Functional outcome in patients with advanced head and neck cancer: surgery and reconstruction with free flaps versus primary radiochemotherapy

Abstract

The objective was to compare functional outcome in patients with advanced head and neck cancer (HNC) treated with (a) surgical resection and reconstruction with microvascular free flaps (MVFF) followed by radiochemotherapy versus (b) primary radiochemotherapy (RCT) on the basis of the International Classification of Functioning, Disability and Health (ICF) from WHO. This was a cross-sectional, multi-institutional study. The outcome measures included ICF Core Sets for HNC, the EORTC-QLQ, modules c30 + hn35 and the University of Washington-Quality of life Questionnaire (UW-QOL). Analyses included descriptive statistics, ranking exercises, and regression analyses in a cumulative logit model; 27 patients were treated with MVFF and 22 with RCT. Global Quality of life scores suggested a slightly better functional outcome for the surgical approach. The majority of ICF categories (81/93, 87%) did not show a difference in functional outcome between the two treatment approaches. In the remaining 12 ICF categories, n = 3 body structures were more affected in the MVFF group, while n = 3 body functions, and n = 6 activities/participations were more problematic in the RCT group. This included oral swallowing and weight maintenance functions as well as social relationships, acquiring a job, and economic self-sufficiency. In addition, nine contextual environmental factors were more relevant to the RCT group. Both treatment approaches seemed appropriate to advanced HNC from the perspective of functional outcome. The influence of treatment modalities on the social and economic lives of cancer survivors needs to be explored further. In order to guide rehabilitation according to patients' needs, the ICF offers a multidimensional view comprising body structures, body functions, and activities and participation in life.

Health-related quality of life of patients with squamous cell carcinoma: a comparison according to tumor location

“…In this study, health-related QOL was evaluated using the QLQ-C30, QLQ-HN35, and UW-QOL, as in previous studies. 2,3,5,6,8,14,16,17 Our QLQ-C30 results are similar to those reported by Crombie et al 3 and Ch'ng et al 16 for oral SCC and to those reported by Tribius et al 17 for head and neck SCC. The global health status scores obtained in this study are similar to those reported in a previous study of patients with head and neck cancer.…”

“…5,8 Each item is scored on a 0-100 scale. 3,14 Given the small number of QOL studies in patients with head and neck cancer, an expansion of knowledge about QOL assessment in patients undergoing cancer treatment is needed. 15 Therefore, the aim of this study was to evaluate the health-related QOL of patients with squamous cell carcinoma (SCC) according to tumor location.…”

“…2,3,4,6,8 The QLQ-C30 and QLQ-HN35 are instruments composed of questions that assess the patient's QOL in the last week with total score ranges of 0-100L. 3,14 The QLQ-C30, which is the EORTC's core QOL instrument, includes a single general health/QOL scale, five functional scales, eight physical symptom scales, and a single item related to financial difficulty (see Table 1 for scales). The QLQ-HN35 is the EORTC's head and neck cancer-specific module questionnaire (EORTC modules are each administered with the core QLQ-C30 assessment).…”

Functional outcome after different oncological interventions in head and neck cancer patients

“…The effect of radiotherapy on the head and neck has been well investigated and becomes obvious in the clinical situation by scarring and tissue fibrosis accompanied by vessel depletion (Bengtson et al 1993;Jones et al 2007). These circumstances lead to a decrease in head and neck mobility and mouth opening, which are strongly correlated with the quality of life of patients, especially if the mandible is affected also (Chambers et al 2004;Tschiesner et al 2011;Airoldi et al 2011;Mücke et al2011). As already indicated in the present study, patients are seriously affected by the side effects of both therapy modalities, surgery and radiotherapy, as a high percentage of patients would be not willing to repeat the performed treatments (30 vs. 28 patients, Table 4).…”

“…Clinical, physical, and sociodemographic factors also contribute to patients' outcome after treatment and should be taken into the patients' oncologic concept (Karvonen-Gutierrez et al 2008). Although several questionnaires to assess the quality of life exist, an objective and reproducible assessment of the physiological function in the head and neck region is not available (Rogers et al 2002;Tschiesner et al 2011). For that reason, an objective functional status was developed and examination of different patients undergoing different treatments performed.…”