Assessing quality of life in patients treated for advanced head and neck cancer.

A pilot study was undertaken to determine which measures of Quality of Life (QL) would be of most use in the follow-up of patients participating in clinical trials of treatments for head and neck cancer. A total of 96 non-randomized patients who had been treated for head and neck cancer either by surgery (three patients), radiotherapy (54 patients), or combined modality therapy (39 patients) completed a detailed questionnaire assessing a wide range of QL parameters. All participating patients were clinically disease-free. It was found that questions relating to quality of speech, ability to eat, levels of energy and activity, and aspects of psychological wellbeing detected the largest effects on QL. The level of QL impairment was consistently greater in those patients treated by surgery plus radiotherapy as compared to those treated by radiotherapy alone. Eleven patients were interviewed in their own homes and the findings generally supported the conclusions drawn from the questionnaire responses. The interviews also demonstrated that impairment of arm movement amongst some surgically treated patients detracted from QL by causing difficulties in performing everyday selfcare and domestic tasks. This study has provided the basis for a QL assessment to be incorporated into a randomized trial of radiotherapy alone versus surgery plus radiotherapy in the treatment of advanced head and neck cancer. The findings suggest that QL impairment is greater for patients who have surgery in addition to radiotherapy as primary treatment but this may be acceptable if a clear survival advantage is demonstrated.