Head and neck cancer-specific quality of life: Instrument validation

Background: The disfigurement and dysfunction associated with head and neck cancer affect emotional well being and some of the most basic functions of life. Most cancer-specific quality-of-life assessments give a single composite score for head and neck cancer-related quality of life. Objective: To develop and evaluate an improved multidimensional instrument to assess head and neck cancer-related functional status and well-being. Methods: The item selection process included literature review interviews with health care workers, and patient surveys. A survey with 37 disease-specific questions and the SF-12 survey were administered to 253 patients in 3 large medical centers. Factor analysis was performed to identify disease-specific domains. Domain scores were calculated as the standardized score of the component items. These domains were assessed for construct validity based on clinical hypotheses and test-retest reliability. Results: Four relevant domains were identified: Eating (6 items), Communication (4 items), Pain (4 items), and Emotion (6 items). Each had an internal consistency (Cronbach α value) of greater than 0.80. Construct validity was demonstrated by moderate correlations with the SF-12 Physical and Mental component scores (r=0.43- 0.60). Test-retest reliability for each domain demonstrated strong reliability between the 2 time points. Correlations were strong for each individual question, ranging from 0.53 to 0.93. Construct validity testing demonstrated that the direction of differences for each domain were as hypothesized. Conclusion: The Head and Neck Quality of Life questionnaire is a promising multidimensional tool with which to assess head and neck cancer- specific quality of life.