shown that patients reconstructed with free flap had a better appearance and better shoulder function as well as better role emotion when compared to those patients reconstructed with other loco-regional flaps. The composite score and overall QOL as assessed using the UW-QOL scale (version 4) were modestly high in our series of patients who had undergone free flap reconstruction.