Original Investigation |

Quality of Life Among Long-Term Survivors of Head and Neck Cancer Treated by Intensity-Modulated Radiotherapy

Allen M. Chen, MD1; Megan E. Daly, MD1; D. Gregory Farwell, MD2; Esther Vazquez, RN1; Jean Courquin, RN1; Derick H. Lau, MD, PhD3; James A. Purdy, PhD1
[+] Author Affiliations
1Department of Radiation Oncology, University of California–Davis Comprehensive Cancer Center, Sacramento
2Department of Otolaryngology–Head and Neck Surgery, University of California–Davis Comprehensive Cancer Center, Sacramento
3Department of Medical Oncology, University of California–Davis Comprehensive Cancer Center, Sacramento
JAMA Otolaryngol Head Neck Surg. 2014;140(2):129-133. doi:10.1001/jamaoto.2013.5988.
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Importance  Radiation therapy to the head and neck has traditionally been associated with adverse effects that can affect oral health and physical functioning. Although intensity-modulated radiotherapy (IMRT) has been widely adopted as a means of decreasing toxic effects, limited clinical data exist on its potential effect on long-term quality of life.

Objective  To analyze quality of life among long-term survivors of head and neck cancer treated with IMRT.

Design, Setting, and Participants  This cross-sectional analysis studied 50 consecutive long-term survivors of head and neck cancer from a comprehensive cancer center who had previously undergone IMRT that required bilateral neck irradiation for locally advanced disease. All patients were clinically without evidence of recurrent disease and had at least 5 years of follow-up.

Main Outcomes and Measures  The University of Washington Quality of Life (UW-QOL) scores were reviewed for all study participants. The UW-QOL questionnaire consists of 12 domains that pertain to the degree of quality of life in the categories of pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder function, taste, saliva, mood, and anxiety.

Results  Five years after completion of IMRT, 42 patients (84%) reported that their health-related quality of life was “much better” or “somewhat better” than at the time of cancer diagnosis. With respect to recent health-related quality of life during the preceding 7 days at the time of completing the UW-QOL questionnaire, 40 patients (80%) treated with IMRT reported “outstanding” or “very good” levels of functioning. Five years after completion of treatment, 41 (82%) rated their overall quality of life as “outstanding” or “very good.” The lowest domain score on the UW-QOL questionnaire at 5 years pertained to salivary dysfunction. However, 42 patients (84%) reported saliva “of normal consistency” or “less saliva than normal but enough” compared with 8 (16%) reporting “too little saliva.” No patient reported having “no saliva.”

Conclusions and Relevance  Our findings add to the body of literature that supports the acceptance of IMRT as standard treatment for head and neck cancer. The fact that most 5-year survivors were satisfied with their quality of lives points to the ability of IMRT to preserve long-term functioning.

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