Assessment of Quality of Life in Head and Neck Cancer Patients before and after Radiation Therapy- A Prospective, Analytical Questionnaire-Based Study from a Tertiary Cancer Centre
DOI:
https://doi.org/10.30683/1927-7229.2024.13.04Keywords:
EORTC QLQ H&N C30, EORTC QLQ H&N-35, head-and-neck cancer, quality of life, QoL, Radiotherapy, CTRTAbstract
Head-and-neck cancer (HNC) is a major global health issue, with significantly higher incidence rates in India compared to other countries. The diagnosis and treatment of HNC can severely affect a patient’s quality of life (QoL). This study aims to evaluate and compare the QoL of head and neck cancer patients before and after radiation therapy with or without chemotherapy.
We conducted a prospective study on 45 newly diagnosed HNC patients who underwent radiation therapy, either alone or in combination with chemotherapy at our department. We assessed QoL using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) for general assessment and the EORTC QLQ H&N-35 for head and neck-specific evaluation before starting of the treatment and 4 weeks after the completion of the treatment. We used paired t-tests, Mann-Whitney U test and Kruskal-Wallis ANOVA for statistical analysis, with a significance level set at p ≤ 0.05.
The most commonly affected site was the oral cavity. All participants initially had a good performance status (PS) of either 1 or 2, with Stage IV being the most prevalent. Analysis of the EORTC QLQ-C30 revealed a decline in global health status, and the EORTC QLQ H&N-35 showed deterioration across all domains from pretreatment. On the functional scale, emotional well-being was notably more impaired, while physical, cognitive, and social functions were less affected. Pain, swallowing difficulties, mucositis, and speech issues were identified as the most severely impacted aspects of QoL.
In Conclusion, our study shows a significant decline in QoL following treatment due to the acute and subacute side effects of radiation therapy and chemotherapy. These findings highlight the need for comprehensive supportive care to address the broad impact of HNC treatment on patients quality of life.
References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71: 209-249. https://doi.org/10.3322/caac.21660
World Health Organization. Global health observatory globocan India. Population fact sheets (2020), pp. 1-2. Available from: https://gco.iarc.fr/today/data/factsheets/ populations/356-india-fact-sheets.pdf. Accessed 1st Apr 2021.
Kulkarni MR. Head and neck cancer burden in India. Int J Head Neck Surg 2013; 3(4): 29-35. https://doi.org/10.5005/jp-journals-10001-1132
National Cancer Institute. Head and Neck Cancer. United states National Cancer Institute, National Institute of Health 2018. [07/06/23].
Pindborg JJ, Reichart PA, Smith CJ. Histological Typing of Cancer and Precancer of the Oral Mucosa. Geneva: WHO; [07/06/23]. [https://apps.who.int/iris/handle/10665/43552]
Liu JC, Kaplon A, Blackman E, Miyamoto C, Savior D, Ragin C. The impact of the multidisciplinary tumor board on head and neck cancer outcomes. Laryngoscope 2020; 130(4): 946-950. https://doi.org/10.1002/lary.28066
Asthana S, Patil RS, Labani S. Tobacco‑related cancers in India: A review of incidence reported from population‑based cancer registries. Indian J Med Paediatr Oncol 2016; 37: 152-7. https://doi.org/10.4103/0971-5851.190357
Goswami U, Banerjee S, Dutta S and Bera A. Treatment outcome and toxicity of hypo-fractionated radiotherapy with concomitant chemotherapy versus conventional fractionated concomitant chemoradiation in locally advanced head-and-neck carcinoma: A comparative study. Asian J Pharm Clin Res 2022; 15(7): 167-171. https://doi.org/10.22159/ajpcr.2022.v15i7.44857
Mohanti BK, Nachiappan P, Pandey RM, Sharma A, Bahadur S and Thakar A. Analysis of 2167 head and neck cancer patients’ management, treatment compliance, and outcomes from a regional cancer center, Delhi, India. J Laryngol Otol 2007; 121(1): 49-56. https://doi.org/10.1017/S0022215106002751
Morton RP, Izzard ME. Quality-of-life outcomes in head and neck cancer patients. World J Surg 2003; 27: 884-9. https://doi.org/10.1007/s00268-003-7117-2
Gomes E, Aranha A, Borges AH, Volpato L. Head and Neck Cancer Patients Quality of Life: Analysis of Three Instruments. J Dent 2020; 21(1): 31-41. https://doi.org/10.1016/j.jdent.2012.09.013
Soldera EB, Ortigara GB, Bonzanini LIL, et al. Clinical and sociodemographic factors associated with oral health-related quality of life in survivors of head and neck cancer. Head Neck 2020; 42(5): 886-897. https://doi.org/10.1002/hed.26063
Hinz A, Mehnert A, Degi C, et al. The relationship between global and specific components of quality of life, assessed with the EORTC QLQ-C30 in sample of 2019 cancer patients. Eur J Cancer Care 2017; 26(2). https://doi.org/10.1111/ecc.12416
Lewandowska A, Rudzki G, Lewandowski T, et al. Quality of Life of Cancer Patients Treated with Chemotherapy. Int J Envior Res Public Health 2020; 17(19): 6938. https://doi.org/10.3390/ijerph17196938
Wilson IB, Cleary PD. Linking clinical variables with health‑related Karimi, et al. HRQoL in HNC patients undergoing radiotherapy quality of life. A conceptual model of patient outcomes. JAMA 1995; 273: 59-65. https://doi.org/10.1001/jama.1995.03520250075037
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez N, et al. The European organization for research and treatment of cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85(5): 365-376. https://doi.org/10.1093/jnci/85.5.365
Bjordal K, Hammerlid E, Ahlner-Elmqvist M, de Graeff A, Boysen M, Evensen J, et al. Quality of life in head and neck cancer patients: Validation of the European organization for research and treatment of cancer quality of life questionnaire- H&N35. J Clin Oncol 1999; 17(3): 1008-1019. https://doi.org/10.1200/JCO.1999.17.3.1008
Bray F, Laversanne M, Weiderpass E, Soerjomataram I. The ever-increasing importance of cancer as a leading cause of premature death worldwide. Cancer. In press.
Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory. Lyon: International Agency for Research on Cancer 2020. [07/06/23].
World Health Organization. WHO Report on Cancer: Setting Priorities, Investing Wisely and Providing Care for All. Geneva: WHO 2020.
Sathishkumar K, Chaturvedi M, Das P, et al. Cancer incidence estimates for 2022 & projection for 2025: result from National Cancer Registry Programme, India. Indian J Med Res 2022; 156: 598-607. https://doi.org/10.4103/ijmr.ijmr_1821_22
Kulkarni MR. Head and neck cancer burden in India. Int J Head Neck Surg 2013; 3(4): 29-35. https://doi.org/10.5005/jp-journals-10001-1132
Das R, Kataki AC, Sharma JD, Baishya N, Kalita M, Krishnatreya M. A study of head and neck cancer patients with special reference to tobacco use and educational level. Clin Cancer Investig J 2017; 6: 21-25. https://doi.org/10.4103/ccij.ccij_24_17
Kumar A, Sharma A, Ahlawat B, Sharma S. Site specific effect of tobacco addiction in upper aerodigestive tract tumors: a retrospective clinicopathological study. Scientific World Journal 2014; 2014: 460194. https://doi.org/10.1155/2014/460194
Sahmoud T. Larynx preservation in pyriform sinus cancer: Preliminary results of a European organization for research and treatment of cancer Phase III trial. EORTC Head and neck cancer cooperative group. J Natl Cancer Inst 1996; 88: 890-899. https://doi.org/10.1093/jnci/88.13.890
Department of Veterans Affairs Laryngeal Cancer Study Group, Wolf GT, Fisher SG, Hong WK, Hillman R, Spaulding M, et al. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991; 324(24): 1685-1690. https://doi.org/10.1056/NEJM199106133242402
Pignon JP, Le Maître A, Maillard E, Bourhis J and MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 93 randomized trials and 17,346 patients. Radiother Oncol 2009; 92(1): 4-14. https://doi.org/10.1016/j.radonc.2009.04.014
Chaukar DA, Das AK, Deshpande MS, Pai PS, Pathak KA, Chaturvedi P, et al. Quality of life of head and neck cancer patient: Validation of the European Organization for Research and Treatment of Cancer QLQ-C30 and European Organization for Research and Treatment of Cancer QLQ-H&N 35 in Indian patients. Indian J Cancer 2005; 42: 178-84. https://doi.org/10.4103/0019-509X.19202
Bjordal K, Ahlner‑Elmqvist M, Hammerlid E, Boysen M, Evensen JF, Biörklund A, et al. A prospective study of quality of life in headand neck cancer patients. Part II: Longitudinal data. Laryngoscope 2001; 111: 1440-52. https://doi.org/10.1097/00005537-200108000-00022
Akkas EA, Yucel B, Kilickap S, Altuntas EE. Evaluation of quality of life in Turkish patients with head and neck cancer. Asian Pac J Cancer Prev 2013; 14: 4805-9. https://doi.org/10.7314/APJCP.2013.14.8.4805
Epstein JB, Hong C, Logan RM, Barasch A, Gordon SM, Oberle‑Edwards L, et al. A systematic review of orofacial pain in patients receiving cancer therapy. Support Care Cancer 2010; 18: 1023-31. https://doi.org/10.1007/s00520-010-0897-7
Wan Leung S, Lee TF, Chien CY, Chao PJ, Tsai WL, Fang FM, et al. Health-related quality of life in 640 head and neck cancer survivors after radiotherapy using EORTC QLQ‑C30 and QLQ-H&N35 questionnaires. BMC Cancer 2011; 11: 128. https://doi.org/10.1186/1471-2407-11-128
Martino R, Ringash J. Evaluation of quality of life and organ function in head and neck squamous cell carcinoma. Hematol Oncol Clin North Am 2008; 22: 1239-56. https://doi.org/10.1016/j.hoc.2008.08.011
Kim TW, Youm HY, Byun H, Son YI, Baek CH. Treatment outcomes and quality of life in oropharyngeal cancer after surgery-based versus radiation-based treatment. Clin Exp Otorhinolaryngol 2010; 3: 153-60. https://doi.org/10.3342/ceo.2010.3.3.153
Boscolo-Rizzo P, Stellin M, Fuson R, Marchiori C, Gava A, Da Mosto MC, et al. Long‑term quality of life after treatment for locally advanced oropharyngeal carcinoma: Surgery and postoperative radiotherapy versus concurrent chemoradiation. Oral Oncol 2009; 45: 953-7. https://doi.org/10.1016/j.oraloncology.2009.06.005
Stoeckli SJ, Guidicelli M, Schneider A, Huber A, Schmid S. Quality of life after treatment for early laryngeal carcinoma. Eur Arch Otorhinolaryngol 2001; 258: 96-9. https://doi.org/10.1007/s004050000307
Mosel DD, Bauer RL, Lynch DP, Hwang ST. Oral complications in the treatment of cancer patients. Oral Dis 2011; 17: 550-9. https://doi.org/10.1111/j.1601-0825.2011.01788.x
Chambers MS, Garden AS, Kies MS, Martin JW. Radiation-induced xerostomia in patients with head and neck cancer: Pathogenesis, impact on quality of life, and management. Head Neck 2004; 26: 796-807. https://doi.org/10.1002/hed.20045
Epstein JB, Tsang AH, Warkentin D, Ship JA. The role of salivary function in modulating chemotherapy-induced oropharyngeal mucositis: A review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 39-44. https://doi.org/10.1067/moe.2002.126018
Aplak B, Maltoc M, Gelecek N, Sen M. Quality of life of Turkish patients with head and neck cancer. Turk J Cancer 2007; 37: 129-36.
Campbell BH, Marbella A, Layde PM. Quality of life and recurrence concern in survivors of head and neck cancer. Laryngoscope 2000; 110: 895-906. https://doi.org/10.1097/00005537-200006000-00003
Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363: 733-42. https://doi.org/10.1056/NEJMoa1000678
Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
