Prospective, Longitudinal Quality‐of‐Life Study of Patients With Head and Neck Cancer: A Feasibility Study Including the EORTC QLQ‐C30

Abstract

Despite modern advances in the treatment of head and neck cancer, the survival rate fails to improve. Considering the different treatment modalities involved, quality of life has been thought of as an additional end point criterion for use in clinical trials. A Nordic protocol to measure the quality of life of head and neck cancer patients before, during, and after treatment was established. Before the study, a pilot study was done with this protocol. The main purpose of this pilot study was to find out whether this cancer population would answer quality-of-life questionnaires repeatedly (six times) over a 1-year period and whether the chosen questionnaires-a core questionnaire (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30)), a tumor-specific questionnaire, and a psychological distress measure (Hospital Anxiety and Depression scale (HAD))-were sensitive for changes to functions and symptoms during the study year. The results presented in this article all refer to the pilot study. Forty-eight consecutive patients agreed to participate in the study. The most common tumor locations were the oral cavity (17) and the larynx (12). Almost all patients received combined treatment: 45 of 48 radiation therapy, 18 of 48 chemotherapy, and 17 of 48 surgery. After the primary treatment, 40 patients had complete tumor remission. Four of the 48 patients did not answer any questionnaires and were therefore excluded from the study. Of the remaining 44 patients, 3 died during the study year, and another 6 withdrew for various reasons. Thirty-five (85%) of the 41 patients alive at the 1-year follow-up answered all six questionnaires and thus completed the study. Mailed questionnaires were used throughout the study. All questionnaires were well accepted and found to be sensitive to changes during the study year. The greatest variability was found for symptoms and functions related specifically to head and neck cancer. The symptoms were swallowing difficulties, hoarse voice, sore mouth, dry mouth, and problems with taste. They all showed the same pattern, with an increase of symptoms during and just after finishing the treatment. The HAD scale revealed a high level of psychological distress, with 21% probable cases of psychiatric morbidity at diagnosis. In conclusion, it was shown that the study design and questionnaires were feasible for the forthcoming prospective quality-of-life assessment of Swedish and Norwegian head and neck cancer patients.

A prospective multicentre study in Sweden and Norway of mental distress and psychiatric morbidity in head and neck cancer patients

“…To avoid multiple significance testing, we selected three of the six measurement points: at diagnosis (before treatment), at 3 months (just after finishing treatment), when symptoms and problems are at their peak (Hammerlid et al, 1997a), and at the 1-year follow-up. The significance testing included only those patients who completed 3 months (n = 261) and 12 months (n = 215) follow-up respectively.…”

“…It has also been used in Scandinavia to screen for psychiatric illness among head and neck cancer patients (Hammerlid et al, 1997a(Hammerlid et al, , 1997b as well as among patients with other types of cancer (Bergman et al, 1991;Brandberg et al, 1992Brandberg et al, , 1995Nordin et al, 1996).…”

“…Head and neck cancer patients' psychiatric morbidity has been studied in cross-sectional studies (Morton et al, 1984;Espie et al, 1989;Rapoport et al, 1993;Bjordal and Kaasa, 1995;McDonough et al, 1996) and prospectively (Davies et al, 1986;Baile et al, 1992;Hammerlid et al, 1997aHammerlid et al, , 1997b. The level of mental distress among these patients corresponds with those found for other cancer locations.…”

“…The study design was tested and proved feasible in a previous study (Hammerlid et al, 1997a). The battery of questionnaires found sensitive to change over time in this cancer population included, apart from the Hospital Anxiety and Depression scale (HAD) presented in this paper, the European Organization for Research and Treatment of Cancer Core 30 questionnaire (EORTC QLQ-C30) and the EORTC head and neck cancer module, (QLQ-H&N35).…”

A prospective study of the impact of nasopharyngeal cancer and radiotherapy on the psychosocial condition of Chinese patients

“…Results from the few studies that have been conducted in patients with NPC have been limited by a cross-sectional focus, small patient numbers, varied lengths of patient follow-up after diagnosis, and brief posttreatment follow-up periods. 8,16 Although NPC may be classified as 1 type of head and neck cancer, its clinical presentation, treatment of choice, prognosis, and potential side effects can differ dramatically.…”