Sociodemographic factors and quality of life as prognostic indicators in head and neck cancer
Introduction
Quality of life (QOL) is increasingly acknowledged as an important endpoint in cancer clinical trials and clinical practice, along with the traditional endpoints like tumour response rate, disease-free survival and overall survival 1, 2. Studies that include a QOL endpoint have focused primarily on the longitudinal impact of disease or treatment on QOL. However, recent studies have established that pretreatment QOL may also have prognostic significance [3].
One of the first measures of QOL was the Karnofsky performance status (KPS) [4], which is a physician-rated instrument evaluating three dimensions of health status simultaneously (activity, work, and self-care) [5]. Although by today's standards this is considered to be an inadequate tool to measure QOL, it has been shown to correlate with survival in several studies in cancer patients 6, 7, 8. However, it seems that some multidimensional measures of QOL may be more accurate predictors of survival than the KPS. Pre-treatment QOL has been shown to correlate with survival in studies in lung cancer 9, 10, 11, 12, 13, 14, breast cancer 15, 16, colorectal cancer 17, 18, multiple myeloma [19], malignant melanoma [20], and mixed populations of cancer patients 21, 22, 23, 24, 25, 26, 27. The majority of these studies used patient-rated instruments; in some of the studies a physician-rated instrument (the Spitzer QOL Index) [28] was also or only used 15, 18, 20, 21. Almost all of these studies were performed in patients with advanced and often incurable disease, and QOL was usually assessed prior to chemotherapy, usually within a clinical trial.
Sociodemographic factors, in particular marital and socioeconomic status, have been shown to correlate with survival in cancer patients. In a population-based study in 27 779 cancer patients, unmarried persons had an increased risk of dying (relative risk (RR) 1.23, 95% confidence interval (95% CI) 1.19–1.28) [29]. In one of the studies assessing the prognostic influence of QOL on survival in lung cancer patients, marital status was also found to have an influence on survival [10]. In a Canadian study, in several types of cancer (including head and neck cancer), a strong and statistically significant association was found between socioeconomic status and survival [30]. Socioeconomic differences in cancer survival were also found in another study [31].
In cancer patients, disease- and treatment-related factors have a major influence on prognosis, and any study of prognostic factors should take these into account. In head and neck cancer, stage is probably the most important factor. Other factors, such as site, grade of differentiation, growth pattern, type of treatment and positive tumour margins may also have an influence, but their prognostic influence is less clear [32].
We performed a prospective study in patients with head and neck cancer receiving surgery and/or radiotherapy with curative intent, in which QOL was measured before treatment. One of the aims of the study was to assess the prognostic significance (with regard to both recurrence and survival) of pre-treatment QOL variables in this patient group. We also studied whether smoking, drinking and sociodemographic variables were an independent prognostic factor. In this paper, we analyse the results after a minimum follow-up of 3 years.
Section snippets
Patients
Patients were eligible for the study if they had squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx or larynx treated with surgery and/or radiotherapy with curative intent. Other inclusion criteria were: age less than 80 years; no previous or synchronous malignancies; no cognitive impairment (as judged by the physician); ability to understand and to read Dutch. During the inclusion period (May 1994–June 1996), 266 patients met the inclusion criteria. Fifty-eight patients
Results
The median follow-up of the living patients is 45 months (range 36–62). The occurrence of local recurrence and/or distant metastases, secondary tumours and death is shown in Table 3. 55 patients developed a local recurrence and/or distant metastases. At the time of the analysis, 16 of these patients had received curative treatment (laryngectomy or neck dissection) and were free of disease, two were alive with incurable disease, and 37 had died of local recurrence or distant metastases.
Discussion
In this prospective study in patients with head and neck cancer receiving primary treatment with surgery and/or radiotherapy, we found that cognitive functioning, as measured by the EORTC QLQ-C30(+3), was a strong predictor of recurrence and survival, independent of medical factors (stage and radicality). Marital status was only an independent prognostic factor with regard to TTE. When only QOL variables were studied, social functioning was also predictive of survival, but this effect
References (50)
- et al.
Prognostic factors in resected stage I and II adenocarcinoma of the lung
J Thorac Cardiovasc Surg
(1990) - et al.
Prognostic factors for patients with inoperable non-small cell lung cancer, limited disease
Radiother Oncol
(1989) - et al.
Prognostic value of quality of life scores in a trial of chemotherapy with or without interferon in patients with metastatic melanoma
Eur J Cancer
(1993) - et al.
Quality of life in oncology practice: prognostic value of EORTC QLQ-C30 scores in patients with advanced malignancy
Eur J Cancer
(1997) Attitude and disposition: do they make a difference in cancer survival?
Mayo Clin Proc
(1997)Quality of life and clinical trials
Lancet
(1995)Measuring quality of life: an emerging science
Sem Oncol
(1994)Lessons learned from measuring health-related quality of life in oncology
J Clin Oncol
(1994)- et al.
The evaluation of chemotherapeutics in cancer
Quality-of-life assessment, performance status upstaged?
J Clin Oncol
(1992)
Identification of major prognostic subgroups of patients with large-cell lymphoma treated with m-BACOD or M-BACOD
Ann Intern Med.
Evaluation of patients with advanced cancer using the Karnofsky performance status
Cancer
The patients' perception of his own quality of life might have an adjunctive prognostic significance in lung cancer
Lung Cancer
Quality of life assessment. An independent prognostic variable for survival in lung cancer
Cancer
Is quality of life predictive of the survival of patients with advanced nonsmall cell lung carcinoma
Cancer
Quality of life assessment in lung surgery for bronchogenic carcinoma
Theoretical Surg
Quality of life in lung cancer surgical adjuvant trials
Chest
for the Australian New Zealand Breast Cancer Trials Group. Prognostic value of quality-of-life scores during chemotherapy for advanced breast cancer
J Clin Oncol
Quality of life in phase II trials: a study of methodology and predictive value in patients with advanced breast cancer treated with paclitaxel plus granulocyte colony-stimulating factor
J Natl Cancer Institute
Relation between tumor size, quality of life, and survival in patients with colorectal liver metastases
J Clin Oncol
Randomized comparison of four tools measuring overall quality of life in patients with advanced cancer
J Clin Oncol
Health-related quality of life assessed before and during chemotherapy predicts for survival in multiple myeloma. Nordic Myeloma Study Group
Br J Haematol
Can the Spitzer Quality of Life Index help to reduce prognostic uncertainty in terminal care?
Br J Cancer
Quality of life and survival: the role of multidimensional symptom assessment
Cancer
Quality of life scores: An independent prognostic variable in a general population of cancer patients receiving chemotherapy
Qual Lif Res.
Cited by (169)
Comparison between the radial forearm and groin soft tissue free flaps for reconstruction in patients with oral cavity cancer: a quality of life analysis
2022, International Journal of Oral and Maxillofacial SurgeryOral and oropharyngeal cancer surgery with free-flap reconstruction in the elderly: Factors associated with long-term quality of life, patient needs and concerns. A GETTEC cross-sectional study
2020, Surgical OncologyCitation Excerpt :Global QoL and functioning scales were well-preserved, with social functioning being the most affected functioning scale, as commonly reported in the literature [13,15–17]. In a study on OOPC patients treated by surgery with or without RT, de Graeff et al. found remarkably similar results with a 1-year post-treatment score of nearly 70% for global QoL and nearly 80% for all functioning scales [18]. As in other QoL studies in head and neck cancer patients, fatigue and insomnia, in the present study, were also among the most frequent persistent general symptoms [13,15,16,18].
Patient-Centered Outcomes in Radiation Oncology
2019, Hematology/Oncology Clinics of North AmericaSurvival analysis of head and neck cancer: Results from a hospital based cancer registry in southern Karnataka
2019, Clinical Epidemiology and Global HealthInsurance Status is Associated With Recurrence in Cutaneous Head and Neck Squamous Cell Carcinoma
2024, Otolaryngology - Head and Neck Surgery (United States)