Are psycho-social and behavioural factors related to health related-quality of life in patients with head and neck cancer? A systematic review.

The survival rate in advanced cancer of the head and neck has remained at approximately 50%, and efforts are now directed towards reducing the impact of the disease and its treatment in terms of functioning and health related-quality of life (HR-QoL). Factors such as stage, site of disease and type of treatment all impact on HR-QoL, but it is unclear what additional factors influence HR-QoL. A systematic review was undertaken of studies that have investigated psycho-social or behavioural factors associated with HR-QoL in this patient group. Literature was systematically searched using electronic databases and hand-searching relevant journals. Data were sought on HR-QoL and studies were only included if the measurement instrument was recognised as a reliable and valid measure of HR-QoL. Studies had to include at least one psycho-social or behavioural predictor variable. Sixteen studies fulfilling the inclusion criteria were identified and reviewed. Five main factors were associated with varying degrees with HR-QoL, personality, social support, satisfaction with consultation and information, behavioural factors, such as consuming alcohol and smoking, and depressive symptoms. The major difficulty with synthesising the findings was the amount of different indices of QoL that have been used. However, a number of psycho-social factors have been investigated in relation to HR-QoL in head and neck cancer patients, some of which are potentially modifiable, such as those related to informational needs. Further research is needed to investigate other psychological factors which may influence aspects of HR-QoL. By understanding the relationship between HR-QoL and potentially modifiable variables, interventions can be designed with the aim of improving a patient's long-term well-being.