Quality of life after treatment of laryngeal carcinoma: a single centre cross-sectional study

Abstract

The mainstays of treatment for head and neck cancers include surgery, chemotherapy and radiotherapy given alone or in combination. However, the side effects of these treatments are multifactorial in nature, causing substantial physical as well as psychosocial morbidity.1,2 Their location inherently affects life's basic and vital functions including breathing, feeding and oral communication. Furthermore, altered appearance, difficulty in swallowing and pain as a result of treatment can cause problems with social function and have a further effect on a patient's quality of life (QOL). 3A number of studies have revealed QOL is affected by T and N stage, 4,5 time after treatment and treatment modality. [5][6][7] Investigation into the effect of these factors on specific aspects of QOL such as saliva production and swallowing has yielded varying conclusions. 7-10The aim of this study was to identify whether factors including patient age, treatment modality, tumour stage and nodal status significantly affect quality of life in patients treated for laryngeal cancer. It was hypothesised that patients with advanced T stage and nodal disease would experience poorer QOL. Furthermore, patients undergoing surgical treatment with or without chemoradiotherapy would experience poorer QOL than those undergoing primary radiotherapy.We aimed to identify those aspects of QOL that are significantly affected in order to counsel patients regarding the significant risks and benefits of treatment with uncertain curative outcomes. Furthermore, we aimed to identify patients at risk of significant side effects before treatment in order to effectively prepare them for their treatment experience and focus support from health professionals on the appropriate patients. MethodsThe University of Washington Quality of Life (UW-QOL) questionnaire is a validated tool for determining QOL outcomes in patients treated for head and neck cancer.9,11,12 We used version 3 of the questionnaire (the most current at the time), which consists of ten domain specific questions that ask patients regarding their experiences of pain, appearance, activity level, recreation, swallowing, chewing, speech, shoulder function, taste and saliva production in the last seven days, compared to the month before they de- . We aimed to identify which aspects of QOL and which patients are most affected by the various treatment options. METHODS The University of Washington Quality of Life (UW-QOL) questionnaire was administered to all patients with laryngeal cancer treated at a single institution over a seven-year period (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). RESULTS In total, 41 patients responded. All had been treated for squamous cell carcinoma of the larynx. Questionnaires were completed at a median of 18.5 months after treatment. The overall quality of life was 81.1/100 as assessed by the UW-QOL scale, with only 4.9% reporting 'poor' or worse QOL. Neither patient age nor time after treatment significantly affected any aspect of QOL. Patients undergoing primary r...

Changes in health related quality of life in women and men undergoing radiation treatment for head and neck cancer and the impact of smoking status in the radiation treatment period

“…Sex was not a significant factor in a study by de Graeff et al (2000), but age had an influence on fatigue, physical functioning, social eating, and speech; as older patients had worse scores. Williamson et al (2011) found no evidence of an age effect when they evaluated HRQOL of patients with head and neck cancer, but they did not include sex analyses in their study.…”

“…Sex was not a significant factor in a study by de Graeff et al (2000), but age had an influence on fatigue, physical functioning, social eating, and speech; as older patients had worse scores. Williamson et al (2011) found no evidence of an age effect when they evaluated HRQOL of patients with head and neck cancer, but they did not include sex analyses in their study.HRQOL was associated with patients' age in Lòpez-Jornets et al study (2012), who evaluated 94 patients undergoing treatment for head and neck cancer in Spain. In their study females had a slight tendency to score worse than males for some functioning scales with symptoms, financial difficulty and sexuality.…”

Head and Neck Cancer Patients’ Quality of Life

“…Mitra et al divided QOL into special branches that need to be taken care of in order to achieve as good results as possible [16]. Swallowing, voice, airway control, nutrition, pain, mucositis control, xerostomia, taste and auditory function, wound care (fistula and carotid rupture), osteoradionecrosis, dermatitis and soft tissue damage, and psychological support seems to be the most important factors in proper life relief therapy [17].…”

Scientific Evidence Regarding the Quality of Life of Total Laryngectomees

“…The objective of another study [4] was to identify the aspects of quality of life of patients with cancer of the larynx after the different forms of treatment. Quality of life was assessed by applying the "University of Washington Quality of Life" -(UW-QOL), questionnaire to 41 individuals treated with combined modalities (surgery and chemotherapy/radiotherapy in 11 patients), primary radiotherapy ( n = 26), and chemoradiotherapy ( n = 4).…”