Quality of life of cancer patients

Introduction
A history of research during the past decades has shown that cancer and cancer treatment have a large impact on the quality of life (QoL) of cancer patients. Much less is known about the prognostic factors associated with QoL or the consequences of changes in QoL such as the need for supportive care, and public health consequences, for the well-being of patients as well as their informal caregivers. Furthermore, QoL seems significantly associated with survival in cancer patients, independently from known predictors as sociodemographic and clinical parameters, including age, functional status, histological grading, disease stage, and treatment modality.
1) To describe the long-term course of QoL in newly-diagnosed cancer patients.
2) To prospectively examine patients’ and caregivers’ need for supportive care and the association with the long-term course of QoL.
3) To investigate the association between QoL and survival in cancer patients, in relation to some moderating factors as sociodemographic and cancer-related determinants.

Results
The relation between health related quality of life (HRQOL) and survival was investigated at baseline and 6 months in 80 patients with advanced oral or oropharyngeal cancer after microvascular reconstructive surgery and adjuvant radiotherapy. Multivariate Cox regression analyses of overall and disease specific survival were performed including sociodemographic (age, gender, marital status, comorbidity), and clinical (tumour stage and site, radical surgical, metastasis, radiotherapy) parameters, and QOL (EORTC QLQ-C30 global quality of life scale).
Before treatment, younger age and having a partner were predictors of disease specific survival; younger age predicted overall survival. At 6 months post treatment, disease specific and overall survival was predicted by (deterioration of) global quality of life solely. It can be concluded that deterioration of global quality of life after treatment is an independent predictor of survival in patients with advanced oral or oropharyngeal cancer. Currently, this association is being analysed in a cohort of 60 patients treated for advanced laryngeal or hypopharyngeal cancer.

Of the 80 advanced oral or oropharyngeal cancer patients treated with free-flap reconstruction and postoperative radiotherapy, 27 patients were long-term survivors (mean 9.2 years, range 8-11 years). The HRQOL of 26 patients (response rate 96%) was assessed with the EORTC QLQ-C30 and QLQ-H&N35 questionnaires at 4 points in time: pretreatment (baseline), and at 6 months, 12 months (short term) and 8-11 years (long-term) follow-up. A study-specific questionnaire was developed to evaluate the need for and use of supportive care (allied health services, peer support, psychosocial care, and complementary care). A number of QOL domains worsened significantly (p<0.05) over the long-term: global quality of life, social functioning, swallowing, speech, coughing, feeling ill, problems with teeth, opening mouth, dry mouth, sexuality, and constipation. At long-term follow-up, the need for supportive care was limited to a dental hygienist (46%) and a physical therapist (23%).
Currently, data on the need for supportive care in the first year after treatment are being analysed in a group of patients and their spouses.

Funding:
VU University Medical Center (VUmc) / dpt. Otolaryngology-Head&Neck Surgery

Staff
PhD student
I.M. Oskam, MD, Otolaryngologist, dpt. Otolaryngology-Head&Neck Surgery, VUmc.
Project leaders
Prof I.M. Verdonck-de Leeuw, PhD, Psychologist, Speech & Language Therapist, Linguist, dpt. Otolaryngology-Head&Neck Surgery, VUmc.
Prof C.R. Leemans, PhD MD, Otolaryngologist / Head & Neck Surgeon, dpt. Otolaryngology-Head&Neck Surgery, VUmc.
Project members
Prof N.K. Aaronson, PhD, Psychosocial Oncologist, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute.
Prof J.A. Langendijk, PhD MD, Radiation Oncologist, dpt. of Radiotherapy, University Medical Center Groningen (UMCG).
Prof R. de Bree, PhD MD, Otolaryngologist / Head & Neck Surgeon, dpt. Otolaryngology-Head&Neck Surgery, VUmc.
P. Doornaert, MD Radiation Oncologist, dpt. Radiotherapy, VUmc
B. Witte, PhD, Epidemiologist, dpt. of Clinical Epidemiology and Biostatistics, VUmc

Questions?
For questions, please contact:
Inge Oskam, MD, Otolaryngologist
E-mail: im.oskam@hotmail.com