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Jeffrey E. Terrell, MD; Susan G. Fisher, PhD; Gregory T. Wolf, MD; for the Veterans Affairs Laryngeal Cancer Study Group

Arch Otolaryngol Head Neck Surg. 1998;124:964-971.

Objective  To assess long-term quality of life in surviving patients with advanced laryngeal cancer.

Design  A follow-up long-term quality-of-life survey of patients randomized to the Veterans Affairs Laryngeal Cancer Study No. 268 on induction chemotherapy and radiation (CT + RT) vs surgery and RT.

Setting and Patients  Forty-six (71%) of the 65 surviving patients with prior stage III or IV laryngeal cancer who could be contacted completed the survey: 25 from the surgery and RT group and 21 from the CT + RT group. Baseline demographic and clinical characteristics among survey respondents were similar, except that those in the CT + RT group were significantly older (mean, 61.2 years) than those in the surgery and RT group (mean, 55.7 years; P<.05).

Interventions and Main Outcome Measures  Patients completed the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, the Medical Outcomes Studies Short-Form 36 (SF-36) general health survey, the Beck Depression Inventory as well as smoking and alcohol consumption surveys.

Results  Patients randomized to the CT + RT group had significantly better (P<.05) quality-of-life scores on the SF-36 mental health domain (76.0) than the surgery and RT group (63.0), and also had better HNQOL pain scores (81.3 vs 64.3). Compared with patients who underwent laryngectomy, patients with intact larynges (CT + RT with larynx) had significantly less bodily pain (88.5 vs 56.5), better scores on the SF-36 mental health (79.8 vs 64.7), and better HNQOL emotion (89.7 vs 79.4) scores. More patients in the surgery and RT group (28%) were depressed than in the CT+RT group (15%).

Conclusion  Better quality-of-life scores in the CT+RT groups appear to be related to more freedom from pain, better emotional well-being, and lower levels of depression than to preservation of speech function.

From the Health Services Research Division of the Ann Arbor Veterans Affairs Medical Center (Dr Terrell); the Department of Otolaryngology, University of Michigan Health System (Drs Terrell and Wolf), Ann Arbor, Mich; and the Cooperative Studies Program Coordinating Center, Hines, Ill (Dr Fisher). A complete listing of the members of the Veterans Affairs Laryngeal Cancer Study Group was published previously (N Engl J Med.1991;324: 1685).

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