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Mark El-Deiry, MD; Gerry F. Funk, MD; Sarvi Nalwa, MD; Lucy H. Karnell, PhD; Russell B. Smith, MD; John M. Buatti, MD; Henry T. Hoffman, MD; Gerry H. Clamon, MD; Scott M. Graham, MD; Douglas K. Trask, MD, PhD; Kenneth J. Dornfeld, MD; Min Yao, MD

Arch Otolaryngol Head Neck Surg. 2005;131:879-885.

Objective  To compare the long-term, health-related quality-of-life outcomes in patients with advanced head and neck cancer (HNC) treated with surgery and postoperative radiation therapy (SRT) or concurrent chemotherapy and radiation therapy (CRT).

Design  Matched-pair study comparing patients with advanced HNC treated with SRT or CRT at least 12 months after treatment. Patients completed 2 validated surveys addressing HNC-specific outcomes and depressive symptoms and provided information on employment and tobacco and alcohol use. Results for the 2 groups were compared using paired-sample t test and ² analysis.

Setting  University-based study.

Patients  Patients with stage III or IV squamous cell carcinoma of the oropharynx, hypopharynx, and larynx who underwent SRT or received CRT.

Main Outcome Measures  Head and neck cancer–specific health-related quality of life from the Head and Neck Cancer Inventory and level of depressive symptoms from the Beck Depression Inventory.

Results  The matching process resulted in 27 patients in each treatment group. The HNC-specific domain scores (with higher scores representing better outcomes) for CRT vs SRT were eating, 37.8 vs 40.8 (P = .69); speech, 65.1 vs 56.0 (P = .23); aesthetics, 80.3 vs 69.2 (P = .14); and social disruption, 69.7 vs 70.6 (P = .90). Overall health-related quality of life was 64.0 with SRT and 55.0 with CRT (P = .142). For the Beck Depression Inventory (with higher scores representing worse outcomes), patients who underwent SRT had a mean score of 9.6 compared with 11.6 for patients who received CRT (P = .42).

Conclusion  As nonsurgical means of treating HNC have become more aggressive and surgical techniques have become more focused on function preservation and rehabilitation, the overall health-related quality of life resulting from these different approaches is similar.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs El-Deiry, Funk, Nalwa, Karnell, Smith, Hoffman, Graham, and Trask), Radiation Oncology (Drs Buatti, Dornfeld, and Yao), and Medical Oncology (Dr Clamon), University of Iowa Hospitals and Clinics, Iowa City.

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