GP3a - What Predictors Reduce Quality of Life in Head and Neck Cancer Patients?

Abstract:

Introduction:
Head and neck cancers (HNCA) encompasses about 4% of all cancers in the U.S. However, the disease has a disproportionate impact on patients’ quality of life (QOL). Surgical and medical therapies can result in deformities of the head and neck, leading to severe impairment in speech, swallowing, and psychosocial problems. There is a primary focus on disease-specific treatment and survival, but QOL is a treatment outcome that has been increasingly recognized as an important outcome parameter in HNCA.

Objective:
Postoperative QOL may be overlooked when managing head and neck cancer patients. The purpose of this study is to identify patient and surgical factors influencing QOL of head and neck cancer patients in hopes to improve patient outcomes.

Materials and methods:
The authors implemented a retrospective cohort study design and enrolled a sample composed of head and neck cancer patients treated between 2017 and 2018. The predictor variables were grouped into the following categories: risk factors (smoking, alcohol, past medical history), demographic (sex, age, marital status), anatomic (tumor location, tumor stage), perioperative (utilization of a feeding tube, tracheostomy, neck dissection) and postoperative factors (chemotherapy or radiation therapy utilization). The primary outcome variable was the Head and Neck Quality of Life (HNQOL) score with higher scores correlated with poorer QOL. Descriptive statistics were completed for all the variables. Association between the predictor variables and HNQOL scores were examined using bivariate statistics and statistical significance was set at P < .05.

Results:
The study sample composed of 78 patients presenting or referred to the Center of Head and Neck Maxillofacial and Reconstructive Surgery Clinic at Ascension Macomb-Oakland from January 1, 2017, to August 31, 2018. Surgeries were completed at Ascension Macomb-Oakland and Ascension St. John Hospitals by 1 primary surgeon in the metro Detroit area. Of the 78 patients meeting inclusion, 31 patients completed the validated University of Michigan HNQOL instrument. The sample’s mean age was 66 (±1.7) and 71% were male. The median HNCA QOL score was 18 with a maximum score of 80. Variables associated with poorer QOL scores were: radiation therapy (21 vs. 5.5, P = .033), perioperative feeding tube (31 vs. 9, P = .012), utilization of chemotherapy (12.5 vs 9.0, P = .60), male gender (17 vs 9.5, P = .39), perioperative tracheostomy (26 vs. 14.5, P = .26), current/prior tobacco use (19.5 vs. 11.5, P = .81), single marital status (27 vs. 16, P = .48), neck dissection (17.5 vs. 15.5, P = .91), and alcohol use (18.5 vs. 16.0, P = .65).

Conclusion:
The study results suggest that the presence of a feeding tube and utilization of radiotherapy most significantly decreased QOL among HNCA. Additional factors associated with poorer QOL were radiation therapy, utilization of a feeding tube, chemotherapy, male sex, tracheostomy utilization, tobacco use, single/divorced marital status, neck dissection, and alcohol abuse.

References:
1. Terrell JE, Ronis DL, Fowler KE, et al: Clinical predictors of quality of life in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 130(4):401‐408, 2004

2. Taylor JC, Terrell JE, Ronis DL, et al: Disability in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 130(6):764-769, 2004