STRUCTURED ASSESSMENT OF THE CONSEQUENCES OF COMPOSITE RESECTION

A structured quality of life questionnaire was developed as an instrum ent for the assessment of the functional. physical, psychosocial, and counselling problems in patients treated surgically for an oropharynge al cancer. The questionnaire was tested in a pilot study in a relative ly homogeneous group of 15 selected patients (all of whom had a compar able surgical defect, i.e. a composite resection of the oropharynx and neck, and had undergone an identical reconstruction method, i.e. a pe dicled pectoralis major myocutaneous flap). All but two patients were irradiated as well. A high reliability (Crombach's alpha) was found in most of the applied subscales, indicating good internal consistency o f the different questions. Significant correlations were found between several quality of life dimensions. The most frequently reported comp laints concerned problems related to eating, speaking, and facial disf igurement. Problems with mastication, oral transport, and swallowing p rohibited 11 patients returning to their normal diet. Regarding speech , 11 patients reported decreased intelligibility, in eight this was du e to some degree of rhinolalia aperta. A significant association was f ound between moderate intelligibility and anxiety about speaking in pu blic (P < 0.05). Eleven patients felt that the surgery had caused cons iderable facial disfigurement. For five of them this had a negative in fluence on their social interactions and activities outdoors. Thus, th e consequences of the surgical treatment of oropharyngeal cancer can b e assessed in a systematic and formal way with this specially designed structured questionnaire. Despite the small sample size, the selectio n of a homogeneous patient group appeared to give significant informat ion: and to establish meaningful correlations.