gms | German Medical Science

Many head and neck cancer patients with incurable tumors suffer symptoms entailing reduced quality of life. Moreover, these patients frequently experience swallowing and speech disorders which impede their role and social functioning in society. Recently, cancer therapy research interest has focused on integrating quality-of-life end points within clinical trials to supplement standard end points in terms of response and survival [Ref. 1]. The goal of this collaborative prospective study was to assess the quality of life as experienced by head and neck cancer patients under palliative care in order to ascertain as to whether quality of life correlates with survival time.

Thirty-five patients with malignant, incurable head and neck tumors prospectively filled out the EORTC Quality of Life Core Questionnaire (QLQ-C30). This instrument was developed to assess the quality of life in cancer patients [Ref. 2]. The QLQ-C30 is a copyrighted questionnaire which has been validated and translated into 43 languages and as a core questionnaire suited for all cancer patients. It was first published in the late 80s followed by a 2nd edition in 1993. It is cancer-specific, multidimensional and comprises five functional scales (physical, role, cognitive, emotional, social), three symptom scales (pain, nausea/vomiting, fatigue), one global health status (5 items), and one item on perceived financial impact of the disease. Most of the scales and single items are rated on a four-point Likert scale. Physical and role function are rated dichotomously (dichotomous choice), whereas global health status is assessed with a seven-point scale [Ref. 3]. The quantitative scores range from 0-100; whereby 0 represents the worst and 100 the best score. We did not use other more specifically oriented head and neck questionnaires (such as the EORTC H+N 35 or KLQ H+N-R1) because we were only interested in assessing survival time and QOL-correlates and not specifics in treatment management. The mean age of the patients was 54.4 years (ranging from 24 - 74); and the patient sample comprised 31 men and 4 women. All patients gave their informed consent. Patient data were continually assessed. Based on patient assessments we were able to calculate that the mean QOL assessment occurred 9.3 months prior to death (range: 2 - 24 months). Tumor primary sites were: 8 laryngeal tumors, 13 hypopharyngeal tumors, and 7 oropharyngeal tumors. The other patients had different primary site tumors.

Results show that the patients reported significant impairments in "role functioning", "emotional functioning", and "social functioning" [Fig. 1].

Moreover, "global health status" was also given a relatively low rating demonstrating that these cancer patients judged their general quality of life as being considerably impaired. The high intraindividual differences in terms of functional impairments were rather striking (see SD and range in Table 1 [Fig. 1]). Surprising for us were those results, which showed that patients, who only had a short time to live (retrospectively), reported relatively minor functional and symptomatic impairments. One explanation could be that these patients used emotional regulating coping strategies and denials to downplay or deemphasize their symptoms. Fatigue and pain were reported as especially cumbersome in terms of symptoms [Fig. 2] as well as sleep disturbances and loss of appetite. Table 3 [Fig. 3] shows only significant correlations with global health status. The general global health status assessments (a global measure of quality of life) correlated significantly (positive) with physical, emotional, and social functioning as well as a significant correlation for global health status and fatigue and sleep disturbance. We were unable to find a linear correlation between symptom, functional impairment and survival time.

Our results show that the EORTC QLQ-30 is a suitable instrument for measuring functional and symptomatic impairments in patients with incurable head and neck cancer. The standardized assessment of quality is also a suitable instrument for assessing functional and social impairments of cancer patients receiving interdisciplinary palliative care as the instrument does not only apply to symptoms. However, our data did not reveal any significant correlations between quality of life and survival time. Nevertheless, functional and emotional outcomes are important parameters and this should prospectively be evaluated in future clinical trials in head and neck cancer research. From a phoniatrical perspective we would like to emphasize that the items of the EORTC QLQ-C30 are not comprehensive enough to map the vocal and interactional problems of many patients with head and neck tumours. Typical functional impairments and adverse effects such as "swallowing difficulties" or "verbal communication skills" do not receive any or insufficient considerations [Ref. 4].