Patient-reported outcomes of head and neck surgery in focus

By Joanna Lyford, Senior medwireNews Reporter

Researchers have taken the first step toward developing a new measure of health-related quality of life (HRQoL) in people who have undergone head and neck reconstruction.

They say that their qualitative approach to assessing health and appearance concerns following head and neck surgery "serves as the foundation for development of a new patient-reported outcomes [PRO] instrument."

Noting that HRQoL is increasingly recognized as an important outcome and that available PRO instruments for head and neck reconstruction are suboptimal, Evan Matros (Memorial Sloan Kettering Cancer Center, New York, USA) undertook qualitative interviews with 26 patients with head and neck cancer.

The interviews were semistructured and lasted approximately 1 hour. Topics were drawn from the medical literature, current PRO instruments, and suggestions from an expert panel of plastic surgeons.

The patients were typically over 60 years of age and the most common surgery was midface reconstruction (41%), followed by lower face (27%) and upper face (22%).

The interviews identified several important concerns for patients with head and neck cancers, which the researchers classified into four main themes. These were altered facial function (such as problems with speech, eating, salivation, facial sensation, smile, and vision); altered facial appearance (such as a crooked jaw or asymmetrical face); the psychosocial impact of altered facial function and appearance; and mediators (such as fear of cancer, appearance investment, and expectations).

Writing in Clinics in Plastic Surgery, Matros and co-workers say that their interviews and analysis form the preliminary phase of the development of a new PRO. The second phase would be to field-test a preliminary questionnaire to refine the items, while the third and final phase would be to validate the final questionnaire in an external population.

Using the themes that emerged in the present study as a benchmark, existing PRO instruments have several limitations, note the authors. These include the omission of midface symptoms, a lack of emphasis on psychosocial sequelae, exclusion of patients who have undergone facial allotransplantation, and omission of concepts such as appearance investment and expectations.

The researchers write: "The information obtained from the current study serves as the framework for item generation of a new PRO instrument for patients with head and neck cancers: the reconstructive module for the FACE-Q.

"With increasing focus on evidence-based medicine and cost-effectiveness, PRO instruments are an important data source to justify many of the interventions performed by plastic and reconstructive surgeons."

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