Purpose: This study characterizes longitudinal changes in health-related quality of life (HRQoL) following radiotherapy in patients with head and neck cancer (HNC) and quantifies associated toxicity burden to inform future health technology assessments (HTA).Materials and Methods: HNC patients receiving definitive, postoperative radiotherapy, or chemoradiation at the University Medical Center Groningen from March 2007 to September 2022 were included.Health status and utility were assessed using EQ-5D-3L and EQ-VAS, while patient-reported HRQoL and symptom burden were evaluated with EORTC QLQ-C30 and QLQ-H&N35.Toxicities were rated by physicians using CTCAE v4.0 and the UMCG dysphagia scale.Assessments were conducted before radiotherapy, at 12 weeks, and 6, 12, 18, 24, 30, 36, 48, and 60 months post-treatment.Generalized Estimating Equations (GEE) analyzed health utility values.Results: Among 1,851 patients, HRQoL declined during radiotherapy and partially recovered within the first year, remaining stable up to 60 months.Model-estimated EQ-5D utility decreased during treatment and recovered to above baseline levels by 12 months.Dry mouth and sticky saliva persisted at long-term follow-up.In multivariable GEE models, CTCAE Grade 3 xerostomia and dysphagia were associated with utility decrements of -0.051 and -0.062, respectively, while grade 3 pharyngolaryngeal pain showed the largest reduction (-0.106).Increasing physicianrated toxicity severity was consistently associated with greater disutility. Conclusion:Xerostomia, pharyngolaryngeal pain, oral pain, , and dysphagia significantly impacted EQ-5D-derived utility values.Disutility increased with higher CTCAE-rated toxicities.Symptoms persisted for up to five years post-treatment.These findings can inform QALY-based health economic evaluations and suggest interventions targeting key toxicities to improve patient HRQoL.
Larrotta-Castillo et al. (2026) studied this question.