A scientometric study on research trends and characteristics of oral health-related quality of life among head and neck cancer patients

Abstract

Background/purpose

With the evolving interest in patient-centered outcomes, assessing quality of life has become essential to cancer research and clinical practice. The purpose of this study was to analyze the scientometric characteristics and research trends of oral health-related quality of life (OHQL) among head and neck cancer (HNC) patients.

Materials and methods

All the articles on OHQL among HNC patients were comprehensively retrieved from the Scopus database, with emphasis on the analysis of research keywords in different decades and disciplines.

Results

There were 300 (57.3 %) and 224 (42.7 %) articles published by stomatologists and other scholars, respectively. Notably, 28 items for questionnaire such as swallowing, xerostomia, speech, pain, mastication, dysphagia, stomatitis, and fatigue were identified. As for distinctive keywords, alcohol consumption, dental procedure, denture, eating, mood, oral surgical procedures, psychological adaptation, saliva, and salivation were used more frequently by stomatologists. Antineoplastic agents, brachytherapy, diarrhea, deglutition disorders, dyspnea, dietary supplements, drug efficacy, etoposide, cyclophosphamide, functional status, glossectomy, nausea, nutritional support, patient-reported outcome, postoperative complication, surgical flaps, and vomiting were used more frequently by other scholars. After 2020, the focus of OHQL among HNC patients has shifted towards drug therapy, reconstruction, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and specific patient-reported outcomes such as diarrhea, dyspnea, insomnia, trismus, speech disorder, and malnutrition.

Conclusion

This study elucidated the scientometric characteristics of OHQL among HNC patients, and proposed that multidisciplinary comprehensive management should be conducted to improve the patients’ symptoms and quality of life.

Introduction

The cancers of head and neck region, especially oral cavity and oropharynx, have a profound impact on patients, affecting not only their physical appearance but also fundamental aspects of their daily lives.1 Oral cavity and oropharynx areas have intricated structural relationships and are necessary for vital functions like chewing, swallowing, and speaking. Surgery, radiation, chemotherapy, and/or a combination of these treatments are the available options for treating head and neck cancer (HNC).2–4 Treatment-related complications such as difficulty in eating and speech, dysphagia, xerostomia, taste changes, alternation in physical appearance, disfigurement, fatigue, and infirmity are unavoidable. Moreover, anxiety and stress throughout the cancer treatment have a substantial impact on quality of life.3,4 Although HNC survivors adapt to the constraints of everyday life, they still have unmet needs, and therefore, there is a need for quantitative measures to assess the wellness levels of these patients.5,6 Hence, HNC patients are often given priority for special care over patients with other cancers.

The concept of quality of life encompasses a broad range of issues, including physical functioning, emotional well-being, and social functioning in which an individual lives. As one of the well-being indicators, oral health-related quality of life (OHQL) can represent people’s quality of life from the oral health perspective, including eating, drinking, speaking, social appearance, and other day-to-day life functions.7 HNC patients have to face devastating effects of uncertainties about their recovery and fear of recurrence combined with various physical, functional, emotional, and social issues, ultimately affecting the general quality of life.7 Scientometrics/bibliometrics is a useful tool that utilizes citation and literature data to assess scientific output and research trend within a specific research field.8–10 Although there were two bibliometric analyses of HNC patients’ quality of life,11,12 little has been conducted to focus on the analysis of research keywords in different decades and disciplines from the oral health perspective. Therefore, the purpose of this study was to analyze the scientometric characteristics and research trends of OHQL among HNC patients, highlighting the discipline and chronological comparison of the keywords.

Materials and methods

As per the methodology described previously,8–10 all the papers on OHQL among HNC patients in the Scopus database were retrieved on 30 Oct 2025. We used medical subject terms “oral OR mouth” and “quality of life OR life quality” in the title AND “carcino^* OR cancer* OR malignan* OR neoplas* OR tumo*” in the title/abstract/keywords in literature search without restriction to year of publication. Article was included since this type of publications substantially reflects original research, and only English language literature was included because it is an international language of knowledge exchange. The articles with the word “dent* OR oral OR maxillofac* OR stomatolog*” in the affiliations generally represent scientific output of stomatologists, and the remaining articles generally represent scientific output of other scholars. The years of publication were divided into before 2020 and Jan 2020–Oct 2025, so that the number of articles can be to some extent compared in the analysis of research trends. The bibliometric characteristics of all the eligible articles were reviewed and recorded for the following information: title, keyword, citation count, publication year, journal of publication, authorship, affiliation, and country/region of origin. Data search and extraction were performed independently by two investigators, and any discrepancy of results was resolved in a consensus symposium. Microsoft Office Excel 365 was used for index model building and the Bibliometrix Biblioshiny R-package software was used for bibliometric statistics. In this descriptive study, variables are presented as numbers and percentages. No comparisons were made, and thus no P-values were set.

Results

Bibliometric characteristics

With the search strategy algorithm, a total of 524 articles on OHQL among HNC patients were retrieved in the Scopus database. There were 300 (57.3 %) and 224 (42.7 %) articles published by stomatologists and other scholars, respectively. The detailed information on publication year, title, journal, citation count, authors, keywords, affiliations and countries/regions of these articles on O0HQL among HNC patients are presented in Supplementary Table S1. To further concretize the trends of scientific output, we assessed the annual number and annual accumulated citations of the articles on OHQL among HNC patients during 2005–2024 (Fig. 1A). The annual number of the publications by stomatologists changed from 3 to 29, and the accumulated citations of these articles stably raised from 61 to 665 during 2005–2024. The annual number of the publications by other scholars changed from 4 to 21, and the accumulated citations of these articles increased slowly from 142 to 455 during this period. Fig. 1B displays cloud graphs of journals of publications, contributing authors, institutions, and countries/regions of origin of these articles by stomatologists and other scholars.

Figure 1.

Bibliometric characteristics of the articles on oral health-related quality of life among head and neck cancer patients. (A) The annual number and accumulated citations of the articles during 2005–2024. (B) Cloud graphs of journal of publication, contributing authors, institutions, and countries/regions of origin. The font size indicates the number of articles; a larger size means more articles in the cloud graphs.

Research characteristics of publications by stomatologists versus other scholars

Based on the frequency of keywords in all included articles on OHQL among HNC patients, the keywords were automatically recognized in the order of highest to lowest frequency in the Scopus database. Fig. 2A displays cloud graph of the main keywords, and Fig. 2B displays cloud graph of the 28 items for questionnaire of OHQL among HNC patients. Common research keywords, such as oral cancer, oral health, psychology, follow up, HNC, squamous cell carcinoma, radiotherapy, and pathology, were similar in the publications by stomatologists and other scholars. As for distinctive keywords (Fig. 2C), age factors, alcohol consumption, cancer recurrence, coping behavior, dental procedure, denture, dental health, eating, mood, mandible resection, oral squamous cell carcinoma, oral submucous fibrosis, oral surgical procedures, psychological adaptation, physical disability, patient satisfaction, physiology, prevalence, morbidity, saliva, salivation, and social disability were used more frequently by stomatologists. On the other hand, time factors, antineoplastic agents, body mass, brachytherapy, breast cancer, cisplatin, fluorouracil, comorbidity, constipation, controlled clinical trial, diarrhea, deglutition disorders, dyspnea, dietary supplements, drug efficacy, drug safety, etoposide, cyclophosphamide, functional status, glossectomy, nausea, nutritional support, patient compliance, patient-reported outcome, postoperative complication, surgical flaps, and vomiting were used more frequently by other scholars.

Figure 2.

Research characteristics of the articles on oral health-related quality of life among head and neck cancer patients. (A) Cloud graph of all the main keywords. (B) Cloud graph of the related items for questionnaire. Cloud graph of distinctive keywords of (C) articles published by stomatologists and other scholars and (D) articles published before 2020 and after 2020. The font size indicates the number of articles; a larger size means more articles in the cloud graphs. EORTC QLQ-C3, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30.

Research trends of publications before 2020 versus after 2020

There were 274 (52.3 %) articles on OHQL among HNC patients published before 2020 and 250 (47.7 %) articles published between Jan 2020 and Oct 2025. Before 2020, age factors, time factors, sex factors, sex difference, cognition, eating, vomiting, mood, psychological adaptation, coping behavior, saliva, rating scale, scoring system, daily life activity, and University of Washington Quality of Life (UW-QoL) were distinctive keywords of clinical investigation. Multi-modality cancer therapy, mandible resection, plastic surgery, surgical flaps, postoperative care, cancer adjuvant therapy, cyclophosphamide, fluorouracil, and antineoplastic agents were therapeutic keywords before 2020 (Fig. 2D). After 2020, body mass, body weight loss, dental procedure, clinical outcome, cancer prognosis, overall survival, tumor recurrence, lymph node metastasis, reconstruction, drug therapy, drug effect, adverse event, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) were distinctive keywords of clinical investigation. Further, diarrhea, dyspnea, insomnia, trismus, speech disorder, loss of appetite, malnutrition, nutritional status, nutrition supplement, dietary supplement, social behavior, social interaction, mouth hygiene, postoperative complication, and patient-reported outcome were used more frequently in the investigation. Besides, case–control study, observational study, systematic review, and double-blind procedure were mainly conducted after 2020.

Discussion

Oral health-related quality of life (OHQL) is a separate model from the general health perceptions, which elaborate a multidimensional approach to the quality of life that highlights oral functional and psychosocial dimensions.7 With the evolving interest in patient-centered outcomes, assessing quality of life has become essential to cancer research and clinical practice. Along with the morbidity and mortality of HNC, OHQL has emerged as a distinct and growing clinical challenge. The increasing numbers and citations of the articles on OHQL among HNC patients each year suggest that the issue has governed growing attention and investigation. It could be speculated that the numbers and citations will continue to grow in the coming years. The number of articles in after 2020 was roughly equal to that before 2020, indicating that investigation on this issue is undergoing a rapid developmental stage. Bibliometric items in sequence would aid clinicians and researchers in choosing target journals, finding potential collaborators or partner institutions, as well as promoting mutual understanding and more reciprocal cooperation. Importantly, the current study identified the relevant items for questionnaire (Fig. 2B), which provide researchers and policymakers with baseline data to frame research strategies for improving OHQL among HNC patients.

The strength of this scientometric study was to analyze the keywords in different disciplines (stomatology versus others) and different decades (before 2020 versus 2020–2025). The distinctive keywords can reflect research directions and topics of concern. Given the complex and diverse symptoms of HNC patients during and after treatment, collaboration between stomatologists and others such as oncologists, radiologists and nurses is essential for bridging research gaps and increasing the impact of studies. 13–15 A multidisciplinary approach is crucial for managing effectively and improving patients’ symptoms and quality of life. Herein, we also highlight the awareness of early prevention and management of the relevant symptoms, which are crucial to enhance the access to care for these symptoms and patients’ quality of life during and after cancer treatment.16,17 After 2020, the focus of OHQL among HNC patients has shifted towards drug therapy, reconstruction, EORTC QLQ-C30 and specific patient-reported outcomes such as diarrhea, dyspnea, insomnia, trismus, speech disorder, and malnutrition.17–20 The impact of nutritional changes on patients’ lives such as fatigue and weight loss. Patients often express anxiety and stress throughout their cancer treatment.17 Future research should focus on interventions and strategies to improve survival outcomes, effective management of specific symptoms and toxicities, and the impact of novel treatment modalities on OHQL among HNC patients.

In summary, this scientometric study elucidated the current scenario and research trends of OHQL among HNC patients. Finding the scientometrics would elucidate the comprehensive identification and recognition of the important and relevant research topics concerned, but also help in improving in reciprocal collaboration and communication for investigations on this disease. Multidisciplinary comprehensive management should be proposed to improve the patients’ symptoms and quality of life.

Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.jds.2025.12.031.

Funding Statement

This work was supported by Shanghai’s Top Priority Research Center (2022ZZ01017), CAMS Innovation Fund for Medical Sciences (CIFMS; 2019-I2M-5-037), and Excellent Research Physician Project of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine (JYYJX202403, 2023yxyjxys)