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Quality of life in head and neck cancer

Authors
Jill Gilbert, MD
Barbara A Murphy, MD
Leanne Jackson, MD
Section Editors
Bruce E Brockstein, MD
Patricia A Ganz, MD
David M Brizel, MD
Marvin P Fried, MD, FACS
Deputy Editor
Michael E Ross, MD

INTRODUCTION

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 [3]. (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 [4]. 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" [5]. 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" [6]. 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'.)

DEFINITION

Health-related QOL focuses upon the patient's perception of the impact of illness before, during, and after treatment. The fundamental premise of health-related QOL includes:

Multidimensionality – QOL encompasses a broad range of domains [5]. These include:

                          

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Literature review current through: Nov 2016. | This topic last updated: Wed Mar 23 00:00:00 GMT 2016.
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