Health-related quality of life scores in long-term head and neck cancer survivors predict subsequent survival: a prospective cohort study.

OBJECTIVE

To examine the survival prediction of long-term health-related quality of life in patients with head and neck squamous cell carcinoma.

DESIGN

Patients with head and neck squamous cell carcinoma diagnosed in the period between July 1992 and October 2001, who had been disease free for a minimum of 1 year following therapy, responded to structured interviews including several validated questionnaires in the period from October 2002 to March 2004. The study ended in June 2009 with a mean observation time of 75 ± 4 months among the survivors. Twenty-four deaths were observed.

SETTING

University hospital, referral centre of the Western Norway.

PARTICIPANTS

One hundred and thirty-nine cognitive functioning patients.

MAIN OUTCOME MEASUREMENTS: Overall survival as of June 2009. This was correlated with various clinical factors and the EORTC QLQ-C30 questionnaire, the Eysenck Personality Inventory and the Coping inventory completed between October 2001 and March 2004.

RESULTS

A general symptom sum score was significantly predictive of survival directly and after sequential adjustment for self-reported levels of neuroticism, avoidance focused coping, coping by suppression of competing activity, alcohol consumption, smoking status and heart/lung disease, as well as gender, age, time between diagnosis and inclusion, tumour node metastasis (TNM) stage and tumour site. Similar results were found for the health-related quality of life indices 'fatigue', 'dyspnoea' and 'sleep disturbance'. A dichotomised variable based on the general symptom sum score was calculated, and a high risk group, as to mortality, including less than a quintile of the total patient population was established. A hazard ratio of 5.15 was found for the dichotomised general symptom sum score.

CONCLUSION

We have shown a unique and independent survival prediction from long-term EORTC QLQ-C30 scores in successfully treated and cognitive functioning head and neck squamous cell carcinoma patients.