A prospective study of quality of life in head and neck cancer patients. Part I: At diagnosis

Purpose: A Swedish and Norwegian study was designed to examine health-relat ed quality of life (HQL) in patients with head and neck cancer (head and ne ck) at diagnosis and during treatment and rehabilitation. The overall aim w as to examine the impact on HQL at diagnosis depending on tumor location, s tage, sex, and age (part I) and to describe HQL longitudinally and determin e for which patients and during which period HQL deteriorated most (part II ), This article presents the results at diagnosis. Method Patients with hea d and neck cancer at five hospitals in Sweden and Norway were consecutively requested to participate, They were asked to answer the EORTC QLQ-C30 and QLQ-H&N35 (the European Organization for Research and Treatment of Cancer, Core 30 questionnaire and head and neck cancer module) repeatedly during I year. A total of 357 patients (mean age, 63 y; 72% males) were included, Re sults: Patients with different tumor locations all had their special proble ms at diagnosis, for example, those with tumors in the larynx with communic ation, those with oral tumors with pain, and those with pharyngeal tumors w ith nutrition and pain. The patients with hypopharyngeal cancer reported th e worst HQL. Stage appeared to have the strongest impact on HQL. Patients w ith a more advanced tumor stage reported significantly worse HQL scores for 24 of 32 variables reflecting functioning or problems. The females scored worse than the males for some areas, in particular, emotional functioning. The older patients scored significantly better for emotional and social fun ctioning than patients <65 years but worse for physical functioning and var ious symptoms. The traditional way of grouping the tumor locations into ora l, pharyngeal, laryngeal, and "other" tumors (salivary gland, sinus and nos e, and unknown primary) was tested from a HQL point of view and found to be consistent. Conclusions: The chosen questionnaires differentiated between different sites of head and neck cancer at diagnosis. Tumor stage had the m ost powerful impact on HQL score.