Quality of life after treatment for head and neck cancer associated with longer-term survival

Quality of life measured one year after treatment for head and neck cancer appears to be associated with longer-term survival, according to a study in the January issue of Archives of Otolaryngology – Head & Neck Surgery.

Several studies have provided evidence that quality of life (QOL) might be associated with long-term survival in cancer patients, according to background information in the article. However, many studies have examined QOL in patients whose cancers were advanced and were in palliative care, so their results might not apply to people undergoing treatment to cure their cancer. Previous studies on head and neck cancer patients had assessed their QOL before they entered treatment and found no association with survival, the authors report.

Hisham M. Mehanna, B.Med.Sc. (Hon), M.B. Ch.B. (Hon), F.R.C.S., of University Hospitals Coventry and Warwickshire, England, and Randall P. Morton, M.B., B.S., M.Sc., F.R.A.C.S., Auckland City Hospital, New Zealand, assessed whether pretreatment and post-treatment QOL is associated with long-term survival in patients with head and neck cancers. A group of 200 consecutive patients with these types of cancers completed a QOL questionnaire when they were diagnosed with their disease, and again 12 months later, after treatment, if they were free of recurrent cancer.

After 10 years, 136 (68 percent) of the patients died, 48 were alive and the status of 16 was unknown. Those who had a lower QOL one year after treatment--as well as those who had head and neck pain--were more likely to have died.

"We hypothesized that, intuitively, it is more likely that the steady-state QOL, after patients had adjusted to the effects of the diagnosis and of treatment and had mobilized their coping strategies accordingly, would be the determinant of long-term survival, rather than pretreatment QOL," the authors report. "This was based on the observations that QOL status usually decreases noticeably during and in the period immediately after treatment and that patients return to a steady-state QOL at about one year after diagnosis. The findings of this study seem to corroborate this premise."

"However, the observed associations between survival benefit and one-year QOL may be confounded by comorbidity, which was not measured and deserves further investigation," they conclude.