Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 2001 Jan;84(2):149–156. doi: 10.1054/bjoc.2000.1576

Health-related quality of life in long-term head and neck cancer survivors: a comparison with general population norms

E Hammerlid 1, C Taft 2
PMCID: PMC2363699  PMID: 11161369

Abstract

To examine the health-related quality of life (HRQL) in long-term head and neck (H&N) cancer survivors compared with general population norms. HRQL was assessed with three standardized questionnaires: the SF-36 Health Survey (Short Form 36) and the EORTC QLQ-C30 and QLQ-H&N35 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, -Core 30 and -Head and Neck 35 cancer module). Altogether 135 H&N cancer patients (mean age 62 years, 31% females) of 151 survivors (89% acceptance) from a longitudinal HRQL study (n = 232) were included 3 years after diagnosis. The H&N cancer patients' SF-36 scores did not differ significantly from those of an age- and sex-matched sample (n = 871) from the Swedish normative population, except on the role-physical functioning scale. On the other hand, treatment-related side-effects and disease-specific problems (e.g., swallowing, local pain and dry mouth) measured by the H&N cancer module were, with few exceptions, significantly worse than norm values. Gender comparisons revealed that female H&N cancer patients generally scored better than the norms on both the SF-36 and the EORTC QLQ-C30, while the male patients scored significantly worse on most SF-36 scales. Patients ≥65 years more often scored worse than the norm than did patients <65. Clinically relevant differences were found on the majority of SF-36 scales in comparison of tumour sites, however, comparisons of patients with small (stage I+II) versus advanced (stage III+IV) tumours revealed few differences. Three years after diagnosis H&N cancer patients still suffer significant functional limitations/problems related to their disease and its treatment but these problems do not generally affect their overall HRQL. Tumour stage no longer differentiates HRQL at 3 years, however, factors related to the patients' age, gender and location of the tumour appear to have bearing on their reported health status. © 2001 Cancer Research Campaign http://www.bjcancer.com

Keywords: head and neck cancer, survivors, health-related quality of life (HRQL), SF-36, EORTC QLQ-H&N35

Full Text

The Full Text of this article is available as a PDF (172.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aaronson N. K., Ahmedzai S., Bergman B., Bullinger M., Cull A., Duez N. J., Filiberti A., Flechtner H., Fleishman S. B., de Haes J. C. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993 Mar 3;85(5):365–376. doi: 10.1093/jnci/85.5.365. [DOI] [PubMed] [Google Scholar]
  2. Bjordal K., Ahlner-Elmqvist M., Tollesson E., Jensen A. B., Razavi D., Maher E. J., Kaasa S. Development of a European Organization for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. EORTC Quality of Life Study Group. Acta Oncol. 1994;33(8):879–885. doi: 10.3109/02841869409098450. [DOI] [PubMed] [Google Scholar]
  3. Bjordal K., Freng A., Thorvik J., Kaasa S. Patient self-reported and clinician-rated quality of life in head and neck cancer patients: a cross-sectional study. Eur J Cancer B Oral Oncol. 1995 Jul;31B(4):235–241. doi: 10.1016/0964-1955(95)00010-f. [DOI] [PubMed] [Google Scholar]
  4. Bjordal K., Hammerlid E., Ahlner-Elmqvist M., de Graeff A., Boysen M., Evensen J. F., Biörklund A., de Leeuw J. R., Fayers P. M., Jannert M. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. J Clin Oncol. 1999 Mar;17(3):1008–1019. doi: 10.1200/JCO.1999.17.3.1008. [DOI] [PubMed] [Google Scholar]
  5. Bjordal K., Kaasa S., Mastekaasa A. Quality of life in patients treated for head and neck cancer: a follow-up study 7 to 11 years after radiotherapy. Int J Radiat Oncol Biol Phys. 1994 Mar 1;28(4):847–856. doi: 10.1016/0360-3016(94)90104-x. [DOI] [PubMed] [Google Scholar]
  6. Bjordal K., Kaasa S. Psychological distress in head and neck cancer patients 7-11 years after curative treatment. Br J Cancer. 1995 Mar;71(3):592–597. doi: 10.1038/bjc.1995.115. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bjordal K., Kaasa S. Psychometric validation of the EORTC Core Quality of Life Questionnaire, 30-item version and a diagnosis-specific module for head and neck cancer patients. Acta Oncol. 1992;31(3):311–321. doi: 10.3109/02841869209108178. [DOI] [PubMed] [Google Scholar]
  8. Chin M. H., Goldman L. Gender differences in 1-year survival and quality of life among patients admitted with congestive heart failure. Med Care. 1998 Jul;36(7):1033–1046. doi: 10.1097/00005650-199807000-00010. [DOI] [PubMed] [Google Scholar]
  9. De Boer M. F., McCormick L. K., Pruyn J. F., Ryckman R. M., van den Borne B. W. Physical and psychosocial correlates of head and neck cancer: a review of the literature. Otolaryngol Head Neck Surg. 1999 Mar;120(3):427–436. doi: 10.1016/S0194-5998(99)70287-1. [DOI] [PubMed] [Google Scholar]
  10. Deleyiannis F. W., Weymuller E. A., Jr, Coltrera M. D., Futran N. Quality of life after laryngectomy: are functional disabilities important? Head Neck. 1999 Jul;21(4):319–324. doi: 10.1002/(sici)1097-0347(199907)21:4<319::aid-hed5>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  11. Deleyiannis F. W., Weymuller E. A., Jr, Coltrera M. D. Quality of life of disease-free survivors of advanced (stage III or IV) oropharyngeal cancer. Head Neck. 1997 Sep;19(6):466–473. doi: 10.1002/(sici)1097-0347(199709)19:6<466::aid-hed2>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  12. Funk G. F., Karnell L. H., Dawson C. J., Means M. E., Colwill M. L., Gliklich R. E., Alford E. L., Stewart M. G. Baseline and post-treatment assessment of the general health status of head and neck cancer patients compared with United States population norms. Head Neck. 1997 Dec;19(8):675–683. doi: 10.1002/(sici)1097-0347(199712)19:8<675::aid-hed5>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  13. Hammerlid E., Ahlner-Elmqvist M., Bjordal K., Biörklund A., Evensen J., Boysen M., Jannert M., Kaasa S., Sullivan M., Westin T. A prospective multicentre study in Sweden and Norway of mental distress and psychiatric morbidity in head and neck cancer patients. Br J Cancer. 1999 May;80(5-6):766–774. doi: 10.1038/sj.bjc.6690420. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hammerlid E., Bjordal K., Ahlner-Elmqvist M., Jannert M., Kaasa S., Sullivan M., Westin T. Prospective, longitudinal quality-of-life study of patients with head and neck cancer: a feasibility study including the EORTC QLQ-C30. Otolaryngol Head Neck Surg. 1997 Jun;116(6 Pt 1):666–673. doi: 10.1016/S0194-59989770246-8. [DOI] [PubMed] [Google Scholar]
  15. Hammerlid E., Mercke C., Sullivan M., Westin T. A prospective quality of life study of patients with laryngeal carcinoma by tumor stage and different radiation therapy schedules. Laryngoscope. 1998 May;108(5):747–759. doi: 10.1097/00005537-199805000-00023. [DOI] [PubMed] [Google Scholar]
  16. Hammerlid E., Mercke C., Sullivan M., Westin T. A prospective quality of life study of patients with oral or pharyngeal carcinoma treated with external beam irradiation with or without brachytherapy. Oral Oncol. 1997 May;33(3):189–196. doi: 10.1016/s0964-1955(96)00069-3. [DOI] [PubMed] [Google Scholar]
  17. Hammerlid E., Persson L. O., Sullivan M., Westin T. Quality-of-life effects of psychosocial intervention in patients with head and neck cancer. Otolaryngol Head Neck Surg. 1999 Apr;120(4):507–516. doi: 10.1053/hn.1999.v120.a90352. [DOI] [PubMed] [Google Scholar]
  18. Hammerlid E., Wirblad B., Sandin C., Mercke C., Edström S., Kaasa S., Sullivan M., Westin T. Malnutrition and food intake in relation to quality of life in head and neck cancer patients. Head Neck. 1998 Sep;20(6):540–548. doi: 10.1002/(sici)1097-0347(199809)20:6<540::aid-hed9>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  19. Hjermstad M. J., Fayers P. M., Bjordal K., Kaasa S. Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: the QLQ=C30 (+ 3). J Clin Oncol. 1998 Mar;16(3):1188–1196. doi: 10.1200/JCO.1998.16.3.1188. [DOI] [PubMed] [Google Scholar]
  20. Hjermstad M. J., Fayers P. M., Bjordal K., Kaasa S. Using reference data on quality of life--the importance of adjusting for age and gender, exemplified by the EORTC QLQ-C30 (+3). Eur J Cancer. 1998 Aug;34(9):1381–1389. doi: 10.1016/s0959-8049(98)00136-1. [DOI] [PubMed] [Google Scholar]
  21. Hjermstad M. J., Fossa S. D., Bjordal K., Kaasa S. Test/retest study of the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire. J Clin Oncol. 1995 May;13(5):1249–1254. doi: 10.1200/JCO.1995.13.5.1249. [DOI] [PubMed] [Google Scholar]
  22. Jones E., Lund V. J., Howard D. J., Greenberg M. P., McCarthy M. Quality of life of patients treated surgically for head and neck cancer. J Laryngol Otol. 1992 Mar;106(3):238–242. doi: 10.1017/s0022215100119152. [DOI] [PubMed] [Google Scholar]
  23. King M. T. The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res. 1996 Dec;5(6):555–567. doi: 10.1007/BF00439229. [DOI] [PubMed] [Google Scholar]
  24. List M. A., Ritter-Sterr C. A., Baker T. M., Colangelo L. A., Matz G., Pauloski B. R., Logemann J. A. Longitudinal assessment of quality of life in laryngeal cancer patients. Head Neck. 1996 Jan-Feb;18(1):1–10. doi: 10.1002/(SICI)1097-0347(199601/02)18:1<1::AID-HED1>3.0.CO;2-7. [DOI] [PubMed] [Google Scholar]
  25. List M. A., Siston A., Haraf D., Schumm P., Kies M., Stenson K., Vokes E. E. Quality of life and performance in advanced head and neck cancer patients on concomitant chemoradiotherapy: a prospective examination. J Clin Oncol. 1999 Mar;17(3):1020–1028. doi: 10.1200/JCO.1999.17.3.1020. [DOI] [PubMed] [Google Scholar]
  26. Morton R. P. Laryngeal cancer: quality-of-life and cost-effectiveness. Head Neck. 1997 Jul;19(4):243–250. doi: 10.1002/(sici)1097-0347(199707)19:4<243::aid-hed1>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  27. Osborne M. L., Vollmer W. M., Linton K. L., Buist A. S. Characteristics of patients with asthma within a large HMO: a comparison by age and gender. Am J Respir Crit Care Med. 1998 Jan;157(1):123–128. doi: 10.1164/ajrccm.157.1.9612063. [DOI] [PubMed] [Google Scholar]
  28. Osoba D., Rodrigues G., Myles J., Zee B., Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998 Jan;16(1):139–144. doi: 10.1200/JCO.1998.16.1.139. [DOI] [PubMed] [Google Scholar]
  29. Osoba D., Zee B., Pater J., Warr D., Kaizer L., Latreille J. Psychometric properties and responsiveness of the EORTC quality of Life Questionnaire (QLQ-C30) in patients with breast, ovarian and lung cancer. Qual Life Res. 1994 Oct;3(5):353–364. doi: 10.1007/BF00451727. [DOI] [PubMed] [Google Scholar]
  32. Pruyn J. F., de Jong P. C., Bosman L. J., van Poppel J. W., van Den Borne H. W., Ryckman R. M., de Meij K. Psychosocial aspects of head and neck cancer--a review of the literature. Clin Otolaryngol Allied Sci. 1986 Dec;11(6):469–474. doi: 10.1111/j.1365-2273.1986.tb00153.x. [DOI] [PubMed] [Google Scholar]
  33. Rogers S. N., Lowe D., Brown J. S., Vaughan E. D. The University of Washington head and neck cancer measure as a predictor of outcome following primary surgery for oral cancer. Head Neck. 1999 Aug;21(5):394–401. doi: 10.1002/(sici)1097-0347(199908)21:5<394::aid-hed3>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  34. Sullivan M., Karlsson J., Ware J. E., Jr The Swedish SF-36 Health Survey--I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med. 1995 Nov;41(10):1349–1358. doi: 10.1016/0277-9536(95)00125-q. [DOI] [PubMed] [Google Scholar]
  35. Terrell J. E., Nanavati K., Esclamado R. M., Bradford C. R., Wolf G. T. Health impact of head and neck cancer. Otolaryngol Head Neck Surg. 1999 Jun;120(6):852–859. doi: 10.1016/S0194-5998(99)70326-8. [DOI] [PubMed] [Google Scholar]
  36. Ware J. E., Jr, Sherbourne C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed] [Google Scholar]
  37. de Graeff A., de Leeuw J. R., Ros W. J., Hordijk G. J., Blijham G. H., Winnubst J. A. A prospective study on quality of life of patients with cancer of the oral cavity or oropharynx treated with surgery with or without radiotherapy. Oral Oncol. 1999 Jan;35(1):27–32. doi: 10.1016/s1368-8375(98)00049-9. [DOI] [PubMed] [Google Scholar]
  38. de Graeff A., de Leeuw R. J., Ros W. J., Hordijk G. J., Battermann J. J., Blijham G. H., Winnubst J. A. A prospective study on quality of life of laryngeal cancer patients treated with radiotherapy. Head Neck. 1999 Jul;21(4):291–296. doi: 10.1002/(sici)1097-0347(199907)21:4<291::aid-hed1>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES