Quality of life in head and neck cancer patients

Abstract

Quality of life (QOL) is a measure of an individual’s overall well-being. It is a patient-reported outcome that can only be accurately assessed by the individual. It is measured using standardized instruments with known validity and reliability. These include multidimensional questionnaires or single-item indices. Specialized QOL instruments are available for certain diseases, symptoms, or treatments. A related concept is health utility, which quantifies not only health but its value to the individual under conditions of uncertainty. Results for both QOL and utility instruments are most useful when reported in the context of their significance-both statistical (probability of error) and clinical (whether magnitude is meaningful to patients). Each individual conceptualizes QOL in a personal way. When QOL is an outcome of a clinical trial, prospective measurement at multiple time points is preferred. However, “baseline QOL” is measured after cancer diagnosis and does not reflect “healthy” QOL. Additionally, individuals may reconceptualize QOL over time, so concurrent comparative cohorts are needed to interpret QOL changes over time. Missing data is especially important in QOL research, because healthier patients are more likely to comply with assessments. Specific concerns such as xerostomia, pain, dysphagia, and speech disruption often dominate the posttreatment QOL experience of head and neck cancer (HNC) patients. Instruments designed specifically for HNC will best discriminate between patients and respond to change over time. Among a number of HNC-specific QOL instruments, the most commonly used are the EORTC QLQ-C30/HN35, FACT-H&N, and UW-QOL. Few phase III randomized controlled trials in HNC have yet reported QOL results. The use of intensity-modulated radiation therapy to reduce parotid dose lessens xerostomia and improves QOL; certain supportive care initiatives improve QOL during HNC treatment. Additionally, baseline QOL is among the strongest prognostic factors in HNC and is an obvious candidate for stratification in future clinical trials.