Head and Neck Cancer—Specific Quality of Life:  Instrument Validation

Jeffrey E. Terrell, MD; Kinjal A. Nanavati, MPH; Ramon M. Esclamado, MD; Julie K. Bishop, CCC-SLP; Carol R. Bradford, MD; Gregory T. Wolf, MD
Arch Otolaryngol Head Neck Surg. 1997;123(10):1125-1132. doi:10.1001/archotol.1997.01900100101014.
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Background:  The disfigurement and dysfunction associated with head and neck cancer affect emotional well-being and some of the most basic functions of life. Most cancer-specific quality-of-life assessments give a single composite score for head and neck cancer—related quality of life.

Objective:  To develop and evaluate an improved multidimensional instrument to assess head and neck cancer—related functional status and well-being.

Methods:  The item selection process included literature review, interviews with health care workers, and patient surveys. A survey with 37 disease-specific questions and the SF-12 survey were administered to 253 patients in 3 large medical centers. Factor analysis was performed to identify disease-specific domains. Domain scores were calculated as the standardized score of the component items. These domains were assessed for construct validity based on clinical hypotheses and test-retest reliability.

Results:  Four relevant domains were identified: Eating (6 items), Communication (4 items), Pain (4 items), and Emotion (6 items). Each had an internal consistency (Cronbach α value) of greater than 0.80. Construct validity was demonstrated by moderate correlations with the SF-12 Physical and Mental component scores (r=0.43-0.60). Test-retest reliability for each domain demonstrated strong reliability between the 2 time points. Correlations were strong for each individual question, ranging from 0.53 to 0.93. Construct validity testing demonstrated that the direction of differences for each domain were as hypothesized.

Conclusion:  The Head and Neck Quality of Life questionnaire is a promising multidimensional tool with which to assess head and neck cancer—specific quality of life.Arch Otolaryngol Head Neck Surg. 1997;123:1125-1132


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