Quality Of Life In Head And Neck Cancer: A Longitudinal Cohort Study

Objectives: Previous research suggests that quality of life (QoL) for people with head and neck cancer (HNC) worsens following diagnosis after which people adapt and return to a (nearly) “new normal” by 12 months. The aim of this study was to examine whether clinical, demographic, or psychological characteristics were associated with QoL at 1 year.

Methods: Data from the Head and Neck 5000 prospective cohort study was used which includes people with HNC from 76 centres in the UK. Quality of life (EORTC-QLQ-C30) together with clinical (TNM stage, tumour location, comorbidities, treatment modality, PEG tube), demographic (age, gender, deprivation, marital status, education) and psychological factors (optimism, anxiety, depression, fear of recurrence) were measured at diagnosis, 4- and 12-months.
Results: For this analysis, people were included if they had diagnosis QoL scores and were alive at 12 months (N=3037; mean age = 60.7; male 2289). Repeated measure ANOVAs indicated changes in QoL over the first year for the six scales (physical, role, emotional, cognitive, social, global health (all ps < .001)). QoL decreased (got worse) at 4-months, with the exception of emotional functioning, which was lowest at diagnosis. QoL increased by 12 months; however, scores did not always return to diagnosis levels. In the regression analyses, predictors of QoL at 1 year were: age, deprivation, education, co-morbidities, QoL, anxiety and depression at diagnosis, fear of recurrence and PEG tube at 4-months, and being disease free at 1 year. The amount of variance accounted for in the QoL models ranged from 28-56%.

Conclusions: Key demographic and psychological factors at baseline and 4-months were associated with QoL for HNC at 1 year. TNM stage, tumour location and treatment modality were not associated with QoL. Further exploration is needed of the potential pathways by which key factors influence QoL and survival outcomes.