In the year following their first treatment, patients with head and neck cancer report declines in their physical quality of life but improvements in their mental health quality of life, according to a report in the March issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals. Some types of treatment--especially feeding tube placement, chemotherapy and radiation therapy--were associated with changes in quality of life.
More than 40,000 new cases of head and neck cancer are diagnosed in the United States each year, according to background information in the article. "In addition to mortality [death], head and neck cancer and its treatment produce substantial reductions in health-related quality of life," the authors write. "The treatments tend to produce pain, disfigurement, eating problems and communication problems. Many patients become disabled, and about one-third of patients continue to smoke and half are depressed."
David L. Ronis, Ph.D., of the Veterans Affairs Ann Arbor Healthcare System and the University of Michigan School of Nursing, Ann Arbor, and colleagues studied 316 patients newly diagnosed with head and neck cancer at three otolaryngology clinics. Participants completed surveys with information about demographics, smoking status, alcohol problems, clinical and treatment variables and depression. Their quality of life was assessed using established scales that measured physical and social functioning, eating and swallowing, communication, head and neck pain and emotional well-being. Patients were reassessed one year later to identify any changes in quality of life.
Smoking, symptoms of depression and co-occurring illnesses were associated with low quality of life scores at the beginning of the study. At the one-year follow-up, quality of life decreased for physical functioning measures and eating but improved for mental health. Treatment factors, especially feeding tube placement, chemotherapy and radiation therapy, were associated with decreases in quality of life from the beginning of the study through one year. "Baseline smoking and depressive symptoms also remained significant predictors of several quality of life scales at one year," the authors write.
Physicians may be able to improve quality of life in patients with head and neck cancer by treating depression and by emphasizing the negative effects smoking can have on everyday life, the authors note. In addition, "physicians should alert patients to the relative effects on quality of life one may experience with different treatments," the authors conclude.
(Arch Otolaryngol Head Neck Surg. 2008;134:241-248. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by a grant made available by the U.S. National Institutes of Health through the University of Michigan Head and Neck Specialized Program of Research Excellence. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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