Background
Materials and methods
Study design and patients
QOL questionnaires
EORTC QLQ-C30 version 3
EORTC QLQ-H&N35
Utility instrument
Statistical analysis
Results
Characteristic | Total | % |
---|---|---|
Age, mean (SD), years | 56.7 (10.1) | |
Gender | ||
Female | 20 | 16% |
Male | 107 | 84% |
Tumor site | ||
Oral cancer | 51 | 40% |
Nasopharyngeal cancer | 24 | 19% |
Thyroid cancer | 17 | 12% |
Oropharyngeal cancer | 15 | 8% |
Laryngeal cancer | 10 | 8% |
Hypopharyngeal cancer | 10 | 13% |
Education (years) | ||
Less than 6 years | 21 | 17% |
6–12 years | 97 | 77% |
More than 12 years | 9 | 7% |
Occupational status | ||
Employed | 62 | 49% |
Homemaking | 5 | 4% |
None | 60 | 47% |
Marital status | ||
With a spouse | 95 | 75% |
Without a spouse | 32 | 25% |
Annual family income | ||
> 1,000,000 NTD | 88 | 69% |
500,000~1,000,000 NTD | 32 | 25% |
< 500,000 NTD | 7 | 6% |
Habits related to cancer | ||
Tobacco use | 81 | 64% |
Betel nut use | 58 | 46% |
Alcohol use | 63 | 50% |
Comorbidity (YES) | 53 | 42% |
AJCC (7th edition) Stage | ||
I | 36 | 28% |
II | 15 | 12% |
III | 23 | 18% |
IV | 50 | 39% |
Treatment | ||
Chemotherapy | ||
Yes | 80 | 66% |
No | 41 | 34% |
Radiation therapy | ||
Yes | 96 | 79% |
No | 26 | 21% |
Surgery | ||
Yes | 98 | 85% |
No | 18 | 15% |
F/U time, mean (SD), years | 3.3(0.2) |
EORTC QLQ-C30
Oral cancer (n = 51) | Nasopharyngeal cancer (n = 24) | Oropharyngeal cancer (n = 15) | Hypopharyngeal cancer (n = 10) | Laryngeal cancer (n = 10) | Thyroid cancer (n = 17) | Total (n = 127) | Published reference norm values (n = 562) | p1 | Published Head and neck cancer survivors | p2 | |
---|---|---|---|---|---|---|---|---|---|---|---|
(n = 133) | |||||||||||
Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | |||
Functional scales | |||||||||||
Physical functioning | 89.80 (20.28) | 93.05 (8.67) | 90.67 (12.03) | 94(8.58) | 75.33 (27.41) | 96.86 (5.33) | 90.66 (16.78) | 88.9 (18.1) | 0.28 | 85.6 (21.2) | 0.03 |
Role functioning | 95.42 (20.02) | 95.83 (14.95) | 95.56 (17.21) | 100 | 88.33 (22.29) | 100 | 95.93 (16.63) | 86.5 (24.8) | < 0.01 | 83.3 (30.1) | < 0.01 |
Emotional functioning | 88.73 (15.08) | 86.81 (19.18) | 92.78 (14.04) | 94.17 (11.15) | 93.33 (10.97) | 81.86 (18.22) | 88.71 (15.87) | 84.6 (20.1) | 0.01 | 85.0 (18.7) | 0.09 |
Cognitive functioning | 85.29 (17.53) | 81.94 (13.83) | 84.44 (18.33) | 95 (11.25) | 83.33 (15.71) | 78.43 (18.41) | 84.25 (16.7) | 89.5 (20.6) | < 0.01 | 86.0 (22.2) | 0.4 |
Social functioning | 92.16 (19.25) | 95.83 (8.86) | 97.78 (8.61) | 96.67 (7.03) | 93.33 (19.56) | 92.16 (10.40) | 93.96 (14.80) | 86.9 (18.1) | < 0.01 | 87.0 (16.5) | < 0.01 |
Symptom scales/items | |||||||||||
Fatigue | 16.56 (24.68) | 14.81 (19.29) | 14.07 (27.69) | 10 (15.23) | 18.89 (20.98) | 17.65 (20.05) | 15.75 (22.33) | 19.7 (21.4) | 0.07 | 22.8 (22.9) | 0.01 |
Nausea and vomiting | 2.29 (7.47) | 2.78 (8.03) | 0 | 5 (11.25) | 3.33 (10.54) | 1.96 (8.09) | 2.36 (7.78) | 3.3 (11.0) | 0.28 | 3.1 (9.0) | 0.5 |
Pain | 17.97 (25.9) | 10.42 (13.74) | 10 (16.43) | 16.67 (22.22) | 26.67 (33.52) | 8.82 (8.58) | 14.96 (21.91) | 17.7 (24.6) | 0.22 | 14.9 (20.7) | 0.97 |
Dyspnea | 6.54 (20.02) | 2.78 (9.41) | 8.89 (19.79) | 6.67 (14.06) | 13.33 (23.31) | 1.96 (8.09) | 6.04 (17.02) | 16.5 (24.1) | < 0.01 | 17.8 (23.9) | < 0.01 |
Insomnia | 24.2 (36.6) | 9.7 (18.3) | 8.9 (26.6) | 23.3 (31.6) | 20 (28.1) | 25.5 (27.7) | 19.4 (30.7) | 16.5 (24.9) | 0.32 | 18.8 (26.4) | 0.87 |
Appetite loss | 8.50 (21.95) | 11.11 (25.38) | 15.56 (30.52) | 16.67 (17.57) | 16.67 (28.33) | 7.84 (14.57) | 11.02 (23.02) | 3.4 (12.7) | < 0.01 | 11.7 (25.1) | 0.81 |
Constipation | 11.76 (19.80) | 9.72 (20.80) | 11.11 (27.22) | 6.67 (14.05) | 6.67 (14.05) | 17.65 (20.81) | 11.28 (20.24) | 5.1 (15.9) | < 0.01 | 3.8 (11.4) | < 0.01 |
Diarrhea | 4.58 (16.35) | 4.17 (11.26) | 0 | 3.33 (10.54) | 3.33 (10.54) | 17.65 (29.15) | 5.51 (16.67) | 5.0 (16.0) | 0.75 | 10.8 (21.9) | 0.03 |
Financial difficulties | 7.19 (16.75) | 5.56 (16.05) | 11.11 (27.22) | 10 (22.50) | 16.67 (23.57) | 5.88 (13.10) | 8.14 (18.65) | 6.6 (19.7) | 0.41 | 11.6 (25.2) | 0.2 |
Global health status/QOL | |||||||||||
Global health status/QOL | 74.67 (19.86) | 65.97 (19.80) | 70 (28.49) | 71.67 (19.72) | 69.17 (30.44) | 67.65 (22.42) | 70.87 (22.09) | 76.5 (22.0) | < 0.01 | 73.2 (21.3) | 0.4 |
Utility (N = 102) | 0.71 (0.17) | 0.73 (0.20) | 0.76 (0.14) | 0.72 (0.24) | 0.70 (0.20) | 0.70 (0.21) | 0.7 (0.2) | NA | NA | NA | NA |
Correlation of global QOL and utility
EORTC QLQ- HN35
Symptom scales/items | Oral cancer (n = 51) | Nasopharyngeal cancer (n = 24) | Oropharyngeal cancer (n = 15) | Hypopharyngeal cancer (n = 10) | Laryngeal cancer (n = 10) | Thyroid cancer (n = 17) | Total (n = 127) | Published Reference norm values (n = 562) | p1 | Published Head and neck cancer survivors (n = 133) | p2 |
---|---|---|---|---|---|---|---|---|---|---|---|
Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | |||
Pain | 10.13 (18.66) | 6.60 (12.03) | 11.67 (26.50) | 4.17 (8.10) | 7.5 (10.72) | 3.92 (8.90) | 8.14 (16.52) | 3.0 (9.4) | < 0.01 | 14.5 (19.8) | < 0.01 |
Swallowing | 9.80 (17.46) | 9.72 (25.38) | 18.33 (24.44) | 8.33 (15.71) | 14.17 (22.59) | 6.37 (11.98) | 10.56 (19.71) | 2.0 (7.2) | < 0.01 | 10.9 (19.6) | 0.9 |
Sense problems | 7.19 (18.33) | 18.06 (25.97) | 22.22 (24.13) | 16.67 (19.25) | 21.67 (32.44) | 1.96 (5.54) | 12.21 (21.87) | 5.8 (16.1) | < 0.01 | 20.5 (27.4) | < 0.01 |
Speech problems | 12.20 (19.41) | 8.33 (15.46) | 20 (25.27) | 1.11 (19.91) | 15.56 (28.30) | 8.50 (8.36) | 11.29 (19.50) | 6.1 (13.2) | < 0.01 | 12.1 (19.1) | 0.73 |
Trouble with social eating | 17.81 (27.64) | 12.15 (21.14) | 27.22 (30.78) | 12.5 (20.88) | 10.83 (26.07) | 2.94 (10.18) | 14.90 (25.04) | 2.7 (10.0) | < 0.01 | 11.7 (22.6) | 0.28 |
Trouble with social contact | 9.15 (18.81) | 4.72 (11.37) | 2.67 (6.07) | 2.67 (4.66) | 10.67 (24.78) | 3.92 (5.80) | 6.46 (15.05) | 3.8 (10.6) | 0.05 | 7.6 (14.7) | 0.55 |
Less sexuality | 12.75 (36.15) | 11.11 (37.64) | 31.11 (47.50) | 6.67 (25.09) | 10 (30.63) | 10.78 (42.06) | 13.65 (37.53) | 26.1 (33.6) | < 0.01 | 28.8 (36.3) | < 0.01 |
Dental problems | 32.68 (36.20) | 27.78 (28.94) | 20 (35.19) | 43.33 (44.58) | 23.33 (31.62) | 13.73 (20.62) | 27.82 (33.80) | 10.1 (21.4) | < 0.01 | 21.4 (32.3) | 0.12 |
Mouth opening | 32.68 (36.20) | 27.78 (28.94) | 20 (35.19) | 43.33 (44.58) | 23.33 (31.62) | 13.73 (20.62) | 27.82 (33.80) | 1.8 (10.8) | < 0.01 | 17.6 (29.3) | < 0.01 |
Dry mouth | 30.07 (39.58) | 16.67 (26.01) | 31.11 (36.66) | 10 (22.50) | 16.67 (32.39) | 1.96 (8.09) | 21.26 (33.51) | 12.3 (22.3) | < 0.01 | 47.3 (36.3) | < 0.01 |
Sticky saliva | 37.25 (38.09) | 33.33 (31.08) | 42.22 (36.66) | 36.67 (39.91) | 33.33 (31.43) | 25.49 (27.71) | 35.17 (34.71) | 6.9 (17.5) | < 0.01 | 18.6 (28.4) | < 0.01 |
Coughing | 20.92 (31.24) | 31.94 (34.72) | 53.33 (35.18) | 23.33 (35.31) | 20 (32.20) | 13.73 (26.51) | 25.98 (33.57) | 16.8 (24.4) | < 0.01 | 17.3 (24.6) | 0.02 |
Malaise | 17.65 (27.77) | 18.06 (29.45) | 24.44 (40.76) | 20 (32.20) | 16.67 (32.39) | 17.65 (17.15) | 18.64 (28.99) | 11.3 (21.5) | < 0.01 | 10.8 (20.0) | 0.01 |
Factors related to global QOL and utility
Characteristic | Global QOL Mean (SD) | P-value | Utility Mean (SD) | P-value |
---|---|---|---|---|
Age | ||||
< 65 y/o | 70.1 (21.8) | 0.46* | 0.7 (0.18) | 0.99* |
≥ 65 y/o | 73.7 (23.4) | 0.72 (0.19) | ||
Gender | ||||
Female | 66.3 (27.4) | 0.31* | 0.75 (0.17) | 0.40* |
Male | 71.7 (21.0) | 0.71 (0.19) | ||
Tumor site | ||||
Oral | 74.7 (19.9) | 0.68† | 0.71 (0.17) | 0.98† |
Nasopharyngeal | 66.0 (19.8) | 0.73 (0.20) | ||
Thyroid | 67.6 (22.4) | 0.70 (0.21) | ||
Oropharyngeal | 66.7 (29.1) | 0.76 (0.14) | ||
Laryngeal | 69.2 (30.4) | 0.70 (0.20) | ||
Hypopharyngeal | 71.7 (19.7) | 0.72 (0.24) | ||
Education (years) | ||||
Less than 6 years | 76.6 (20.9) | 0.37† | 0.76 (0.18) | 0.59† |
6–12 years | 70.1 (22.0) | 0.71 (0.19) | ||
More than 12 years | 65.7 (25.5) | 0.67 (0.18) | ||
Occupational status | ||||
Employed | 71.8 (20.0) | 0.85† | 0.75 (0.17) | 0.14† |
Homemaking | 66.7 (23.6) | 0.70 (0.13) | ||
No | 70.3 (24.3) | 0.68 (0.20) | ||
Marital status | ||||
With a spouse | 72.1 (22.4) | 0.28* | 0.74 (0.17) | 0.02* |
Without a spouse | 67.2 (21.2) | 0.64 (0.21) | ||
Annual family income | ||||
> 1,000,000 NTD | 77.0 (19.4) | < 0.01† | 0.72 (0.18) | 0.02† |
500,000~1,000,000 NTD | 59.1 (21.4) | 0.75 (0.20) | ||
< 500,000 NTD | 47.6 (22.9) | 0.52 (0.12) | ||
Habits related to cancer | ||||
Tobacco use (+) | 72.0 (20.5) | 0.44* | 0.72 (0.18) | 0.85* |
Tobacco use (−) | ||||
Betel nut use (+) | 69.8 (20.5) | 0.63* | 0.71 (0.18) | 0.75* |
Betel nut use (−) | ||||
Alcohol use (+) | 71.4 (22.4) | 0.78* | 0.74 (0.18) | 0.24* |
Alcohol use (+) | ||||
AJCC(7th edition) Stage | ||||
I | 75 (20.7) | 0.59† | 0.72 (0.19) | 0.98† |
II | 72.2 (23.3) | 0.73 (0.11) | ||
III | 70.7 (19.3) | 0.72 (0.20) | ||
IV | 68.3 (24.1) | 0.71 (0.18) | ||
Treatment | ||||
Chemotherapy | ||||
Yes | 70.2 (22.3) | 0.49* | 0.73 (0.18) | 0.90* |
No | 73.2 (21.9) | 0.72 (0.17) | ||
Radiation therapy | ||||
Yes | 69.9 (21.6) | 0.24* | 0.73 (0.18) | 0.50* |
No | 75.6 (23.4) | 0.70 (0.18) | ||
Radiotherapy course | 73.5 (21.6) | 0.03* | 0.70 (0.20) | 0.40 |
Received 1st course | 71.2 (21.3) | 0.74 (0.17) | ||
Received 2nd course | 56.6 (23.8) | 0.67 (0.22) | ||
Radiotherapy modalities | 0.38 | 0.95 | ||
3D CRT+ IMRT | 61.7 (21.7) | 0.78 (0.14) | ||
IMRT | 63.0 (24.8) | 0.73 (0.20) | ||
VMAT | 75 (20.4) | 0.72 (0.21) | ||
HT | 71.9 (21.7) | 0.72 (0.17) | ||
Surgery | ||||
Yes | 71.4 (22.4) | 0.40* | 0.71 (0.18) | 0.26* |
No | 66.7 (20.6) | 0.77 (0.18) | ||
F/U time | ||||
< 1 year | 67.4 (18.1) | 0.41 | 0.66 (0.19) | 0.12 |
≧ 1 year | 71.6 (22.9) | 0.73 (0.18) |