Performance data and survival in head and neck cancer

Comorbidity and performance status as independent prognostic factors in patients with head and neck squamous cell carcinoma

BACKGROUND

The purpose of this study was to evaluate the individual and combined relationship of comorbidity and performance status (PS) on head and neck squamous cell carcinoma (HNSCC) survival.

METHODS

Six hundred patients with HNSCC were prospectively recruited. Comorbidity and PS were measured using the Charlson Comorbidity Index (CCI) and the Eastern Cooperative Oncology Group (ECOG) Scale. Outcomes were overall survival (OS) and cancer-specific survival (CSS).

RESULTS

A total of 48.3% of the patients had at least 1 comorbidity, and 42.3% had impaired PS at baseline. There was no correlation between CCI and ECOG (Spearman's ρ = 0.033; p = .42). In multivariate analysis, CCI score was significantly associated with OS (p = .01). ECOG was not associated with OS, but seems to act as an effect modifier in the association between comorbidity and OS. CCI and ECOG were not associated with CSS.

CONCLUSION

CCI and ECOG scores both provide prognostic information in predicting OS in HNSCC, but a significant association with CSS was not observed.

Pretreatment health behaviors predict survival among patients with head and neck squamous cell carcinoma

PURPOSE

Our prior work has shown that the health behaviors of head and neck cancer patients are interrelated and are associated with quality of life; however, other than smoking, the relationship between health behaviors and survival is unclear.

PATIENTS AND METHODS

A prospective cohort study was conducted to determine the relationship between five pretreatment health behaviors (smoking, alcohol, diet, physical activity, and sleep) and all-cause survival among 504 head and neck cancer patients.

RESULTS

Smoking status was the strongest predictor of survival, with both current smokers (hazard ratio [HR] = 2.4; 95% CI, 1.3 to 4.4) and former smokers (HR = 2.0; 95% CI, 1.2 to 3.5) showing significant associations with poor survival. Problem drinking was associated with survival in the univariate analysis (HR = 1.4; 95% CI, 1.0 to 2.0) but lost significance when controlling for other factors. Low fruit intake was negatively associated with survival in the univariate analysis only (HR = 1.6; 95% CI, 1.1 to 2.1), whereas vegetable intake was not significant in either univariate or multivariate analyses. Although physical activity was associated with survival in the univariate analysis (HR = 0.95; 95% CI, 0.93 to 0.97), it was not significant in the multivariate model. Sleep was not significantly associated with survival in either univariate or multivariate analysis. Control variables that were also independently associated with survival in the multivariate analysis were age, education, tumor site, cancer stage, and surgical treatment.

CONCLUSION

Variation in selected pretreatment health behaviors (eg, smoking, fruit intake, and physical activity) in this population is associated with variation in survival.

WHOQOL-BREF as predictors of mortality: A two-year follow-up study at veteran homes

The main purpose of this study was to evaluate the effectiveness of the brief version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire as a predictor of mortality amongst the elderly. A total of 689 male residents of veteran homes, all above the age of 65 years, were randomly selected in 2001. The Taiwan version of the WHOQOL-BREF was administered as the baseline, with each of these subjects being interviewed and subsequently followed up for mortality until the end of 2003. Data on self-reported global health, life satisfaction, medical status, physical performance and health behavior was also collected. Following the death of 105 of the 689 subjects during the 2-year follow-up period, the relative risk (RR) of death was subsequently assessed using Cox's proportional hazard regression analyses. After adjusting for other predictors (age group, chronic diseases, emergency visits, hospitalization, physical performance, regular exercise, self-reported global health and life satisfaction), almost all of the WHOQOL-BREF items and domains failed to predict mortality; the one exception was working capacity levels (score 1-2 vs. score 4-5) which, after adjusting for other predictors, did demonstrate the ability to predict mortality (RR = 1.96, p < 0.05).

Health-related quality of life and health utility for the institutional elderly in Taiwan

OBJECTIVE

To explore the health-related quality of life (HRQOL) and health utility in an institutional elderly population.

METHODS

Four hundred sixty-five elderly persons living in long-term care institutions in Taiwan were interviewed using Taiwan's abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF), rating scale (RS) and the Time-Trade-Off (TTO) utility measurement.

RESULTS

The WHOQOL-BREF showed acceptable internal consistency (alpha range: 0.75-0.80 across domains) and validity. The sexual activity facet had the lowest response rate. Educational level, number of chronic diseases, physical performance, and number of caregivers had significant (p < 0.05) impacts on the domain scores of the WHOQOL-BREF. Physical performance had the strongest impact on the physical domain (R2 = 0.40) and accounted for significant percentages of the variance on the other three domains (R2 = 0.06-0.13). The mean RS score (score 0-100) was 61.3 +/- 16.2 (mean +/- SD). The mean TTO utility (score 0-1) was 0.92 +/- 0.22.

CONCLUSIONS

Results indicate that the WHOQOL-BREF, excepting the sexual activity item, is useful for evaluating HRQOL of conscious elderly in institutions. The validity of TTO utility for studying the institutionalized elderly needs further evaluation.

The relation between health-related quality of life, past medical history, and American Society of Anesthesiologists’ ASA grade in patients having primary operations for oral and oropharyngeal cancer

Pre-existing medical problems have the potential to affect postoperative survival, complications, and health-related quality of life (QoL). Our aim was to explore the relation between past medical history, American Society of Anesthesiologists' (ASA) score, health-related QoL, and survival. We collected data from 278 consecutive patients with previously untreated oral and oropharyngeal squamous cell carcinoma operated on primarily from 1995 to 1999 inclusive. Past medical history was recorded from the case notes, ASA grade from the anaesthetic record, and QoL was measured using the University of Washington Quality of Life Questionnaire (UW-QoL). Responses to questionnaires were received from (71%) at baseline (63%) at 6 months (73%) at 1 year, and (65%) 18 months or longer. Past medical history was associated with lower ASA scores. At baseline both history and ASA scores were related to the UW-QoL. Longitudinally patients in ASA grade 1 or with no past history scored better in these UW-QoL domains. Past history did not predict survival (P = 0.83), nor did the UW-QoL composite score (P = 0.30), whilst ASA was associated with crude survival (P = 0.003) and disease-specific survival (P = 0.03). When analyses were stratified for adjuvant radiotherapy, type of operation, size of tumour, and age then the relation to ASA was maintained and trends in the past history and UW-QoL remained not significant. ASA, which is often recorded as part of preoperative assessment, reflects both survival and health-related QoL, and is more useful than past history alone for predicting outcome.