Does quality of life predict long-term survival in patients with head and neck cancer?

Objective: To assess whether pretreatment and post-treatment quality of life (QOL) is associated with long-term survival in patients with head and neck cancer. Design: Ten-year follow-up of an inception cohort. Setting: Regional tertiary referral center. Patients: The study included 200 consecutive patients with primary epithelial head and neck cancer. Interventions: Quality of life and several recognized risk factors for death were assessed prospectively using the Auckland QOL questionnaire before treatment and 12 months after treatment; survival was determined at 10 years. Main Outcome Measures: Survival and odds of death (hazards ratio) were measured. Results: At 10 years, 136 patients (68%) were deceased, 48 patients (24%) were alive, and the status of 16 patients (8%) was unknown. Median survival was 6 years (interquartile range, 4.4-7.7). Before treatment, patients with low QOL had no significantly increased odds of death (hazard ratio, 1.4; 95% confidence interval, 0.8-2.4). In contrast, after treatment, patients with low QOL at 1 year had significantly increased odds of death (2.5; 95% confidence interval, 1.4-4.3; P=.001) even after adjustment for covariates. Conclusions: Findings suggest potential survival benefits from improvements in QOL. However, the observed associations between survival benefit and QOL at 1 year may be confounded by comorbidity, which was not measured and deserves further investigation.