LONG-TERM SUBJECTIVE FUNCTIONAL OUTCOME OF SURGERY PLUS POSTOPERATIVERADIOTHERAPY FOR ADVANCED-STAGE ORAL CAVITY AND OROPHARYNGEAL CARCINOMA

BACKGROUND: Although long-term cures have been achieved for locally ad vanced squamous cell carcinomas of the head and neck, there is a pauci ty of information available regarding patients' perspectives of their functional outcome, PATIENTS AND METHODS: Thirty-five long-term surviv ors free of disease following surgery and postoperative radiotherapy f or advanced cancers of the oral cavity and oropharynx were sent questi onnaires to evaluate their long-term functional outcome after therapy. The questionnaires included a subjective performance status scale tha t assessed the patient's perceived (1) ability to eat in public, (2) u nderstandability of speech, and (3) normalcy of diet. Twenty-nine of 3 5 patients participated in this function assessment and are the subjec ts of this report, RESULTS: The mean function scores for all patients were as follows: 72 for eating in public, 69 for understandability of speech, and 58 for normalcy of diet. Functional results were further a nalyzed by T stage and anatomic subsite. Inferior results were noted w ith increasing T stage. A two-way analysis of variance showed that thi s difference was significant even after adjusting for the effect of an atomic subsite (P = 0.0002, P = 0.018, and P = 0.0018 for the three ou tcome variables). In addition, patients with base of tongue lesions ha d a worse functional outcome for both early T stage (T1/T2) and advanc ed T stage (T3/T4) when compared to other subsites, This difference av eraged across T stage was statistically significant for understandabil ity of speech (P = 0.0019) and normalcy of diet (P = 0.013), but was n ot significant for eating in public (P = 0.16). CONCLUSIONS: This perf ormance status scale was found to be a useful tool for functional asse ssment following definitive therapy for advanced stage head and neck c arcinomas. These subjective functional scores deteriorated with increa sing T stage, In addition, functional scores for oral tongue, floor of mouth, and tonsillar primaries were superior to those for base of ton gue lesions, These functional outcome scores are consistent with the e xtent of surgery required for the base of tongue subsite and are in di rect relation to the patients' T stage in this study population.