Posttreatment Quality-of-Life Assessment in Patients With Head and Neck Cancer Treated With Intensity-modulated Radiation Therapy

OBJECTIVES: To evaluate patient-reported quality-of-life (QOL) domains in patients with head and neck cancer (HNC) treated with intensity-modulated radiotherapy (IMRT); specifically time-based QOL changes compared with baseline and correlation with independent variables. METHODS: Between January 2002 and August 2006, we prospectively administered the University of Washington Quality of Life-Revised assessment to 143 patients with primary HNC treated with IMRT to investigate the impact of treatment on 12 QOL domains. We analyzed 108 patients with more than 6 months follow-up for correlation between QOL domains and independent variables. RESULTS: Patients were divided into 2 groups based on mean parotid gland dose with a 26-Gy threshold. We saw in general, an acute drop in all scores after starting treatment regardless of the degree of parotid sparing. If the parotid received a mean dose ≥26 Gy, then the acute decrease was larger than if the parotid received less than 26 Gy. Higher radiation dose to the parotid resulted in significantly lower QOL scores over 9 months (pain) and often more than 2 years (chewing and taste). No significance was found between the domains and the independent variables assessed. CONCLUSIONS: Patients with HNC treated with IMRT experienced an acute decrement in QOL across many domains despite parotid sparing. Lower radiation doses to the parotid corresponded to a smaller decrease in QOL and an earlier return to baseline compared with higher doses. Self-reported QOL and functional outcomes are important determinants of patient satisfaction and should be evaluated in future studies.