Health-Related Quality of Life Scores in long-term head and neck cancer survivors predict subsequent survival: a prospective cohort study

OBJECTIVE: To examine the survival prediction of long-term health-related quality of life in patients with head and neck squamous cell carcinoma. DESIGN: Patients with head and neck squamous cell carcinoma diagnosed in the period between July 1992 and October 2001, who had been disease free for a minimum of 1 year following therapy, responded to structured interviews including several validated questionnaires in the period from October 2002 to March 2004. The study ended in June 2009 with a mean observation time of 75 ± 4 months among the survivors. Twenty-four deaths were observed. SETTING: University hospital, referral centre of the Western Norway. PARTICIPANTS: One hundred and thirty-nine cognitive functioning patients. MAIN OUTCOME MEASUREMENTS: Overall survival as of June 2009. This was correlated with various clinical factors and the EORTC QLQ-C30 questionnaire, the Eysenck Personality Inventory and the Coping inventory completed between October 2001 and March 2004. RESULTS: A general symptom sum score was significantly predictive of survival directly and after sequential adjustment for self-reported levels of neuroticism, avoidance focused coping, coping by suppression of competing activity, alcohol consumption, smoking status and heart/lung disease, as well as gender, age, time between diagnosis and inclusion, tumour node metastasis (TNM) stage and tumour site. Similar results were found for the health-related quality of life indices 'fatigue', 'dyspnoea' and 'sleep disturbance'. A dichotomised variable based on the general symptom sum score was calculated, and a high risk group, as to mortality, including less than a quintile of the total patient population was established. A hazard ratio of 5.15 was found for the dichotomised general symptom sum score. CONCLUSION: We have shown a unique and independent survival prediction from long-term EORTC QLQ-C30 scores in successfully treated and cognitive functioning head and neck squamous cell carcinoma patients.