A structured review of journal articles reporting outcomes using the University of Washington Quality of Life Scale

Abstract

The University of Washington Quality of Life Scale (UW-QoL) is one of the most frequently reported health-related quality of life (HR-QoL) questionnaires in head and neck cancer, and since its first publication in 1993 has been used in many different cohorts. There is a considerable amount of information to assimilate and, to date, we know of no attempt that has been made to summarise publications specific to its use in a peer review journal. The aim of this review was to systematically search published papers that report its use, identify common themes, and present a tabulated summary. Several search engines were used (PubMed, Medline, Medical-Journals.com, eMedicine), and 222 abstracts were found and hand searched. A total of 66 papers were eligible for inclusion, 21 on functional outcome, 25 on predictors of HR-QoL, 19 on development or validation of the questionnaire, and one clinical trial. The review includes a diversity of studies and a range of HR-QoL outcomes following head and neck cancer. It provides clinicians and their colleagues in multidisciplinary teams with a source of quick reference to relevant papers reporting the UW-QoL, and gives a short summary of the pertinent conclusions drawn from each paper.

Introduction

The assessment of health-related quality of life (HR-QoL) is not straightforward in patients with head and neck cancer because of the diversity of subsites and anatomical structures that are involved in the pathological process and in the treatment itself. The value of such assessment as a variable of outcome has been recognised for many years, and its evaluation has an established place in clinical practice.1, 2

There are essentially three ways to assess HR-QoL: open interview, semi-structured interviews, and patient-completed questionnaires; the mainstay of evaluation being questionnaires done in the clinic or by postal survey.¹ There are several to choose from and all have their individual strengths, weaknesses, and unique characteristics.3, 4, 5 In the UK, the University of Washington Quality of Life Scale (UW-QoL) is the one most commonly used to assist in recording clinical outcome from the patient's perspective.4, 5 Perhaps one of the main reasons for this is its simplicity, which is helpful for patients, a substantial proportion of whom will have left school at 16 years of age.⁶

The questionnaire was first published in 1993 by Hassan and Weymuller⁷ and since then there have been three revisions. The first comprised nine domains (pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder, and employment). The question about shoulder function, missing on some other questionnaires, is important to a surgical head and neck oncologist. The lack of any copyright agreements and the simplicity in scoring made this version quite straightforward to use. In version 2,⁸ the nine original domains were each followed by an importance-rating scale, and three new single item “quality of life” questions were added. These were useful as they introduced concepts of importance, and global measures of quality of life. Another important change was the addition of a “freetext” area, where patients could make their own comments.⁹ In version 310, 11 two new domains (taste and saliva) were added, and the employment domain was dropped. Rather than asking patients to rank the importance of each individual domain, this version asked them to indicate which three domains had been most important to them in the last seven days. Finally, in version 4, two psychological questions (anxiety and mood) were added to capture these aspects of HR-QoL.¹²

The questionnaire has been widely used for nearly two decades in head and neck cancer. The purpose of this paper was to do a structured review of studies that have used it, and to summarise the evidence identified that was related to patient-reported outcomes.