Quality of life in patients with head and neck cancer: Lessons learned from 549 prospectively evaluated patients

Objectives: To summarize out quality-of-life (QOL) research findings for patients with head and neck cancer, to suggest areas for future productive QOL research, and to discuss how to undertake QOL studies in a cost-effective manner. Design: Review of previously published analysis of advanced larynx cancer, advanced oropharynx cancer, and neck-dissection cases and current data from the complete set of patients. Patients: From January 1, 1993, though December 31, 1998, data on 549 patients were entered in our head and neck database. Of these patients, 364 met additional criteria for histologic findings (squamous cell carcinoma) and the restriction of their cancer to 4 major anatomical sites (oral, oropharynx, hypopharynx, or larynx). Of these, 339 patients were more than 1 year beyond initial treatment. Complete baseline TNM staging and QOL data were obtained for 260 of these patients, of whom 210 presented with an untreated first primary tumor (index cases) to the University of Washington, Seattle. Intervention: Pretreatment QOL was assessed with an interviewer-supervised self-administered questionnaire. Subsequent self-administered tests were completed at 3, 6, 12, 24, and 36 months. Other data collected on each patient included cancer site, stage, treatment, histologic findings, type of surgical reconstruction, and current disease and vital status. Results/Conclusions: It is difficult to achieve 'statistically significant' results in a single-instution setting. The 'composite' QOL score may not be a sufficiently sensitive tool. Analysis of separate domains may be more effective.