Supportive Care in Cancer

, Volume 24, Issue 6, pp 2463–2472 | Cite as

Predictors of quality of life in head and neck cancer survivors up to 5 years after end of treatment: a cross-sectional survey

  • Mary Wells
  • Samantha Swartzman
  • Heidi Lang
  • Margaret Cunningham
  • Lesley Taylor
  • Jane Thomson
  • Julie Philp
  • Colin McCowan
Original Article

Abstract

Purpose

This study aimed to assess quality of life (QoL) in head and neck cancer (HNC) survivors and determine factors predictive of poor QoL in the first 5 years after the end of treatment.

Methods

A cross-sectional survey, including the Quality of Life in Adult Cancer Survivors (QLACS) measure, was sent to HNC survivors in three Scottish health regions, with responses linked to routinely collected clinical data. Independent sample t tests, ANOVAs, Pearson correlations and multiple hierarchical regressions were used to explore associations between and to determine the contribution made by demographic, lifestyle and clinical factors to predicting ‘generic’ and ‘cancer-specific’ quality of life.

Results

Two hundred eighty patients (65 %) returned questionnaires. After adjustment, multivariate analysis showed that younger age, lower socio-economic status, unemployment and self-reported comorbidity independently contributed to poorer generic and cancer-specific quality of life. In addition to these factors, having had a feeding tube or a diagnosis of oral cavity cancer were independently predictive of poorer cancer-specific quality of life.

Conclusions

Socio-economic factors and comorbidity are important predictors of QoL in HNC survivors. These factors and the detrimental long-term effects of feeding tubes need further attention in research and practice.

Keywords

Quality of life Head and neck cancer Survivors Socio-economic status Feeding tube 

References

  1. 1.
    Mehanna H, Jones T, Gregoire V, Ang K (2010) Oropharyngeal carcinoma related to human papillomavirus. BMJ 340Google Scholar
  2. 2.
    NHS Scotland (2012) Cancer in Scotland. In.: Information Services Division, NHS National Services ScotlandGoogle Scholar
  3. 3.
    NHS Scotland (2010) Cancer of the head and neck: Incidence and mortality by deprivation category. In.: Information Services Division, NHS ScotlandGoogle Scholar
  4. 4.
    Rozniatowski O, Reich M, Mallet Y, Penel N, Fournier C, Lefebvre J (2005) Psychosocial factors involved in delayed consultation by patients with head and neck cancer. Head Neck 27(4):274–280CrossRefPubMedGoogle Scholar
  5. 5.
    Statement from director of the National Cancer Research Network in response to a parliamentary question concerning the findings of the 2012 National Cancer Patient Experience Survey [http://ncrndev.org.uk/downloads/MiscDocs/3.2.12%20Overview%20from%202012%20NCPES.pdf]
  6. 6.
  7. 7.
    Fakhry C, Westra W, Li S, Cmelak A, Ridge J, Pinto H, Forastiere A, Gillison M (2008) Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst 100(4):261–269CrossRefPubMedGoogle Scholar
  8. 8.
    Rogers S, Ahad S, Murphy A (2007) A structured review and theme analysis of papers published on ‘quality of life’ in head and neck cancer: 2000-2005. Oral Oncol 43:843–868CrossRefPubMedGoogle Scholar
  9. 9.
    Eades M, Chasen M, Bhargava R (2009) Rehabilitation: long-term physical and functional changes following treatment. Semin Oncol Nurs 25(3):222–230CrossRefPubMedGoogle Scholar
  10. 10.
    Murphy BA, Ridner S, Wells N, Dietrich M (2007) Quality of life research in head and neck cancer: a review of the current state of the science. Critical Reviews in Oncology/Hematology 62(3):251–267CrossRefPubMedGoogle Scholar
  11. 11.
    Humphris G, Rogers S, McNally D, Lee-Jones C, Brown J, Vaughan D (2003) Fear of recurrence and possible cases of anxiety and depression in oro-facial cancer patients. International Journal of Oral & Maxillofacial Surgery 32:486–491CrossRefGoogle Scholar
  12. 12.
    Karvonen-Gutierrez CA, Ronis DL, Fowler KE, Terrell JE, Gruber SB, Duffy SA (2008) Quality of life scores predict survival among patients with head and neck cancer. J Clin Oncol 26(16):2754–2760CrossRefPubMedGoogle Scholar
  13. 13.
    Watson E, Rose P, Neal R, Hulbert-Williams N, Donnelly P, Hubbard G, Elliott J, Campbell C, Weller D, Wilkinson C (2012) Personalised cancer follow-up: risk stratification, needs assessment or both? Br J Cancer 106:1–5CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Terrell J, Ronis D, Fowler G, Bradford C, Chepeha D, Prince M, Wolf G, Duffy S (2004) Clinical predictors of quality of life in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 130:401–408CrossRefPubMedGoogle Scholar
  15. 15.
    El-Deiry M, Futran N, McDowell J, Weymuller E, Yueh B (2009) Influences and predictors of long-term quality of life in head and neck cancer survivors. Archives Otolaryngology Head Neck Surgery 135(4):380–384CrossRefGoogle Scholar
  16. 16.
    Avis N, Ip E, Foley K (2006) Evaluation of the quality of life in adult cancer survivors (QLACS) scale for long-term cancer survivors in a sample of breast cancer survivors. Health and Quality of Life Outcomes 4(1):92CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Avis NE, Smith KW, McGraw S, Smith RG, Petronis VM, Carver CS (2005) Assessing quality of life in adult cancer survivors (QLACS). Qual Life Res 14(4):1007–1023CrossRefPubMedGoogle Scholar
  18. 18.
    Palefsky J (2007) HPV infection in men. Dis Markers 23(4):261–272CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Wells M, Cunningham M, Lang H, Swartzman S, Philp J, Taylor L, Thomson J, McCowan C (2015) Distress, concerns and unmet needs in survivors of head and neck cancer: a cross-sectional survey. European Journal of Cancer Care. doi:10.1111/ecc.12370 Google Scholar
  20. 20.
    National Comprehensive Cancer Network (2012) NCCN clinical practice guidelines in oncology: distress management (Version 2.2013)Google Scholar
  21. 21.
    Rogers S, El-Sheikha J, Lowe D (2009) The development of a patients concerns inventory (PCI) to help reveal patients concerns in the head and neck clinic. Oral Oncol 45:555–561CrossRefPubMedGoogle Scholar
  22. 22.
    Tsikriktsis N (2005) A review of techniques for treating missing data in OM survey research. J Oper Manag 24(1):53–62CrossRefGoogle Scholar
  23. 23.
    Monk B, Tewari K (2007) The spectrum and clinical sequelae of human papillomavirus infection. Gynecol Oncol 107(2 Suppl 1):S6–S13CrossRefPubMedGoogle Scholar
  24. 24.
    Reitzel L, Nguyen N, Zafereo M, Li G, Wei Q, Sturgis E (2012) Neighborhood deprivation and clinical outcomes among head and neck cancer patients. Health & Place 18:861–868CrossRefGoogle Scholar
  25. 25.
    Robertson G, Greenlaw N, Steering Group Committee for the Scottish Audit of Head and Neck Cancers, Bray C, Morrison D (2010) Explaining the effects of socio-economic deprivation on survival in a national prospective cohort study of 1909 patients with head and neck cancers. Cancer Epidemiol 34:682–688CrossRefPubMedGoogle Scholar
  26. 26.
    Demiral AN, Sen M, Demiral Y, Kinay M (2008) The effect of socioeconomic factors on quality of life after treatment in patients with head and neck cancer. Int J Radiat Oncol Biol Phys 70(1):23–27CrossRefPubMedGoogle Scholar
  27. 27.
    Woolley E, Magennis P, Shokar P, Lowe D, Edwards D, Rogers SN (2006) The correlation between indices of deprivation and health-related quality of life in patients with oral and oropharyngeal squamous cell carcinoma. Br J Oral Maxillofac Surg 44(3):177–186CrossRefPubMedGoogle Scholar
  28. 28.
    Castro T, Bussoloti F (2006) Prevalence of human papillomavirus (HPV) in oral cavity and oropharynx. Braz J Otorhinolaryngol 72(2):272–282CrossRefPubMedGoogle Scholar
  29. 29.
    Wright P, Smith A, Booth L, Winterbottom A, Kiely M, Velikova G, Selby P (2005) Psychosocial difficulties, deprivation and cancer: three questionnaire studies involving 609 cancer patients. Br J Cancer 93:622–626CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Fakhry C, Westra W, Li S, Cmelak A, Ridge J, Pinto H, Forastiere A, Gillison ML (2008) Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Ntl Cancer Inst 100:261–269CrossRefGoogle Scholar
  31. 31.
    Scottish Intercollegiate Guidelines Network (2006) Diagnosis and management of head and neck cancer. A national clinical guideline. Network SIG, EdinburghGoogle Scholar
  32. 32.
    Paleri V, Wight R, Silver C, Haigentz M Jr, Takes R, Bradley P, Rinaldo A, Sanabria A, Bien S, Ferlito A (2010) Comorbidity in head and neck cancer: a critical appraisal and recommendations for practice. Oral Oncol 46:712–719CrossRefPubMedGoogle Scholar
  33. 33.
    Szkaradkiewicz A, Kruk-Zagajewska A, Wal M, Jopek A, Wierzbicka MAK (2002) Epstein-Barr virus and human papillomavirus infections and oropharyngeal squamous cell carcinomas. Clin Exp Med 2(3):137–141CrossRefPubMedGoogle Scholar
  34. 34.
    Koyfman S, Adelstein D (2012) Enteral feeding tubes in patients undergoing definitive chemoradiation therapy for head-and-neck cancer: a critical review. Int J Radiat Oncol Biol Phys 84(3):581–589CrossRefPubMedGoogle Scholar
  35. 35.
    Paleri V, Patterson J (2010) Use of gastrostomy in head and neck cancer: a systematic review to identify areas for future research. Clin Otolaryngol 35(3):177–189CrossRefPubMedGoogle Scholar
  36. 36.
    Duffy S, Terrell J, Valenstein M, Ronis D, Copeland L, Connors M (2002) Effect of smoking, alcohol, and depression on the quality of life of head and neck cancer patients. Gen Hosp Psychiatry 24(3):140–147CrossRefPubMedGoogle Scholar
  37. 37.
    Allison P (2002) Alcohol consumption is associated with improved health-related quality of life in head and neck cancer patients. Oral Oncol 38:81–86CrossRefPubMedGoogle Scholar
  38. 38.
    Potash AHL, Christensen AJ, Vander Weg M, Funk GF (2009) Continued alcohol use in patients with head and neck cancer. Head Neck 32:905–912Google Scholar
  39. 39.
    Short P, Vasey J, Tunceli K (2005) Employment pathways in a large cohort of adult cancer survivors. Cancer 103(6):1292–1301CrossRefPubMedGoogle Scholar
  40. 40.
    Van der Wouden J, Greaves-Otte J, Greaves J (1992) Occupational reintegration of long-term cancer survivors. J Occup Med 34(11):1084–1089CrossRefPubMedGoogle Scholar
  41. 41.
    Termine N, Panzarella V, Falaschini S, Russo A, Matranga D, Lo Muzio L, Campisi G (2008) HPV in oral squamous cell carcinoma vs head and neck squamous cell carcinoma biopsies: a meta-analysis (1988-2007). Ann Oncol 19(10):1681–1690CrossRefPubMedGoogle Scholar
  42. 42.
    Wells M, Williams B, Firnigl D, Lang H, Coyle J, Kroll T, MacGillivray S (2012) Supporting ‘work-related goals’ rather than ‘return to work’ after cancer? A systematic review and meta-synthesis of 25 qualitative studies. Psychooncology 22(6):1208–1219CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.NMAHP Research Unit, Scion HouseUniversity of StirlingStirlingUK
  2. 2.School of PsychologyUniversity of DundeeDundeeUK
  3. 3.School of Nursing and MidwiferyUniversity of DundeeDundeeUK
  4. 4.Radiotherapy and OncologyNinewells HospitalDundeeUK
  5. 5.NHS Forth ValleyLarbertScotland
  6. 6.NHS FifeQueen Margaret HospitalDunfermlineUK
  7. 7.Robertson Centre for BiostatisticsUniversity of Glasgow Boyd Orr BuildingGlasgowUK
  8. 8.Medicine and SurgeryKing Abdulaziz Medical CityJeddahSaudi Arabia

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