General health measures and long-term survival in patients with head and neck cancer

Objective: To determine whether a self-reported, subjective general health assessment tool can provide prognostic information about survival in patients with head and neck cancer. Design: Prospective observational cohort study. Setting: Tertiary care center. Patients: Five hundred seventy-one patients with squamous cell carcinoma of the upper aerodigestive tract who were enrolled in the institution's longitudinal Outcomes Assessment Project between January 1, 1995, and November 30, 2004. Main Outcome Measures: Actuarial 5-year observed and disease-specific survival. Results: The physical component summary obtained from the SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey) was significantly associated with ACE-27 (Adult Comorbidity Evaluation-27) comorbidity ratings. The mental component summary was not associated with ACE-27 scores or survival. Although the comorbidity rating was an independent predictor of observed survival (P = .002) only, the physical component summary was independently predictive of both observed (P < .001) and disease-specific (P = .001) survival. These associations continued to be independently significant when site and stage were included in the analysis (P = .003, P < .001, and P = .004, respectively). Conclusion: The physical component summary generated by the SF-36, a self-reported, subjective measure of general physical health, is predictive of both observed and disease-specific survival.