The EORTC QLQ-C30 (version 2.0)9 is a 30-item measure of health-related quality of life. It yields 6 functional scales (Physical, Role, Emotional, Social, Cognitive, and Global quality of life), 3 symptom scales (Fatigue, Pain, and Nausea/vomiting), and 6 single items (Dyspnea, Sleep disturbance, Appetite, Diarrhea, Constipation, and Financial difficulties). Participants respond to items in a yes/no format, a Likert scale, or a visual analog scale. The core instrument was used in tandem with the head and neck module (QLQ-H&N35), a 35-item questionnaire that assesses symptoms encountered specifically by patients with head and neck cancer.15,16 This measure generates 7 multiple-item scales (Pain, Swallowing, Senses, Speech, Social eating, Social contact, and Sexuality), in addition to 11 single items (eg, Opening mouth, Sticky saliva, Dry mouth, etc). To ensure content validity, items were developed in accord with EORTC standardized guidelines,19 which include review by panels of specialists and patients, followed by international field testing. All EORTC scales and single items were scored and linearly transformed to scales of 0 to 100. The functional scales were reversed scored, so that higher scores indicate better functioning. Conversely, higher scores on the symptom scales and individual items indicate greater impairment. The EORTC questionnaires required approximately 8 minutes to complete. Of the 160 EORTC questionnaires included in the analysis, 22 contained missing values (13.8%); a total of 37 items were missing (0.4% of total items). The mean of the scale was used to substitute for missing values, provided at least half of the items on the scale had been completed.