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Lessons Learned From 549 Prospectively Evaluated Patients

Ernest A. Weymuller, Jr, MD; Bevan Yueh, MD, MPH; Frederic W. B. Deleyiannis, MD, MPhil, MPH; Alice L. Kuntz, MD; Ramsey Alsarraf, MD, MPH; Marc D. Coltrera, MD

Arch Otolaryngol Head Neck Surg. 2000;126:329-335.

Objectives  To summarize our quality-of-life (QOL) research findings for patients with head and neck cancer, to suggest areas for future productive QOL research, and to discuss how to undertake QOL studies in a cost-effective manner.

Design  Review of previously published analyses of advanced larynx cancer, advanced oropharynx cancer, and neck-dissection cases and current data from the complete set of patients.

Patients  From January 1, 1993, through December 31, 1998, data on 549 patients were entered in our head and neck database. Of these patients, 364 met additional criteria for histologic findings (squamous cell carcinoma) and the restriction of their cancer to 4 major anatomical sites (oral, oropharynx, hypopharynx, or larynx). Of these, 339 patients were more than 1 year beyond initial treatment. Complete baseline TNM staging and QOL data were obtained for 260 of these patients, of whom 210 presented with an untreated first primary tumor (index cases) to the University of Washington, Seattle.

Intervention  Pretreatment QOL was assessed with an interviewer-supervised self-administered questionnaire. Subsequent self-administered tests were completed at 3, 6, 12, 24, and 36 months. Other data collected on each patient included cancer site, stage, treatment, histologic findings, type of surgical reconstruction, and current disease and vital status.

Results/Conclusions  It is difficult to achieve "statistically significant" results in a single-instution setting. The "composite" QOL score may not be a sufficiently sensitive tool. Analysis of separate domains may be more effective.

From the Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine (Drs Weymuller, Yueh, Deleyiannis, Kuntz, Alsarraf, and Coltrera), and the Health Services Research and Development Service and Surgery Service, Veterans Affairs Puget Sound Health Care System (Dr Yueh), Seattle.

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