Method: A longitudinal study of a cohort of newly diagnosed adult oral cancer patients followed over a period of three months. HRQOL data was collected for each patient upon diagnosis (baseline), one month after commencing treatment (first follow-up) and after three months (second follow-up) using a Malay-translated FACT-H&N (v 4.0), a global question, and a supplementary set of eight questions (maq; obtained after cross-cultural adaptation of the instrument). The FACT-H&N (v 4.0) is a 39-item head-and-neck-cancer-specific instrument which assesses patients' physical (7 items), social (7 items), emotional (6 items), functional (7 items) well-being and head/neck concerns (12 items). FACT-G, FACT-H&N Total Outcome Index (TOI) and FACT-H&N symptom index (FHNSI) scores, which are FACT-H&N derivatives, were also calculated. Paired t-tests were used to test the statistical significance of score changes.
Results: Of the 76 patients recruited at baseline, 42 (55.3%) were followed from baseline to the end of the study. Their HRQOL worsened from baseline (FACT-H&N score= 94.1±17.6) to first follow-up (score=87±20.0; p<0.05) and then improved by the second follow-up (score=91.4±20.9) although not all returned to pre-treatment levels. Worsening by first follow-up was reflected in significant deterioration of combined physical and functional well-being and increased head and neck concerns (FACT-H&N-TOI baseline score=58.4±13.9; first follow-up score=50.1±15.6; p<0.05). Patients' emotional well-being significantly improved from baseline (FACT ewb score=15.6±4.1) to second follow-up (FACT ewb score=18.1; p<0.05). Those undergoing surgical interventions experienced a higher HRQOL improvement by the second follow-up (FACT-H&N=98.5; FACT-G=78.5; FACT-H&N TOI=60.0) than those who received other treatment types (FACT-H&N=83.0; FACT-G=65.5; FACT-H&N TOI=45.0; p<0.05).
Conclusion: Oral cancer patients experience substantial worsening in HRQOL once treatment commences, but this improves with time, especially among those treated surgically.