Long-Term Quality of Life in Survivors of Head and Neck Cancer Who Have had Defects Reconstructed With Radial Forearm Free Flaps

Abstract

The purpose of our study was to investigate (by postal questionnaire) the long-term quality of life (QoL) in Chinese patients who have had resections of head and neck cancer and immediate reconstruction by radial forearm free flaps. We performed a retrospective questionnaire survey and case series in the Affiliated Tumor Hospital of Zhengzhou University. The subjects were consecutive patients treated for head and neck cancers during a 13-year period. The patients completed the University of Washington Quality of Life (version 4) questionnaires. Among the 178 patients treated during the course of 13 years, 87 were alive and disease free. Fifty-six (64.4%) of the 87 questionnaires were returned. The mean follow-up duration was 7.9 years (range, 3-13 y). Of the 12 disease-specific domains on the University of Washington Quality of Life, the best-scoring domain was pain, followed by mood, anxiety, and shoulder, whereas the lowest scores were for saliva, taste, and speech. The domains considered as the most important were saliva, speech, and taste. We conclude that the radial forearm free flap for the reconstruction of defects of the head and neck after resection for cancer significantly influenced the patients' long-term QoL.

Long‐term patient‐reported outcomes after reconstructive surgery for head and neck cancer: A systematic review

“…Swallowing function often deteriorated throughout time (Data S1, Appendix 3, table 2). [13][14][15][17][18][19]21,22,24,26,28,30,31,[34][35][36][37]39,41,42 Mean EORTC QLQ-H&N35 scores for the domains swallowing, speech, and sticky saliva were relatively comparable between studies. For the domain of swallowing, scores ranged approximately from 20 to 30, for speech from 20 to 25, and for sticky saliva around 40 points.…”

“…14,29,45 The study of Li et al showed that long-term survivors of HNC reported more favorable anxiety and mood scores, which may be explained by a longer disease-free period. 22 Anxiety and mood scores varied between the included studies, related to flap type and donor-site morbidity. Patients with a PMMF reconstruction generally reported poorer mood scores compared with patients with a free flap reconstruction, possibly due to worse speech functioning and more shoulder symptoms with the PMMF.…”

“…Many patients reported an increase in fatigue, next to poorer tongue mobility and a deterioration in smell, taste, mouth opening, saliva, and speech (Data S1, Appendix 3, table 3). 14,16,18,19,22,[24][25][26][27][28][29][34][35][36]38…”

“…Patients often experienced anxiety, both before and after their reconstruction (Appendix 3, Table 9). [13][14][15]17,22,[28][29][30]32,[34][35][36][37]39,41,42 Scores for the UW-QoL anxiety and mood domains ranged approximately from 70 to 80, while Bartella et al reported lower scores in patients with osseous reconstructions and Zhang et al reported higher scores (approx. 90 points).…”

“…Better visibility of the donor-site scar was associated with a general decrease in satisfaction with appearance (Data S1, Appendix 3, table 10). 13,22,23,29,30,33 However, almost all PROMs used did not contain donor-site specific domains.…”