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Socioeconomic status and quality of life in patients with locally advanced head and neck cancer

Sozioökonomischer Status und Lebensqualität bei Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren

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Abstract

Purpose

Socioeconomic aspects play an important role in health care. Patients with locally advanced head and neck cancer (LAHNC) experience detrimental effects on their quality of life (QoL). This prospective study examines QoL differences between patients with different socioeconomic status (SES) after intensity-modulated radiation therapy (IMRT).

Patients and methods

In all, 161 patients were questioned at the end of IMRT and at 12 and 24 months follow-up using the questionnaires of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-30 and QLQ-HN35. Patients’ QoL 2 years after IMRT was compared to a population reference sample and QoL of patients from lower, middle, and higher social class 2 years after IMRT was analyzed by ANCOVA using baseline QoL (end of radiation treatment) as a covariate.

Results

Patients with high SES report worse QoL at the end of IMRT in the domains global health status (−15.2; p = 0.005), role function (−23.8; p = 0.002), and social function (−19.4; p = 0.023) compared to patients with middle and low SES. QoL improved during the first 12 and 24 months. However, 2 years after IMRT, middle and low SES patients report lower QoL in the domains global health status, physical function, and role function, and report a higher general (fatigue, pain, dyspnea) and head and neck cancer-specific symptom burden (pain, swallowing, senses, speech, social eating, opening mouth, and felt ill) than patients with high SES.

Conclusion

After IMRT for LAHNC, patients with high SES report worse QoL compared to patients with middle or low SES. There is a marked improvement within the first 24 months in many domains. However, the magnitude of improvement in patients with middle or low SES is significantly smaller compared to patients with high SES.

Zusammenfassung

Zielsetzung

Sozioökonomische Aspekte spielen bei vielen Erkrankungen und deren Therapie eine nicht zu unterschätzende Rolle, so auch bei Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren (LFKHT). Diese Patienten erfahren durch Erkrankung und Therapie Einbußen in ihrer Lebensqualität (QoL). Diese prospektive Studie untersucht den Zusammenhang zwischen QoL und sozioökonomischem Status (SES) bei LFKHT-Patienten nach intensitätsmodulierter Strahlentherapie (IMRT).

Patienten und Methoden

Am Ende der Bestrahlung, nach 6–8 Wochen sowie 6, 12, 18 und 24 Monate nach Abschluss der IMRT haben 161 Patienten die standardisierten Fragebögen der EORTC (European Organization for Research and Treatment of Cancer) QLQ-C30 und QLQ-HN35 ausgefüllt. Nach 2 Jahren wurde die QoL der Gesamtpopulation mit der einer Referenzpopulation verglichen und der Zusammenhang zwischen QoL am Ende der IMRT und SES analysiert (ANCOVA).

Ergebnisse

Patienten der Gruppe mit hohem SES hatten eine deutlich schlechtere QoL in den Domänen globaler Gesundheitsstaus (−15,2; p = 0,005), Rollenfunktion (−23,8; p = 0,002) und soziale Funktion (−19,4; p = 0,023) verglichen mit Patienten der mittleren und niedrigen SES-Gruppen. Nach 12 und 24 Monaten verbesserte sich die QoL in vielen Domänen. Patienten mit mittlerem und niedrigem SES berichten 2 Jahre nach IMRT eine schlechtere QoL in den Domänen globaler Gesundheitszustand, körperliche Funktion und Rollenfunktion und eine höhere Symptomlast (Fatigue, Schmerzen, Dyspnoe). Im spezifischen Kopf-Hals-Tumor-Modul berichteten Patienten mit hohem SES signifikant weniger häufig Symptome im Vergleich zu Patienten mit mittlerem oder niedrigem SES (Schmerzen, Schlucken, Sinne, Sprechen, Essen in Gesellschaft, Mundöffnung und Krankheitsgefühl).

Zusammenfassung

Am Ende der Radio(chemo)therapie für LFKHT schätzen Patienten mit höherem SES ihre QoL schlechter ein als Patienten mit mittlerem oder niedrigem SES. Nach 24 Monaten zeigt sich eine Verbesserung der QoL in vielen Domänen, wobei diese bei niedrigem SES deutlich weniger ausgeprägt ist als bei hohem SES.

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Authors and Affiliations

  1. Department of Radiation Oncology, Asklepios Hospital St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany

    S. Tribius MD, PhD

  2. Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    M. S. Meyer, A. Krüll & C. Petersen

  3. Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    C. Pflug

  4. Department of Oral & Maxillofacial Surgery, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    H. Hanken

  5. Department of Otolaryngology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    C.-J. Busch

  6. Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    C. Bergelt

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  1. S. Tribius MD, PhD
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Correspondence to S. Tribius MD, PhD.

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Conflict of interest

S. Tribius, M.S. Meyer, C. Pflug, H. Hanken, C.‑J. Busch, A. Krüll, C. Petersen, and C. Bergelt declare that they have no competing interests.

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Tribius, S., Meyer, M.S., Pflug, C. et al. Socioeconomic status and quality of life in patients with locally advanced head and neck cancer. Strahlenther Onkol 194, 737–749 (2018). https://doi.org/10.1007/s00066-018-1305-3

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  • DOI: https://doi.org/10.1007/s00066-018-1305-3

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