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:
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Jun 28, 2017.References
- Murphy BA, Ridner S, Wells N, Dietrich M. Quality of life research in head and neck cancer: a review of the current state of the science. Crit Rev Oncol Hematol 2007; 62:251.
- Murphy BA. Late treatment effects: reframing the questions. Lancet Oncol 2009; 10:530.
- Melo Filho MR, Rocha BA, Pires MB, et al. Quality of life of patients with head and neck cancer. Braz J Otorhinolaryngol 2013; 79:82.
- Heutte N, Plisson L, Lange M, et al. Quality of life tools in head and neck oncology. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:33.
- WHO Working Groups. Measuring Quality of Life. Programme on Mental Health, 1997.
- Morton RP, Izzard ME. Quality-of-life outcomes in head and neck cancer patients. World J Surg 2003; 27:884.
- So WK, Chan RJ, Chan DN, et al. Quality-of-life among head and neck cancer survivors at one year after treatment--a systematic review. Eur J Cancer 2012; 48:2391.
- Sayed SI, Elmiyeh B, Rhys-Evans P, et al. Quality of life and outcomes research in head and neck cancer: a review of the state of the discipline and likely future directions. Cancer Treat Rev 2009; 35:397.
- Cella DF. Quality of life: concepts and definition. J Pain Symptom Manage 1994; 9:186.
- Silveira AP, Gonçalves J, Sequeira T, et al. Patient reported outcomes in head and neck cancer: selecting instruments for quality of life integration in clinical protocols. Head Neck Oncol 2010; 2:32.
- Tschiesner U, Rogers SN, Harréus U, et al. Content comparison of quality of life questionnaires used in head and neck cancer based on the international classification of functioning, disability and health: a systematic review. Eur Arch Otorhinolaryngol 2008; 265:627.
- Hanna E, Sherman A, Cash D, et al. Quality of life for patients following total laryngectomy vs chemoradiation for laryngeal preservation. Arch Otolaryngol Head Neck Surg 2004; 130:875.
- List MA, Ritter-Sterr CA, Baker TM, et al. Longitudinal assessment of quality of life in laryngeal cancer patients. Head Neck 1996; 18:1.
- Hertrampf K, Wenz HJ, Lehmann KM, et al. Quality of life of patients with maxillofacial defects after treatment for malignancy. Int J Prosthodont 2004; 17:657.
- Friedlander P, Caruana S, Singh B, et al. Functional status after primary surgical therapy for squamous cell carcinoma of the base of the tongue. Head Neck 2002; 24:111.
- Moore GJ, Parsons JT, Mendenhall WM. Quality of life outcomes after primary radiotherapy for squamous cell carcinoma of the base of tongue. Int J Radiat Oncol Biol Phys 1996; 36:351.
- Finizia C, Hammerlid E, Westin T, Lindström J. Quality of life and voice in patients with laryngeal carcinoma: a posttreatment comparison of laryngectomy (salvage surgery) versus radiotherapy. Laryngoscope 1998; 108:1566.
- Deleyiannis FW, Weymuller EA Jr, Coltrera MD, Futran N. Quality of life after laryngectomy: are functional disabilities important? Head Neck 1999; 21:319.
- Gourin CG, Kaboli KC, Boyce BJ, Burkhead LM. Factors associated with nonparticipation in one-year quality-of-life assessment in patients with head and neck squamous cell carcinoma. Laryngoscope 2010; 120:1435.
- Lipscomb J, Gotay CC, Snyder CF. Patient-reported outcomes in cancer: a review of recent research and policy initiatives. CA Cancer J Clin 2007; 57:278.
- www.euroqol.org/eq-5d-products.html (Accessed on March 2, 2014).
- Ware JE Jr, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol 1998; 51:903.
- Gilson BS, Gilson JS, Bergner M, et al. The sickness impact profile. Development of an outcome measure of health care. Am J Public Health 1975; 65:1304.
- Stein KD, Denniston M, Baker F, et al. Validation of a modified Rotterdam Symptom Checklist for use with cancer patients in the United States. J Pain Symptom Manage 2003; 26:975.
- Ganz PA, Schag CA, Lee JJ, Sim MS. The CARES: a generic measure of health-related quality of life for patients with cancer. Qual Life Res 1992; 1:19.
- Bjordal K, de Graeff A, Fayers PM, et al. A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC Quality of Life Group. Eur J Cancer 2000; 36:1796.
- Weitzner MA, Meyers CA, Gelke CK, et al. The Functional Assessment of Cancer Therapy (FACT) scale. Development of a brain subscale and revalidation of the general version (FACT-G) in patients with primary brain tumors. Cancer 1995; 75:1151.
- Rogers SN, Gwanne S, Lowe D, et al. The addition of mood and anxiety domains to the University of Washington quality of life scale. Head Neck 2002; 24:521.
- Bjordal K, Ahlner-Elmqvist M, Tollesson E, et al. Development of a European Organization for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. EORTC Quality of Life Study Group. Acta Oncol 1994; 33:879.
- List MA, D'Antonio LL, Cella DF, et al. The Performance Status Scale for Head and Neck Cancer Patients and the Functional Assessment of Cancer Therapy-Head and Neck Scale. A study of utility and validity. Cancer 1996; 77:2294.
- Rosenthal DI, Mendoza TR, Chambers MS, et al. Measuring head and neck cancer symptom burden: the development and validation of the M. D. Anderson symptom inventory, head and neck module. Head Neck 2007; 29:923.
- Cooperstein E EJ, Murphy BA, Dietrich MS, GIlbert J. Vanderbilt Head and Neck Symptom Survey version 2.0: a tool for the study of long-term oral health consequences of therapy for head and neck cancer. Am J Clin Oncol 2010; 28:649 (abstract # 9055).
- Hogikyan ND, Sethuraman G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice 1999; 13:557.
- Chen AY, Frankowski R, Bishop-Leone J, et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg 2001; 127:870.
- Eisbruch A, Kim HM, Terrell JE, et al. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001; 50:695.
- Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res 1991; 4:143.
- Kazi R, Johnson C, Prasad V, et al. Quality of life outcome measures following partial glossectomy: assessment using the UW-QOL scale. J Cancer Res Ther 2008; 4:116.
- Browman GP, Levine MN, Hodson DI, et al. The Head and Neck Radiotherapy Questionnaire: a morbidity/quality-of-life instrument for clinical trials of radiation therapy in locally advanced head and neck cancer. J Clin Oncol 1993; 11:863.
- Trotti A, Johnson DJ, Gwede C, et al. Development of a head and neck companion module for the quality of life-radiation therapy instrument (QOL-RTI). Int J Radiat Oncol Biol Phys 1998; 42:257.
- Pace-Balzan A, Cawood JI, Howell R, et al. The Liverpool Oral Rehabilitation Questionnaire: a pilot study. J Oral Rehabil 2004; 31:609.
- Aynehchi BB, Obourn C, Sundaram K, et al. Validation of the Modified Brief Fatigue Inventory in head and neck cancer patients. Otolaryngol Head Neck Surg 2013; 148:69.
- Mathias SD, Crosby RD, Qian Y, et al. Estimating minimally important differences for the worst pain rating of the Brief Pain Inventory-Short Form. J Support Oncol 2011; 9:72.
- Montazeri A. Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008. Health Qual Life Outcomes 2009; 7:102.
- Østhus AA, Aarstad AK, Olofsson J, Aarstad HJ. Prediction of survival by pretreatment health-related quality-of-life scores in a prospective cohort of patients with head and neck squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg 2013; 139:14.
- Karvonen-Gutierrez CA, Ronis DL, Fowler KE, et al. Quality of life scores predict survival among patients with head and neck cancer. J Clin Oncol 2008; 26:2754.
- Aarstad HJ, Osthus AA, Olofsson J, Aarstad AK. Level of distress predicts subsequent survival in successfully treated head and neck cancer patients: a prospective cohort study. Acta Otolaryngol 2014; 134:211.
- McMillan DC. An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc 2008; 67:257.
- Kao SC, Vardy J, Harvie R, et al. Health-related quality of life and inflammatory markers in malignant pleural mesothelioma. Support Care Cancer 2013; 21:697.
- Correia M, Cravo M, Marques-Vidal P, et al. Serum concentrations of TNF-alpha as a surrogate marker for malnutrition and worse quality of life in patients with gastric cancer. Clin Nutr 2007; 26:728.
- Mehanna HM, Morton RP. Deterioration in quality-of-life of late (10-year) survivors of head and neck cancer. Clin Otolaryngol 2006; 31:204.
- Oskam IM, Verdonck-de Leeuw IM, Aaronson NK, et al. Quality of life as predictor of survival: a prospective study on patients treated with combined surgery and radiotherapy for advanced oral and oropharyngeal cancer. Radiother Oncol 2010; 97:258.
- Laraway DC, Lakshmiah R, Lowe D, et al. Quality of life in older people with oral cancer. Br J Oral Maxillofac Surg 2012; 50:715.
- 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 2004; 130:401.
- Verdonck-de Leeuw IM, Buffart LM, Heymans MW, et al. The course of health-related quality of life in head and neck cancer patients treated with chemoradiation: a prospective cohort study. Radiother Oncol 2014; 110:422.
- Langius JA, van Dijk AM, Doornaert P, et al. More than 10% weight loss in head and neck cancer patients during radiotherapy is independently associated with deterioration in quality of life. Nutr Cancer 2013; 65:76.
- Ronis DL, Duffy SA, Fowler KE, et al. Changes in quality of life over 1 year in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 2008; 134:241.
- Egestad H, Emaus N. Changes in health related quality of life in women and men undergoing radiation treatment for head and neck cancer and the impact of smoking status in the radiation treatment period. Eur J Oncol Nurs 2014; 18:339.
- Funk GF, Karnell LH, Christensen AJ. Long-term health-related quality of life in survivors of head and neck cancer. Arch Otolaryngol Head Neck Surg 2012; 138:123.
- Lin BM, Starmer HM, Gourin CG. The relationship between depressive symptoms, quality of life, and swallowing function in head and neck cancer patients 1 year after definitive therapy. Laryngoscope 2012; 122:1518.
- Thompson TL, Pagedar NA, Karnell LH, Funk GF. Factors associated with mortality in 2-year survivors of head and neck cancer. Arch Otolaryngol Head Neck Surg 2011; 137:1100.
- Fingeret MC, Vidrine DJ, Reece GP, et al. Multidimensional analysis of body image concerns among newly diagnosed patients with oral cavity cancer. Head Neck 2010; 32:301.
- Fingeret MC, Hutcheson KA, Jensen K, et al. Associations among speech, eating, and body image concerns for surgical patients with head and neck cancer. Head Neck 2013; 35:354.
- Vickery LE, Latchford G, Hewison J, et al. The impact of head and neck cancer and facial disfigurement on the quality of life of patients and their partners. Head Neck 2003; 25:289.
- Katre C, Johnson IA, Humphris GM, et al. Assessment of problems with appearance, following surgery for oral and oro-pharyngeal cancer using the University of Washington appearance domain and the Derriford appearance scale. Oral Oncol 2008; 44:927.
- Ramírez MJ, Ferriol EE, Doménech FG, et al. Psychosocial adjustment in patients surgically treated for laryngeal cancer. Otolaryngol Head Neck Surg 2003; 129:92.
- Maurer J, Hipp M, Schäfer C, Kölbl O. Dysphagia. Impact on quality of life after radio(chemo)therapy of head and neck cancer. Strahlenther Onkol 2011; 187:744.
- Deng J, Murphy BA, Dietrich MS, et al. Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status, and quality of life. Head Neck 2013; 35:1026.
- Woodard TD, Oplatek A, Petruzzelli GJ. Life after total laryngectomy: a measure of long-term survival, function, and quality of life. Arch Otolaryngol Head Neck Surg 2007; 133:526.
- Schindler A, Mozzanica F, Ginocchio D, et al. Voice-related quality of life in patients after total and partial laryngectomy. Auris Nasus Larynx 2012; 39:77.
- Vilaseca I, Chen AY, Backscheider AG. Long-term quality of life after total laryngectomy. Head Neck 2006; 28:313.
- Kakoei S, Haghdoost AA, Rad M, et al. Xerostomia after radiotherapy and its effect on quality of life in head and neck cancer patients. Arch Iran Med 2012; 15:214.
- Kolnick L, Deng J, Epstein JB, et al. Associations of oral health items of the Vanderbilt Head and Neck Symptom Survey with a dental health assessment. Oral Oncol 2014; 50:135.
- Low CA, Kalinski P, Bovbjerg DH. Neurocognitive Impairment as One Facet of Cancer-Related Sickness Behavior Symptoms. J Natl Cancer Inst 2015; 107.
- Yunus MB. Editorial review: an update on central sensitivity syndromes and the issues of nosology and psychobiology. Curr Rheumatol Rev 2015; 11:70.
- Wulff-Burchfield EM, Dietrich MS, Murphy BA, et al. Late systemic symptom frequency in head and neck cancer survivors as measured by the Vanderbilt Head and Neck Symptom Survey – General Symptom Subscale. J Clin Oncol 2016; 34:6094.
- Hess CB, Rash DL, Daly ME, et al. Competing causes of death and medical comorbidities among patients with human papillomavirus-positive vs human papillomavirus-negative oropharyngeal carcinoma and impact on adherence to radiotherapy. JAMA Otolaryngol Head Neck Surg 2014; 140:312.
- Kwon M, Roh JL, Song J, et al. Noncancer health events as a leading cause of competing mortality in advanced head and neck cancer. Ann Oncol 2014; 25:1208.
- Department of Veterans Affairs Laryngeal Cancer Study Group, Wolf GT, Fisher SG, et al. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991; 324:1685.
- Terrell JE, Fisher SG, Wolf GT. Long-term quality of life after treatment of laryngeal cancer. The Veterans Affairs Laryngeal Cancer Study Group. Arch Otolaryngol Head Neck Surg 1998; 124:964.
- Oskam IM, Verdonck-de Leeuw IM, Aaronson NK, et al. Prospective evaluation of health-related quality of life in long-term oral and oropharyngeal cancer survivors and the perceived need for supportive care. Oral Oncol 2013; 49:443.
- Sherman AC, Simonton S. Advances in quality of life research among head and neck cancer patients. Curr Oncol Rep 2010; 12:208.
- Wan Leung S, Lee TF, Chien CY, et al. Health-related quality of life in 640 head and neck cancer survivors after radiotherapy using EORTC QLQ-C30 and QLQ-H&N35 questionnaires. BMC Cancer 2011; 11:128.
- Lin YL, Lin IC, Liou JC. Symptom patterns of patients with head and neck cancer in a palliative care unit. J Palliat Med 2011; 14:556.
- Bindewald J, Oeken J, Wollbrueck D, et al. Quality of life correlates after surgery for laryngeal carcinoma. Laryngoscope 2007; 117:1770.
- Bjordal K, Ahlner-Elmqvist M, Hammerlid E, et al. A prospective study of quality of life in head and neck cancer patients. Part II: Longitudinal data. Laryngoscope 2001; 111:1440.
- Hammerlid E, Silander E, Hörnestam L, Sullivan M. Health-related quality of life three years after diagnosis of head and neck cancer--a longitudinal study. Head Neck 2001; 23:113.
- Høxbroe Michaelsen S, Grønhøj C, Høxbroe Michaelsen J, et al. Quality of life in survivors of oropharyngeal cancer: A systematic review and meta-analysis of 1366 patients. Eur J Cancer 2017; 78:91.
- Maxwell JH, Mehta V, Wang H, et al. Quality of life in head and neck cancer patients: impact of HPV and primary treatment modality. Laryngoscope 2014; 124:1592.
- Marur S, Li S, Cmelak AJ, et al. E1308: Phase II Trial of Induction Chemotherapy Followed by Reduced-Dose Radiation and Weekly Cetuximab in Patients With HPV-Associated Resectable Squamous Cell Carcinoma of the Oropharynx- ECOG-ACRIN Cancer Research Group. J Clin Oncol 2016; :JCO2016683300.
- Taylor JC, Terrell JE, Ronis DL, et al. Disability in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 2004; 130:764.
- Broglie MA, Soltermann A, Haile SR, et al. Quality of life of oropharyngeal cancer patients with respect to treatment strategy and p16-positivity. Laryngoscope 2013; 123:164.
- Marucci L, Marzi S, Sperduti I, et al. Influence of intensity-modulated radiation therapy technique on xerostomia and related quality of life in patients treated with intensity-modulated radiation therapy for nasopharyngeal cancer. Head Neck 2012; 34:328.
- Rathod S, Gupta T, Ghosh-Laskar S, et al. Quality-of-life (QOL) outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiation therapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT): evidence from a prospective randomized study. Oral Oncol 2013; 49:634.
- Chen AM, Daly ME, Farwell DG, et al. Quality of life among long-term survivors of head and neck cancer treated by intensity-modulated radiotherapy. JAMA Otolaryngol Head Neck Surg 2014; 140:129.
- Guibert M, Lepage B, Woisard V, et al. Quality of life in patients treated for advanced hypopharyngeal or laryngeal cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:218.
- Trivedi NP, Swaminathan DK, Thankappan K, et al. Comparison of quality of life in advanced laryngeal cancer patients after concurrent chemoradiotherapy vs total laryngectomy. Otolaryngol Head Neck Surg 2008; 139:702.
- Crombie AK, Farah CS, Batstone MD. Health-related quality of life of patients treated with primary chemoradiotherapy for oral cavity squamous cell carcinoma: a comparison with surgery. Br J Oral Maxillofac Surg 2014; 52:111.
- Bottomley A, Tridello G, Coens C, et al. An international phase 3 trial in head and neck cancer: quality of life and symptom results: EORTC 24954 on behalf of the EORTC Head and Neck and the EORTC Radiation Oncology Group. Cancer 2014; 120:390.
- Salas S, Baumstarck-Barrau K, Alfonsi M, et al. Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: Prospective randomized trial. Radiother Oncol 2009; 93:503.
- Stevens CS, Lemon B, Lockwood GA, et al. The development and validation of a quality-of-life questionnaire for head and neck cancer patients with enteral feeding tubes: the QOL-EF. Support Care Cancer 2011; 19:1175.
- Passchier E, Stuiver MM, van der Molen L, et al. Feasibility and impact of a dedicated multidisciplinary rehabilitation program on health-related quality of life in advanced head and neck cancer patients. Eur Arch Otorhinolaryngol 2016; 273:1577.
- 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