Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mehanna H, Jones T, Gregoire V, Ang K (2010) Oropharyngeal carcinoma related to human papillomavirus. BMJ 340

  2. NHS Scotland (2012) Cancer in Scotland. In.: Information Services Division, NHS National Services Scotland

  3. NHS Scotland (2010) Cancer of the head and neck: Incidence and mortality by deprivation category. In.: Information Services Division, NHS Scotland

  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):274–280

    Article  PubMed  Google Scholar 

  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. Oral Cancer: UK incidence statistics [http://info.cancerresearchuk.org/cancerstats/types/oral/incidence/index.htm]

  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):261–269

    Article  CAS  PubMed  Google Scholar 

  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 43:843–868

    Article  CAS  PubMed  Google Scholar 

  9. Eades M, Chasen M, Bhargava R (2009) Rehabilitation: long-term physical and functional changes following treatment. Semin Oncol Nurs 25(3):222–230

    Article  PubMed  Google Scholar 

  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):251–267

    Article  PubMed  Google Scholar 

  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 32:486–491

    Article  CAS  Google Scholar 

  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):2754–2760

    Article  PubMed  Google Scholar 

  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 106:1–5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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 130:401–408

    Article  PubMed  Google Scholar 

  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):380–384

    Article  Google Scholar 

  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):92

    Article  PubMed  PubMed Central  Google Scholar 

  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):1007–1023

    Article  PubMed  Google Scholar 

  18. Palefsky J (2007) HPV infection in men. Dis Markers 23(4):261–272

    Article  PubMed  PubMed Central  Google Scholar 

  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. National Comprehensive Cancer Network (2012) NCCN clinical practice guidelines in oncology: distress management (Version 2.2013)

  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 45:555–561

    Article  CAS  PubMed  Google Scholar 

  22. Tsikriktsis N (2005) A review of techniques for treating missing data in OM survey research. J Oper Manag 24(1):53–62

    Article  Google Scholar 

  23. Monk B, Tewari K (2007) The spectrum and clinical sequelae of human papillomavirus infection. Gynecol Oncol 107(2 Suppl 1):S6–S13

    Article  PubMed  Google Scholar 

  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 18:861–868

    Article  Google Scholar 

  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 34:682–688

    Article  PubMed  Google Scholar 

  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):23–27

    Article  PubMed  Google Scholar 

  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):177–186

    Article  CAS  PubMed  Google Scholar 

  28. Castro T, Bussoloti F (2006) Prevalence of human papillomavirus (HPV) in oral cavity and oropharynx. Braz J Otorhinolaryngol 72(2):272–282

    Article  PubMed  Google Scholar 

  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 93:622–626

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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 100:261–269

    Article  CAS  Google Scholar 

  31. Scottish Intercollegiate Guidelines Network (2006) Diagnosis and management of head and neck cancer. A national clinical guideline. Network SIG, Edinburgh

    Google Scholar 

  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 46:712–719

    Article  PubMed  Google Scholar 

  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):137–141

    Article  CAS  PubMed  Google Scholar 

  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):581–589

    Article  PubMed  Google Scholar 

  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):177–189

    Article  CAS  PubMed  Google Scholar 

  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):140–147

    Article  PubMed  Google Scholar 

  37. Allison P (2002) Alcohol consumption is associated with improved health-related quality of life in head and neck cancer patients. Oral Oncol 38:81–86

    Article  CAS  PubMed  Google Scholar 

  38. Potash AHL, Christensen AJ, Vander Weg M, Funk GF (2009) Continued alcohol use in patients with head and neck cancer. Head Neck 32:905–912

    Google Scholar 

  39. Short P, Vasey J, Tunceli K (2005) Employment pathways in a large cohort of adult cancer survivors. Cancer 103(6):1292–1301

    Article  PubMed  Google Scholar 

  40. Van der Wouden J, Greaves-Otte J, Greaves J (1992) Occupational reintegration of long-term cancer survivors. J Occup Med 34(11):1084–1089

    Article  PubMed  Google Scholar 

  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):1681–1690

    Article  CAS  PubMed  Google Scholar 

  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):1208–1219

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Macmillan Cancer Support for funding this study through the Consequences of Cancer Treatment Collaborative (CCaT), Rosanne Bell, Caroline Petrie and Lauren Mackay for administrative support, and the patients who helped with the design of the questionnaire survey.

Author information

Author notes

  1. Jane Thomson

    Present address: Medicine and Surgery, King Abdulaziz Medical City, PO BOc 9515, Jeddah, Saudi Arabia

Authors and Affiliations

  1. NMAHP Research Unit, Scion House, University of Stirling, Stirling, FK9 4HN, UK

    Mary Wells & Margaret Cunningham

  2. School of Psychology, University of Dundee, Scrymgeour Building, Park Place, Dundee, DD1 4HN, UK

    Samantha Swartzman

  3. School of Nursing and Midwifery, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, UK

    Heidi Lang

  4. Radiotherapy and Oncology, Ninewells Hospital, NHS Tayside, Dundee, DD1 9SY, UK

    Lesley Taylor

  5. NHS Forth Valley, Larbert, FK5 4WR, Scotland

    Jane Thomson

  6. NHS Fife, Queen Margaret Hospital, Dunfermline, KY12 OSU, UK

    Julie Philp

  7. Robertson Centre for Biostatistics, University of Glasgow Boyd Orr Building, Level 11, Glasgow, G12 8QQ, UK

    Colin McCowan

Authors
  1. Mary Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samantha Swartzman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heidi Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Margaret Cunningham
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lesley Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jane Thomson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Julie Philp
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Colin McCowan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mary Wells.

Ethics declarations

Conflict of interest

This research was funded by Macmillan Cancer Support. The first author is a specialist advisor to Macmillan. Raw data are available. The authors declare that they have no competing interests.

Ethical approval

Ethical approval was granted by the East of Scotland Research EthicsCommittee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wells, M., Swartzman, S., Lang, H. et al. Predictors of quality of life in head and neck cancer survivors up to 5 years after end of treatment: a cross-sectional survey. Support Care Cancer 24, 2463–2472 (2016). https://doi.org/10.1007/s00520-015-3045-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-015-3045-6

Keywords

Search

Navigation