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Mark J. Jameson, MD, PhD; Lucy Hynds Karnell, PhD; Alan J. Christensen, PhD; Gerry F. Funk, MD

Arch Otolaryngol Head Neck Surg. 2008;134(9):958-964.

Objective  To demonstrate that first-year trends in a self-reported subjective general health assessment tool can provide prognostic information and help predict long-term survival in patients with head and neck cancer.

Design  Prospective observational cohort study.

Setting  Tertiary care center.

Patients  Four hundred three patients with head and neck cancer who were enrolled in a longitudinal outcomes project between January 1, 1995, and December 31, 2005.

Intervention  Self-reported general physical health assessments were collected using the Medical Outcomes Study 36-Item Short-Form Health Survey at diagnosis (pretreatment) and at 3, 6, 9, and 12 months after diagnosis.

Main Outcome Measures  Actuarial 5-year observed (all deaths) and disease-specific (death with cancer present) survival.

Results  Mean physical component summary (PCS) scores decreased at 3 months in all patient groups. While patients who died within the second or third year exhibited virtually no recovery, those who died within the fourth or fifth year exhibited some recovery, and those who survived 5 years or longer approached baseline PCS scores by 12 months. Shorter survival correlated with a greater net decrease in PCS score at 12 months. Groups based on pretreatment and 12-month PCS scores had significantly different survival curves. The net change in PCS score at 12 months (PCS) was a predictor of both observed and disease-specific survival at univariate analysis and an independent predictor of disease-specific survival in multivariate analysis.

Conclusion  First-year trends in the 36-Item Short-Form Health Survey PCS score, a self-reported subjective measure of general physical health, are predictive of long-term survival.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, University of Iowa College of Medicine (Drs Jameson, Karnell, and Funk); Department of Psychology, University of Iowa (Dr Christensen); and Center for Research in the Implementation of Innovative Strategies in Practice, Department of Veterans Affairs Iowa City Health Care System (Dr Christensen), Iowa City, Iowa. Dr Jameson is now with the Department of Otolaryngology–Head and Neck Surgery, University of Virginia Health System, Charlottesville.

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