Abstract
Purpose
This study aims to assess the quality of life and to define its determinants in patients with head and neck cancer undergoing radiotherapy.
Method
This prospective study was performed in an outpatient clinic of radiation oncology with a sample of 54 consecutive patients. Interview forms—European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire and Head and Neck Module to measure quality of life, Radiation Therapy Oncology Group criteria to determine radiation toxicity, and Patient-Generated Subjective Global Assessment to assess nutritional status—were used to obtain personal and disease-related data before, at the end of radiotherapy, and 1 and 3 months post-therapy.
Results
It was determined that various subscales of functional and symptom scales of quality of life were deteriorated at the end of radiotherapy and started to improve at 1 month after treatment. However, dry mouth and sticky saliva symptom scales did not follow the same pattern, and they took more time to improve. Quality of life (QoL) was found to be worse in younger age, higher education, higher income level, type of cancer, advanced stage, presence of tracheostomy, chemoradiation, higher dose of RT, bad nutritional status, and radiation toxicity.
Conclusions
Our results emphasize the vital need of support for head and neck cancer patients during radiotherapy, especially during the first month.
Similar content being viewed by others
References
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Osoba D, Flechtner H, Fleishman SB, de Haes JCJM, Kaasa S, Klee MC, Razavi D, Rofe PB, Schraub S, Sneeuw KCA, Sullivan M, Takeda F (1993) The European Organisation for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376
Abendstein H, Nordgren M, Boysen M, Jannert M, Silander E, Ahlner-Elmqvist M, Hammerlid E, Bjordal K (2005) Quality of life and head and neck cancer: a 5 year prospective study. Laryngoscope 115(12):2183–2192
Akduman D, Karaman M, Uslu C, Bilac O, Turk O, Deniz M, Durmus R (2010) Larynx cancer treatment results: survive and quality of life assessment. Kulak Burun Bogaz Ihtis Dergisi 20(1):25–32
Akgun S, Rao C, Yardim N, Basara BB, Aydın O, Mollahaliloglu S, Lopez AD (2007) Estimating mortality and causes of death in Turkey: methods, results and policy implications. Eur J Public Health 17(6):593–599
Alicikus ZA, Akman F, Ataman OU, Dag N, Orcin E, Bakis B, Kinay M (2008) Importance of patient, tumour and treatment related factors on quality of life in head and neck cancer patients after definitive treatment. Eur Arch Otorhinolaryngol 266(9):1461–1468
Aplak B, MalkoC M, Gelecek N, Sen M (2007) Quality of life of Turkish patients with head and neck cancer. Turkish J Cancer 37(4):129–135
Atasoyu EM, Unver S, Evrenkaya R, Tulbek MY (2003) Subjective global assessment. Turk Nefroloji ve Transplantasyon Dergisi 12(3):134–136
Bauer J, Capra S, Ferguson M (2002) Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56(8):779–785
Bjordal K, Ahlner-Elmqvist M, Tollesson E et al (1994) Development of a European Organization for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. Acta Oncologica 33(8):879–885
Bjordal K, Graeff A, Fayers PM, Hammerlid E, Pottelsberghe C, Curran D, Ahlner-Elmqvist M, Maher EJ, Meyza JW, Bredart A, Soderholm AL, Arraras JJ, Feine JS, Abendstein H, Morton RP, Pignon T, Huguenin P, Bottomly A, Kaasa S (2000) 12 country field study of the EORTC QLQ-C30 (version 3,0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients EORTC Quality of Life Group. Eur J Cancer 36(14):1796–1807
Bjordal K, Hammerlid E, Ahnler-Elmqvist M, Boysen M, Evensen J, Biorklund A (2001) A prospective study of quality of life in head and neck cancer patients. part II: longitudinal data. Laryngoscope 111(8):1440–1452
Braam P, Roesink J, Raaijmakers C, Busschers W, Terhaard C (2007) Quality of life and salivary output in patients with head and neck cancer five years after radiotherapy. Radiat Oncol 2:3. doi:10.1186/1748-717
Cankurtaran ES, Ozalp E, Soygur H, Ozer S, Akbiyik DI, Bottomley A (2008) Understanding the reliability and validity of the EORTC QLQ-C30 in Turkish cancer patients. Eur J Cancer Care 17(1):98–104
Capuano G, Gentile PC, Bianciardi F, Tosti M, Palladino A, Palma M (2009) Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer 18(4):433–437
Carper E, Haas M (2006) Advanced practice nursing in radiation oncology. Semin Oncol Nurs 22(4):203–211
Cengiz M, Ozyar E, Esassolak M, Altun M, Akmansu M, Sen M, Uzel O, Yavuz A, Dalmaz G, Uzal C, Hicsonmez A, Sarihan S, Kaplan B, Atasoy BM, Ulutin C, Abacioğlu U, Demiral AN, Hayran M, Turkish Oncology Group-Working Group of Head and Neck Cancer (2005) Assessment of quality of life of nasopharyngeal carcinoma patients with EORTC QLQ-C30 and H&N-35 modules. Int J Radiat Oncol Biol Phys 63(5):1347–1353
Chaukar DA, Walvekar RR, Das AK, Deshpande MS, Pai PS, Chaturvedi P, Kakade A, D’Cruz AK (2009) Quality of life in head and neck cancer survivors: a cross-sectional survey. Am J Otolaryngol 30(3):176–180
Demez PH, Moreau PR (2009) Perception of head and neck cancer quality of life within the medical world: a multicultural study. Head Neck 31(8):1056–1067
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):23–27
Detsky A, Mclaughlin J, Baker J, Johnston N, Whittaker S, Mendelson R (1987) What is subjective global assessment of nutritional status? J Parenter Enter Nutr 11(1):8–13
Epstein J, Robertson M, Emerton S, Philips N, Stevensen P (2000) Quality of life and oral function in patients treated with radiation therapy for head and neck cancer. Head&Neck 23(5):389–398
Ertem G, Kalkim A, Bulut S, Sevil U (2009) Radyoterapi alan hastaların evde bakım gereksinimleri ve yasam kaliteleri (quality of life and needs towards home care of patients treated with radiotherapy). Maltepe Universitesi Hemsirelik Bilim ve Sanati Dergisi 2(2):45–56
Eser SY (2007) Cancer ıncidence in Turkey. In Tuncer AM (ed) Cancer Control in Turkey. Ankara: National Cancer Advisory Board of Turkey, pp.17-45. Available from: http://www.ukdk.org/kitap_en.php. Accessed: 20.03.2012
Fidaner C, Eser SY, Parkin DM (2001) Incidence in Izmir in 1993–1994: first results from Izmir Cancer Registry. Eu J Ca 37(1):83–92
Gosselin-Acomb T (2006) Role of the radiation oncology nurse. Semin Oncol Nurs 22(4):198–202
Graeff A, Leeuw J, Ros W, Hordijk G, Blijham G, Winnubst J (2000) Long-term quality of life of patients with head and neck cancer. Laryngoscope 110(1):98–106
Hacettepe University Institute of Population Studies (2009) TurkeyDemografic and Health Survey (2008) Hacettepe University of Population Studies, Ministry of Health General Directorate of Mother and Child Health and Family Planning. T.R.Prime Ministry Undersecretary of State Planning Organization and TUBITAK, Ankara
Hammerlid E, Björdal K, Ahnler-Elmqvist M, Boysen M, Evensen J, Biorklund A (2001) A prospective study of quality of life in head and neck cancer patients. Part I: at diagnosis. Laryngoscope 111(4):669–680
Isenring E, Bauer J, Capra S (2003) The scored patient-generated subjective global assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr 57:305–309. doi:10.1038/sj.ijo.1601552
Kagan S (2009) The influence of nursing in head and neck cancer management. Curr Opin Oncol 21(3):248–253
Kandogan T, Sanal A (2005) Quality of life, functional outcome, and voice handicap index in partial laryngectomy patients for early glottic cancer. BMC Ear Nose Throat Disord 5(1):3. doi:10.1186/1472-6815
Larsson M, Hedelin B, Athlin E (2007) A supportive nursing care clinic: conceptions of patients with head and neck cancer. Eur J Oncol Nurs 11(1):49–59
Larsson M, Hedelin B, Athlin E (2007) Needing a hand to hold: lived experiences during the trajectory of care for patients with head and neck cancer treated with radiotherapy. Cancer Nurs 30(4):324–334
Larsson M, Hedelin B, Athlin E (2003) Lived experiences of eating problems for patients with head and neck cancer during radiotherapy. J Clin Nurs 12(4):562–570
Larsson M, Hedelin B, Johansson I, Athlin E (2005) Eating problems and weight loss for patients with head and neck cancer: a chart review from diagnosis until one year after treatment. Cancer Nurs 28(6):425–435
Marur S, Forastiere AA (2008) Head and neck cancer; changing epidemiology diagnosis and treatment. Mayo Clin Proc 83(4):489–501
Ministry of Health (2004) National Burden of Disease and Cost Effectiveness Project. Refik Saydam Hygiene Center Presidency, School of Public Health, Ankara
Ministry of Health Department of Cancer Control (2009) National Cancer Program 2009-2015. Available from: http://www.ukdk.org Accessed: 20.03.2012
Murphy BA (2009) Advances in quality of life and symptom management for head and neck cancer patients. Curr Opin Oncol 21:242–247
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. Crit Rev Oncol Hematol 62(3):251–267
Oates J, Clark J, Read J, Reeves N, Gao K, Jackson M, Boyer M, O’Brien C (2007) Prospective evaluation of quality of life and nutrition before and after treatment for nasopharyngeal carcinoma. Arch Otolaryngol Head and Neck Surgery 133(6):535–540
Oates J, Clark JR, Read J, Reeves N, Gao K, O’Brien CJ (2008) Integration of prospective quality of life and nutritional assessment as routine components of multidisciplinary care of patients with head and neck cancer. Aust N Z J Surg 78(1–2):34–41
Onakoya PA, Nwaorgu OG, Adenipekun AO, Aluko AA, Ibekwe TS (2006) Quality of life in patients with head and neck cancers. J Int Med Assoc 98(5):765–770
Ouwens MM, Hermens RR, Hulscher MM, Merkx MA, Grol RP, Wollersheim HC, Marres HA (2009) Impact of an integrated care program for patients with head and neck cancer on the quality of care. Head&Neck 31(7):902–910
Radiation Therapy Oncology Group. Acute Radiation Morbidity Scoring Criteria Available from:http://www.rtog.org/ResearchAssociates/AdverseEventReporting/AcuteRadiationMorbidityScoringCriteria.aspx Accessed: 22.03.2012
Ravasco P, Monteiro-Grillo I, Camilo ME (2003) Does nutrition influence quality of life in cancer patients undergoing radiotherapy? Radiother Oncol 67(2):213–220
Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME (2005) Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head&Neck 27(8):659–668
Rogers SN, Clifford N, Lowe D (2011) Patient and carer unmet needs: a survey of the British association of head and neck oncology nurses. Br J Oral Maxillofac Surg 49(5):343–348
Sawada NO, Paula JM, Sonobe HM, Zago MM, Guerrero GP, Nicolussi AC (2012) Depression, fatigue, and health-related quality of life in head and neck cancer patients: a prospective pilot study. Support Care Cancer. doi:10.1007/s00520-012-1390-2
Senkal HA, Hayran M, Karakaya E, Yueh B, Weymuller EA Jr, Hoşal AS (2011) The validity and reliability of the Turkish version of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer. Am J Otolaryngol 33(4):417–26
Senocak M (2009) Klinik Bioistatistik (Clinical Biostatistics). Nobel Tip Kitabevleri, Istanbul, p 202
Uslu R, Bilgen C, Essolak M (2006) Baş ve Boyun Kanserleri (Head and Neck Cancers). In: Topuz E, Aydiner A (eds) Onkoloji El Kitabi. Turgut Yayincilik, Istanbul, pp 45–52
Unsal D, Mentes B, Akmansu M, Uner A, Oguz M, Pak Y (2006) Evaluation of nutritional status in cancer patients receiving radiotherapy: a prospective study. Am J Clin Oncol 29(2):183–188
Wells M (2007) A study to evaluate nurse-led on-treatment review for patients undergoing radiotherapy for head and neck cancer. J Cancer Nurs 17(11):1428–1439
Wiederholt RN, Nadine P, Connor D, Gregory K, Hartig M, Harari P, Peggy A (2007) Bridging gaps in multidisciplinary head and neck cancer care: nursing coordination and case management. Int J Radiat Oncol Biol Phys 69(2):88–91
WHO (2008) International Agency for Research on Cancer (IARC). GLOBOCAN: Cancer incidence, mortality and prevalence worldwide 2008. Available from: http://globocan.iarc.fr/factsheet.asp. Accessed:20.03.2012
Acknowledgments
We express our gratitude to all the patients for their willingness to participate in our study. This study was supported by Istanbul University Scientific Research Foundation (project no. 4908).
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Citak, E., Tulek, Z. Longitudinal quality of life in Turkish patients with head and neck cancer undergoing radiotherapy. Support Care Cancer 21, 2171–2183 (2013). https://doi.org/10.1007/s00520-013-1774-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-013-1774-y