Head and neck specific Health Related Quality of Life scores predict subsequent survival in successfully treated head and neck cancer patients: A prospective cohort study

To examine the survival prediction of head and neck (H&N) Health Related Quality of Life (HRQoL) scores among successfully treated and cognitive functioning H&N squamous cell carcinoma (HNSCC) patients. Through structured interviews, self-reported questionnaires were given to 139 successfully treated HNSCC patients, 67 +/- 32 months following diagnosis. HRQoL-scores, measured with the EORTC QLQ-H&N35 inventory, self-reported levels of neuroticism, avoidance focused coping, coping by suppression of competing activity, alcohol consumption, smoking status, and heart and lung disease, as well as gender, age, TNM-stage, and tumor site were determined. The mean observation period was 75 +/- 4 months among the survivors. Twenty-four deaths were observed. A EORTC QLQ-H&N35 sum score, including a dichotomized version (HR 2.73-3.67), was predictive of survival, both directly and after adjustment for all of the above mentioned variables. The H&N HRQoL indices feeling ill, sexuality, open mouth, swallowing, and pain specifically predicted survival. The dichotomized H&N HRQoL sum score compared the 4th upper quartile to the three lower quartiles, and a cut off value of 28.5 was designated. Analyses demonstrated that a high risk group with 33% mortality may include only one quarter of the patient population as opposed to 12.5% mortality among the other patients. Our findings indicate a unique survival prediction from EORTC QLQ-H&N35 sum scores in successfully treated HNSCC patients. HRQoL scores, in particular, related to oral health, predicted survival. Furthermore, HRQoL-scores may be a screening tool for identifying patients with high mortality risk. (C) 2011 Elsevier Ltd. All rights reserved.