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Hisham M. Mehanna, BMedSc(Hon), MB ChB(Hon), FRCS(ORL HNS); Randall P. Morton, MB, BS, MSc, FRACS

Arch Otolaryngol Head Neck Surg. 2006;132:27-31.

Objective  To assess whether pretreatment and posttreatment quality of life (QOL) is associated with long-term survival in patients with head and neck cancer.

Design  Ten-year follow-up of an inception cohort.

Setting  Regional tertiary referral center.

Patients  The study included 200 consecutive patients with primary epithelial head and neck cancer.

Interventions  Quality of life and several recognized risk factors for death were assessed prospectively using the Auckland QOL questionnaire before treatment and 12 months after treatment; survival was determined at 10 years.

Main Outcome Measures  Survival and odds of death (hazards ratio) were measured.

Results  At 10 years, 136 patients (68%) were deceased, 48 patients (24%) were alive, and the status of 16 patients (8%) was unknown. Median survival was 6 years (interquartile range, 4.4-7.7). Before treatment, patients with low QOL had no significantly increased odds of death (hazard ratio, 1.4; 95% confidence interval, 0.8-2.4). In contrast, after treatment, patients with low QOL at 1 year had significantly increased odds of death (2.5; 95% confidence interval, 1.4-4.3; P = .001) even after adjustment for covariates.

Conclusions  Findings suggest potential survival benefits from improvements in QOL. However, the observed associations between survival benefit and QOL at 1 year may be confounded by comorbidity, which was not measured and deserves further investigation.

Author Affiliations: Department of Otorhinolaryngology Head and Neck Surgery, University Hospitals Coventry and Warwickshire, Coventry, England (Dr Mehanna); and Departments of Otolaryngology and Head and Neck Surgery (Dr Morton), Manukau Surgery Centre, Auckland City Hospital, Auckland, New Zealand.

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