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Quality of Life Scores Predict Survival Among Patients With Head and Neck Cancer

Carrie A. Karvonen-Gutierrez, David L. Ronis, Karen E. Fowler, Jeffrey E. Terrell, Stephen B. Gruber, Sonia A. Duffy

From the Veterans’ Affairs (VA) Health Services Research and Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System; Departments of Otolaryngology, Psychiatry, Internal Medicine, Epidemiology, and Human Genetics; and the School of Nursing, University of Michigan, Ann Arbor, MI

Corresponding author: Sonia A. Duffy, PhD, RN, Veterans’ Affairs (VA) Health Services Research and Development Center for Practice Management & Outcomes Research, VA Ann Arbor Healthcare System (11H), PO Box 130170, Ann Arbor, MI 48113-0170; e-mail: bump{at}med.umich.edu

Purpose: The purpose of this study was to examine whether quality of life (QOL) scores predict survival among patients with head and neck cancer, controlling for demographic, health behavior, and clinical variables.

Patients and Methods: A self-administered questionnaire was given to 495 patients being treated for head and neck cancer while they were waiting to be seen for a clinic appointment. Data collected from the survey included demographics, health behaviors, and QOL as measured by Short Form-36 (SF-36) physical and mental component scores and the Head and Neck QOL scores. Clinical measures were collected by chart abstraction. Kaplan-Meier plots and univariate and multivariate Cox proportional hazards models were used to determine the association between QOL scores and survival time.

Results: After controlling for age, time since diagnosis, marital status, education, tumor site and stage, comorbidities, and smoking, the SF-36 physical component score and three of the four Head and Neck QOL scales (pain, eating, and speech domains) were associated with survival. Controlling for the same variables, the SF-36 mental component score and the emotional domain of the Head and Neck QOL were not associated with survival.

Conclusion: QOL instruments may be valuable screening tools to identify patients who are at high risk for poor survival. Those with low QOL scores could be followed more closely, with the potential to identify recurrence earlier and perform salvage treatments, thereby possibly improving survival for this group of patients.

Supported by the Department of Veterans Affairs IIR 98-500, GlaxoSmithKline through the Managed Care Forum, and by the National Institutes of Health grant No. P50 CA97248 through the University of Michigan's Head and Neck Specialized Program of Research Excellence.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.