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Prospective Evaluation of Quality of Life and Nutrition Before and After Treatment for Nasopharyngeal Carcinoma
Justine E. Oates, RN, BSc;
Jonathan R. Clark, MBBS, BSc(Med), FRACS;
Jane Read, BSc, MND, APD;
Nicole Reeves, BAppSc;
Kan Gao, BEngDip;
Michael Jackson, BA, MBBChir, FRANZCR;
Michael Boyer, MBBS, PhD, FRACP;
Christopher J. O’Brien, AM, MBBS, MS, MD, FRACS
Arch Otolaryngol Head Neck Surg. 2007;133(6):533-540.
Objective To prospectively assess quality of life in patients undergoing chemoradiation therapy for nasopharyngeal cancer. Concurrent chemoradiotherapy is standard for advanced nasopharyngeal cancer; however, the toxic effects of this treatment are substantial.
Design Prospective evaluation of quality of life and nutritional status before and after treatment for nasopharyngeal carcinoma.
Patients and Intervention A cohort of 14 patients, treated with concurrent chemoradiotherapy for 7 weeks, completed the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire and Head and Neck Module before and 3, 6, 12, and 24 months after treatment. Changes in score were analyzed and correlated with the toxic effect grade.
Results Quality of life issues during the 24 months of follow-up included poorer global health (P = .01), fatigue (P = .01), appetite loss (P<.001), swallowing difficulties (P = .002), sense problems (P = .03), difficulty with social eating (P = .005), dental problems (P = .045), trismus (P = .001), xerostomia (P<.001), sticky saliva (P = .001), cough (P = .02), and feeling ill (P = .03). Pain (P = .004) and emotional functioning (P<.001) significantly improved from the pretreatment rating. The median weight loss was 7 kg, with most weight loss occurring during treatment, despite nutritional support with gastrostomy feeding tubes. One patient still required percutaneous endoscopic gastrostomy feeding at 2 years after treatment. Physician-scored toxic effects correlated poorly with quality-of-life scores.
Conclusions Quality of life and functional assessment should be important end points in the follow-up of patients with nasopharyngeal cancer who receive chemoradiotherapy. This study supports the need for ongoing support and rehabilitation in a multidisciplinary setting.
Author Affiliations: Sydney Head and Neck Cancer Institute (Mss Oates, Read, and Reeves; Drs Clark and O’Brien; and Mr Gao) and Departments of Radiation Oncology (Dr Jackson) and Medical Oncology (Dr Boyer), Sydney Cancer Centre, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia.
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