Health-related quality of life in head and neck cancer
- Jill Gilbert, MD
Jill Gilbert, MD
- Associate Professor of Medicine
- Vanderbilt University Medical Center
- Barbara A Murphy, MD
Barbara A Murphy, MD
- Professor of Medicine
- Director, Pain and Symptom Management Program
- Vanderbilt Ingram Cancer Center
- Leanne Jackson, MD
Leanne Jackson, MD
- Assistant Professor of Medicine
- Michael E. DeBakey Veterans Affairs Medical Center
- Section Editors
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- Patricia A Ganz, MD
Patricia A Ganz, MD
- Section Editor — Cancer Survivorship
- UCLA Schools of Medicine and Public Health
- Jonsson Comprehensive Cancer Center
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Head and neck cancer (HNC) includes those cancers originating in the oral cavity, pharynx (nasopharynx, oropharynx, or hypopharynx), nasal cavity, paranasal sinuses, salivary glands, and larynx.
Combined multimodality treatment including surgery, chemotherapy, and radiation has increased disease control for locally advanced HNC. These improvements have come at the expense of increased acute and late effects, which may have a more profound effect on function and quality of life (QOL) than has been previously recognized [1,2]. HNC arises in structurally complex and functionally important areas. Impairment of these areas from both disease and therapy can interfere with basic functions, including eating and speech, and can have a profound effect on social interactions and psychological state . (See "Overview of treatment for head and neck cancer" and "Management and prevention of complications during initial treatment of head and neck cancer" and "Management of late complications of head and neck cancer and its treatment".)
QOL is a broad concept, a subjective, multidimensional, global construct that seeks to provide a comprehensive picture of the patient's perception of himself or herself in the world . The World Health Organization (WHO) defines QOL as an "individual's perception of his or her position in life in the context of the culture and value systems in which the patient lives and in relation to his or her goals, expectations, standards, and concerns" . A fitting description defined QOL as the "perceived discrepancy between the reality of what a person has and the concept of what the person wants, needs, or expects" . In judging the efficacy of treatment, extending survival does not always correlate with improvements in QOL. Conversely, specific treatments may not necessarily prolong life but may enhance its quality. The importance of QOL has been increasingly recognized and is reflected in its use as an outcome measure in cancer research, on par with response rate and survival [4,7]. (See "Evaluation of health-related quality of life (HRQL) in patients with a serious life-threatening illness", section on 'Measuring HRQL'.)
Health-related QOL (HRQOL) focuses upon the patient's perception of the impact of illness before, during, and after treatment. The fundamental premise of HRQOL includes:
●Multidimensionality – QOL encompasses a broad range of domains . These include:
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- RELATIONSHIP BETWEEN SYMPTOMS, FUNCTION IMPAIRMENT, AND QOL
- SIGNIFICANCE OF QOL MEASURES IN HNC
- PITFALLS AND LIMITATIONS OF QOL RESEARCH
- PATIENT-REPORTED OUTCOME MEASURES: WHERE DO QOL INSTRUMENTS FIT IN?
- QOL AND SURVIVAL
- PREDICTORS OF QOL
- SPECIFIC SYMPTOMS AND THEIR EFFECT ON QOL
- Systemic symptoms
- FUNCTIONAL PERFORMANCE AND QOL
- TRAJECTORY OF QOL AND ITS RELATIONSHIP TO TUMOR AND TUMOR-RELATED FACTORS
- TUMOR-RELATED FACTORS AND THEIR EFFECT ON QOL
- Disease site
- Cancer stage
- HPV status
- INABILITY TO WORK AND FINANCIAL DISTRESS
- IMPACT OF TREATMENT
- Chemoradiotherapy as primary therapy
- Feeding tubes