The impact of treatment on health related quality of life in head and neck cancer

Abstract

Background: Head and neck cancer is a rare form of cancer and approximately 1000 new cases are diagnosed in Sweden each year. It is more common in men than in women, and treatment includes surgery and/or radiotherapy (both external radiotherapy and/or brachytherapy) + chemotherapy. Five-year survival is about 60 % and morbidity due to treatment is high in the advanced stages.During the last decades health related quality of life (HRQL) has evolved as a new endpoint in evaluating treatment. The most common way to assess HRQL is by quality of life questionnaires. The European Organization for Research and Treatment of Cancer (EORTC) has developed, and validated several HRQL questionnaires, for instance the cancer specific questionnaire (EORTC QLQ-C30) and the head and neck cancer specific questionnaire (EORTC QLQ-H&N35). Methods: HRQL was assessed with the aid of the questionnaires EORTC QLQ-C30, EORTC QLQ-H&N35 and the hospital anxiety and depression scale (HADS), at diagnosis, and 1, 2, 3, 6, 12, 36 months after treatment start. In this thesis HRQL was longitudinally assessed in head and neck patients offered psychosocial support, in head and neck cancer patients with severe weight loss during treatment, and in patients with oral and oropharyngeal cancer.Results: The support had no detectable effect on HRQL, compared to a control group. Pre-treatment HRQL scores could predict weight loss. Patients who reported increased sensation of fatigue at diagnosis developed more then 10% weight loss during treatment. Advanced oral and oropharyngeal cancer (stage III-IV) patients had similar HRQL whether they were treated with a lower external radiotherapy (ERT) dose, and a higher brachytherapy (BT) dose or a higher ERT dose, and lower BT dose. No correlation could be found between HRQL scores and BT dose, and dose rate in patients with stage I-IV oral, and oropharyngeal cancer.Conclusion: In this thesis the impact of treatment in head and neck cancer has been evaluated with HRQL questionnaires. Conclusions drawn are that supporting patients does not appear to affect HRQL, and that those prone to weight loss can be detected already at diagnosis with HRQL questionnaires. Treating advanced oral and oropharyngeal cancer with a lower ERT dose, and a higher BT dose, does not appear to jeopardize HRQL.