The relationship between length of stay and health-related quality of life in patients treated by primary surgery for oral and oropharyngeal cancer

Length of Stay Prediction Models for Oral Cancer Surgery: Machine Learning, Statistical and ACS-NSQIP

OBJECTIVE

Accurate prediction of hospital length of stay (LOS) following surgical management of oral cavity cancer (OCC) may be associated with improved patient counseling, hospital resource utilization and cost. The objective of this study was to compare the performance of statistical models, a machine learning (ML) model, and The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) calculator in predicting LOS following surgery for OCC.

MATERIALS AND METHODS

A retrospective multicenter database study was performed at two major academic head and neck cancer centers. Patients with OCC who underwent major free flap reconstructive surgery between January 2008 and June 2019 surgery were selected. Data were pooled and split into training and validation datasets. Statistical and ML models were developed, and performance was evaluated by comparing predicted and actual LOS using correlation coefficient values and percent accuracy.

RESULTS

Totally 837 patients were selected with mean patient age being 62.5 ± 11.7 [SD] years and 67% being male. The ML model demonstrated the best accuracy (validation correlation 0.48, 4-day accuracy 70%), compared with the statistical models: multivariate analysis (0.45, 67%) and least absolute shrinkage and selection operator (0.42, 70%). All were superior to the ACS-NSQIP calculator's performance (0.23, 59%).

CONCLUSION

We developed statistical and ML models that predicted LOS following major free flap reconstructive surgery for OCC. Our models demonstrated superior predictive performance to the ACS-NSQIP calculator. The ML model identified several novel predictors of LOS. These models must be validated in other institutions before being used in clinical practice.

LEVEL OF EVIDENCE

Level 3 Laryngoscope, 2024.

Nutritional status and post-operative complications in patients undergoing surgery for advanced pharyngeal or laryngeal cancer

PURPOSE

Malnutrition is an important prognostic indicator of post-operative outcomes in patients undergoing surgery for head and neck cancer, however, limited studies utilize validated nutrition assessment tools to accurately assess risk. The aim of this study was to determine the relationship between nutritional status on post-operative complications and length of stay for patients undergoing either a laryngectomy, pharyngectomy or pharyngolaryngectomy for head and neck cancer.

METHODS

Patients with head and neck cancer undergoing a laryngectomy, pharyngectomy or pharyngolaryngectomy at a tertiary hospital in Australia were eligible for this retrospective cohort study (n = 40). Nutritional status was assessed by the dietitian on admission using the validated Subjective Global Assessment tool. Clinical outcomes were collected via retrospective chart review and included length of stay and post-operative complications.

RESULTS

Pre-operative malnutrition incidence was 40%. Malnourished patients had higher incidences of any type of complication (57% vs 44%, p = 0.013) and pressure injury (86% vs 14%, p = 0.011) compared to well-nourished patients. Well-nourished patients had a clinically important shorter median length of stay compared to malnourished patients (17.5 vs 20 days).

CONCLUSION

Early identification and management of malnutrition is essential to minimize risk of post-operative complications and reduce length of stay and should be considered a key component of prehabilitation programs.

Quality of life of dental patients treated with laser surgery: A scoping review

Background and Aims

The use of lasers has been increasing in various surgical procedures. Its specific characteristics have conquered the scalpel used to a major extent in certain surgical procedures. This scoping review aimed to assess the empirical evidence that exists on the quality of life (QoL) of dental patients treated with laser surgery.

Methods

This scoping review was conducted in accordance with the Arksey and O'Malley's guidelines for scoping reviews. Four electronic databases (PubMed, SCOPUS, CINAHL Complete, and APA PsycInfo) were systematically searched through a stepwise approach, informed by the PEO (Population [P], Exposure [E], and Outcome [O]) framework, to retrieve literatures relevant to the review question. After a two-staged and Rayyan-aided screening process, only those literatures meeting the inclusion criteria were included into the review. From the included literatures, data were extracted, collated, summarized, and presented.

Results

The literature search retrieved 246 articles, of which only 10 articles were selected according to the inclusion criteria. Five of the studies were from the United Kingdom and three were from Italy. Study designs were either cohort (60%) or randomized controlled trials (40%). A vast variation was observed in the study populations. The used QoL instruments were mostly disease/condition-specific and oral cancer was the most reported disease in the included articles. The patients who underwent laser surgery had better QoL on the 7th day postoperatively, although it was not significant in later days.

Conclusion

Depending on the indication, Laser is a safe surgical approach that could enhance the clinical outcome as well as the QoL of dental patients. Laser effects were more significant in the domain of postoperative pain. Due to the limited number of studies evaluated in this review, further longitudinal studies are needed to corroborate the findings of this review.

Survival outcomes for head and neck patients with Medicaid: A health insurance paradox

PURPOSE

Privately insured patients with head and neck cancer (HNC) typically have better outcomes; however, differential outcome among Medicaid versus the uninsured is unclear. We aimed to describe outcome disparities among HNC patients uninsured versus on Medicaid.

METHODS

A cohort of 18-64-year-old adults (n = 57 920) with index HNC from the Surveillance, Epidemiology, and End Results 18 database (2007-2015) was analyzed using Fine and Gray multivariable competing risks proportional hazards models for HNC-specific mortality.

RESULTS

Medicaid (sdHR = 1.65, 95% CI 1.58, 1.72) and uninsured patients (sdHR = 1.55, 95% CI 1.46, 1.65) had significantly greater mortality hazard than non-Medicaid patients. Medicaid patients had increased HNC mortality hazard than those uninsured.

CONCLUSION

Compared with those uninsured, HNC patients on Medicaid did not have superior survival, suggesting that there may be underlying mechanisms/factors inherent in this patient population that could undermine access to care benefits from being on Medicaid.

Multilevel Associations Between Patient- and Hospital-Level Factors and In-Hospital Mortality Among Hospitalized Patients With Head and Neck Cancer

Importance

Risk factors for in-hospital mortality of patients with head and neck cancer (HNC) are multilevel. Studies have examined the effect of patient-level characteristics on in-hospital mortality; however, there is a paucity of data on multilevel correlates of in-hospital mortality.

Objective

To examine the multilevel associations of patient- and hospital-level factors with in-hospital mortality and develop a nomogram to predict the risk of in-hospital mortality among patients diagnosed with HNC.

Design, Setting, and Participants

This cross-sectional study used the 2008-2013 National Inpatient Sample database. Hospitalized patients 18 years and older diagnosed (both primary and secondary diagnosis) as having HNC using the International Classification of Diseases, Ninth Revision, Clinical Modification codes were included. Analysis began December 2018.

Main Outcomes and Measures

The primary outcome of interest was in-hospital mortality. A weighted multivariable hierarchical logistic regression model estimated patient- and hospital-level factors associated with in-hospital mortality. Moreover, a multivariable logistic regression analysis was used to build an in-hospital mortality prediction model, presented as a nomogram.

Results

A total of 85 440 patients (mean [SD] age, 62.2 [13.5] years; 61 281 men [71.1%]) were identified, and 4.2% (n = 3610) died in the hospital. Patient-level risk factors associated with higher odds of in-hospital mortality included age (adjusted odds ratio [aOR], 1.03 per 1-year increase; 95% CI, 1.02-1.03), male sex (aOR, 1.23; 95% CI, 1.12-1.35), higher number of comorbidities (aOR, 1.14; 95% CI, 1.11-1.17), having a metastatic cancer (aOR, 1.49; 95% CI, 1.36- 1.64), having a nonelective admission (aOR, 3.26; 95% CI, 2.83-3.75), and being admitted to the hospital on a weekend (aOR, 1.30; 95% CI, 1.16-1.45). Of the hospital-level factors, admission to a nonteaching hospital (aOR, 1.48; 95% CI, 1.24-1.77) was associated with higher odds of in-hospital mortality. The nomogram showed fair in-hospital mortality discrimination (area under the curve of 72%).

Conclusions and Relevance

This cross-sectional study found that both patient- and hospital-level factors were associated with in-hospital mortality, and the nomogram estimated with fair accuracy the probability of in-hospital death among patients with HNC. These multilevel factors are critical indicators of survivorship and should thus be considered when planning programs or interventions aimed to improve survival among this unique population.

Health-Related Quality of Life Measured by EQ-5D in Relation to Hospital Stay and Readmission in Elderly Patients Hospitalized for Acute Illness

We evaluated the predictability of self-reported Health-related quality of life (HRQoL) assessed by the 3-level 5-dimensional Euro-Quality of Life tool (EQ-5D-3L) and the EQ-Visual Analog Scale (EQ-VAS) on clinical outcomes of elderly patients who were admitted to an acute geriatric ward. A total of 102 participants (56.9% men) with a median age of 81.0 years (interquartile range or IQR: 76.0–85.3 years) were studied. The age-adjusted Charlson comorbidity index was 5.0 (IQR: 4.0–6.0) with a median length of stay (LOS) of 9.0 days (IQR: 7.0–15.0 days). No death occurred during hospitalization, and within 30 days after discharge, 15 patients were readmitted. During hospitalization, the EQ-5D-3L index was 0.440 at admission and that improved to 0.648 at discharge (p < 0.001). EQ-VAS scores also improved similarly from 60 to 70 (p < 0.001). Physical, cognitive function, frailty parameters (hand grip strength and walking speed), and nutritional status at admission all improved significantly during hospitalization and were related to EQ-5D-3L index or EQ-VAS scores at discharge. After controlling for relevant factors, EQ-5D-3L index at admission was found to be associated with LOS. In addition, EQ-VAS was marginally related to readmission. HRQoL assessment during hospitalization could be useful to guide clinical practice and to improve outcome.

Factors Associated With Head and Neck Cancer Hospitalization Cost and Length of Stay-A National Study

OBJECTIVES

The aim of the study was to estimate hospitalization cost, and factors associated with hospitalization costs and length of stay (LOS) of patients treated for head and neck cancer in the United States.

METHODS

Data on 71,440 weighted hospital admissions from the 2014 National Inpatient Sample with a diagnosis of head and neck cancer were examined. Multivariable linear regression models estimated factors associated with hospitalization costs, and negative binomial regression models were used to identify factors associated with hospital LOS. Factor variables included characteristics of the patient, clinical, and hospital characteristics.

RESULTS

The average hospitalization cost was US $18,371 and the average LOS was 6.6 days. LOS was significantly associated with admissions involving bacterial infection, major operating procedures, chemo procedure, and radiation procedure as well as admissions at medium or small bed size hospitals, and rural hospitals. Admissions among black patients, elective admissions, admissions involving bacterial infection, major operating procedures, chemo procedure, radiation procedure, and advance comorbidities were associated with increased hospitalization costs. In contrast, admissions at urban nonteaching or rural had increased hospitalization costs.

CONCLUSIONS

Admissions that involve higher number of comorbidities, metastasis, bacterial infection, radiation, and chemo procedures had longer hospital stay and higher cost whereas admissions are rural hospitals had shorter hospital stay and lower cost. Understanding these factors associated with increased LOS and hospitalization cost will help efforts to decrease health care cost and improve quality of care.

Validity of the American College of Surgeons' National Surgical Quality Improvement Program risk calculator in South Australian glossectomy patients

Background:

Appropriate selection of tongue cancer patients considering surgery is critical in ensuring optimal outcomes. The American College of Surgeons' National Surgical Quality Improvement Program (‘ACS-NSQIP’) risk calculator was developed to assess patients' 30-day post-operative risk, providing surgeons with information to guide decision making.

Method:

A retrospective review of 30-day actual mortality and morbidity of tongue cancer patients was undertaken to investigate the validity of this tool for South Australian patients treated from 2005 to 2015.

Results:

One hundred and twenty patients had undergone glossectomy. Predicted length of stay using the risk calculator was significantly different from actual length of stay. Predicted mortality and other complications were found to be similar to actual outcomes.

Conclusion:

The American College of Surgeons' National Surgical Quality Improvement Program risk calculator was found to be effective in predicting post-operative complication rates in South Australian tongue cancer patients. However, significant discrepancies in predicted and actual length of stay may limit its use in this population.

Quantitative tool to evaluate the somatic burden due to chemotherapy-induced adverse events: the somatic burden score

PURPOSE

Although there are several established methods like the Common Terminology Criteria for Adverse Events (CTCAE), heretofore, no objective, quantitative measurement exists for the somatic burden due to chemotherapy-induced adverse events (SB-CHINAE). We developed the Somatic Burden Score (SBS-AE) that combines the severity grade and duration of an AE. This paper describes the development and validation of the SBS-AE.

METHODS

SBS-AE's calculation was based on the number of days of CTCAE grades of a particular AE. The target value was the weighted, relative duration of an AE grade using CTCAE v3.0. We applied the SBS-AE in 64 patients with hematological malignancies and high-dose chemotherapy (HDC). The ratio measurement scale of the SBS-AE allows all statistical measures using SBS-AE, as all necessary mathematical operations are defined for it. We calculated an overall-SBS-HDC, defined as the total SB-CHINAE of HDC. To determine SBS-AE's criterion and construct validity, three self-rating scales and one clinician rating scale were used (German Clinical Trials Register, Main ID: DRKS00003453).

RESULTS

The SBS-AE's criterion validity could be verified both with statistical significance and at least medium-to-large effects (p < 0.05, Cohen's d > 0.79, f (2) > 0.18). The quantitative measured SB-CHINAE was equally associated with subjectively assessed physical health-related quality of life (0.15 ≤ R (2) ≤ 0.49), objectively evaluated toxicities (0.48 ≤ R (2) ≤ 0.67), transfusion-dependent thrombocytopenia, and anemia (Cohen's d > 0.89). Patients' somatic burden of HDC was 5.8-fold greater compared with standard chemotherapy regimens.

CONCLUSIONS

The SBS-AE indicates psychometric and clinical properties and may prove useful in the future design of cancer clinical trials and supportive care interventions inside of the inpatient setting.

Existence of benefit finding and posttraumatic growth in people treated for head and neck cancer: a systematic review

Background. The impact of head and neck cancer (HNC) in long-term survivors differs widely among individuals, and a significant number of them suffer from the negative effects of disease, whereas others report significant positive effect. This systematic review investigated the evidence the implications of treatment for HNC and subsequent development of Benefit Finding (BF) or Posttraumatic Growth (PTG). Purpose. To understand how differing medical, psychological and social characteristics of HNC may lead to BF/PTG and subsequently inform post-treatment interventions to encourage positive outcomes. Method. In February 2012, five databases including Pubmed, and Psych Info, were searched, for peer-reviewed English-language publications. Search strings included key words pertaining to HNC, BF, and PTG. One thousand three hundred and sixty three publications were identified, reviewed, and reduced following Cochrane guidelines and inclusion/exclusion criteria specified by a group of maxillofacial consultants and psychologists. Publications were then quality assessed using the CASP Cohort Critical Appraisal tool. Findings. Five manuscripts met the search and selection criteria, and were sourced for review. All studies were identified as being level IIb evidence which is a medium level of quality. The majority of studies investigated benefit finding (80%) and were split between recruiting participant via cancer clinics and postal survey. They focused on the medical, psychological and social characteristics of the patient following completion of treatment for HNC. Conclusion. Demographic factors across the papers showed similar patterns of relationships across BF and PTG; that higher education/qualification and cohabitation/marriage are associated with increased BF/PTG. Similarly, overlap with disease characteristics and psychosocial factors where hope and optimism were both positively correlated with increased reported BF/PTG.

A structured review of journal articles reporting outcomes using the University of Washington Quality of Life Scale

The University of Washington Quality of Life Scale (UW-QoL) is one of the most frequently reported health-related quality of life (HR-QoL) questionnaires in head and neck cancer, and since its first publication in 1993 has been used in many different cohorts. There is a considerable amount of information to assimilate and, to date, we know of no attempt that has been made to summarise publications specific to its use in a peer review journal. The aim of this review was to systematically search published papers that report its use, identify common themes, and present a tabulated summary. Several search engines were used (PubMed, Medline, Medical-Journals.com, eMedicine), and 222 abstracts were found and hand searched. A total of 66 papers were eligible for inclusion, 21 on functional outcome, 25 on predictors of HR-QoL, 19 on development or validation of the questionnaire, and one clinical trial. The review includes a diversity of studies and a range of HR-QoL outcomes following head and neck cancer. It provides clinicians and their colleagues in multidisciplinary teams with a source of quick reference to relevant papers reporting the UW-QoL, and gives a short summary of the pertinent conclusions drawn from each paper.

Pretreatment malnutrition and quality of life - association with prolonged length of hospital stay among patients with gynecological cancer: a cohort study

Background

Length of hospital stay (LOS) is a surrogate marker for patients' well-being during hospital treatment and is associated with health care costs. Identifying pretreatment factors associated with LOS in surgical patients may enable early intervention in order to reduce postoperative LOS.

Methods

This cohort study enrolled 157 patients with suspected or proven gynecological cancer at a tertiary cancer centre (2004-2006). Before commencing treatment, the scored Patient Generated - Subjective Global Assessment (PG-SGA) measuring nutritional status and the Functional Assessment of Cancer Therapy-General (FACT-G) scale measuring quality of life (QOL) were completed. Clinical and demographic patient characteristics were prospectively obtained. Patients were grouped into those with prolonged LOS if their hospital stay was greater than the median LOS and those with average or below average LOS.

Results

Patients' mean age was 58 years (SD 14 years). Preoperatively, 81 (52%) patients presented with suspected benign disease/pelvic mass, 23 (15%) with suspected advanced ovarian cancer, 36 (23%) patients with suspected endometrial and 17 (11%) with cervical cancer, respectively. In univariate models prolonged LOS was associated with low serum albumin or hemoglobin, malnutrition (PG-SGA score and PG-SGA group B or C), low pretreatment FACT-G score, and suspected diagnosis of cancer. In multivariable models, PG-SGA group B or C, FACT-G score and suspected diagnosis of advanced ovarian cancer independently predicted LOS.

Conclusions

Malnutrition, low quality of life scores and being diagnosed with advanced ovarian cancer are the major determinants of prolonged LOS amongst gynecological cancer patients. Interventions addressing malnutrition and poor QOL may decrease LOS in gynecological cancer patients.

Predictors of prolonged length of stay after major elective head and neck surgery

OBJECTIVE/HYPOTHESIS

Longer length of stay (LOS) after elective surgery is associated with an increased use of health care resources and higher costs. The objectives of this study were to determine the perioperative factors that predict a prolonged LOS after elective major head and neck operations and to test the hypothesis that factors related to process of care (intra- and postoperative) independently predict prolonged LOS after adjustment for preoperative patient characteristics.

STUDY DESIGN

Prospective hospital-based cohort study.

METHODS

The National VA Surgical Quality Improvement Program data were accessed for seven head and neck operations: radical neck dissection (RND) (n = 398), modified RND (n = 891), total laryngectomy (n = 431), total laryngectomy with RND (n = 747), hemiglossectomy with unilateral RND (n = 201), composite resection (n = 105), and composite resection with RND (n = 312). Prolonged LOS was defined as exceeding the 75th percentile for the LOS distribution of each operation. Multivariable logistic regression analysis was performed to identify factors that predicted prolonged LOS.

RESULTS

Sixty-eight variables were analyzed among 3,050 patients who qualified for inclusion. Preoperative patient characteristics that predicted prolonged LOS were older age, poorer functional status, consumption of more than two drinks of alcohol per day, history of chronic obstructive pulmonary disease, and diabetes mellitus. Intraoperative processes that predicted prolonged LOS were a longer operative time and transfusion of erythrocytes. The postoperative variables that predicted a prolonged LOS were a return to the operating room within 30 days of the index operation and the occurrence of two or more operative complications.

CONCLUSION

Several intraoperative processes and postoperative adverse events contributed additional predictive information for prolonged LOS, after consideration of preoperative patient characteristics.

A structured review and theme analysis of papers published on ‘quality of life’ in head and neck cancer: 2000–2005

Over the past 10 years, quality of life (QOL) has been increasingly recognised as an important outcome parameter in head and neck cancer. Validated questionnaires have emerged and there has been an increase in the number of papers published each year. The aim of this article is to review the literature over the past five years (2000-2005 inclusive), to identify papers reporting outcomes using patient self-competed questionnaires and group these into themes. The tabulated summary allows for the areas of health related quality of life research to be identified and to explore issues that are perhaps deficit in the literature. The three authors independently searched the literature published in the English language using the ISI search engine with cross-reference using Pub Med and Ovid. The search terms were; quality of life, questionnaire, and head and neck cancer. Studies were placed in to one of five themes. There were 165 studies identified. The numbers in each theme were predictors of QOL [Hassanein KA, Musgrove BT, Bradbury E. Functional status of patients with oral cancer and its relation to style of coping, social support and psychological status. Br J Oral Maxillofac Surg 2001;39:340-5.], functional outcome [Klug C, Neuburg J, Glaser C, Schwarz B, Kermer C, Millesi W. Quality of life 2-10 years after combined treatment for advanced oral and oropharyngeal cancer. Int J Oral Maxillofac Surg 2002;31:664-9.], questionnaire development [Hanna E, Sherman A, Cash D, Adams D, Vural E, Fan CY, et al. Quality of life for patients following total laryngectomy vs chemoradiation for laryngeal preservation. Arch Otolaryngol Head Neck Surg 2004;130:875-9.], randomised clinical trials [Kanatas AN, Rogers SN. A national survey of health-related quality of life questionnaires in head and neck oncology. Ann R Coll Surg Engl 2004;86:6-10.], and reviews [Kanatas AN, Rogers SN. A national survey of health-related quality of life questionnaires in head and neck oncology. Ann R Coll Surg Engl 2004;86:6-10.]. Although many facets of HRQOL following head and neck cancer have been explored over the last five years the paper identifies issues where research is still lacking.

Health-Related Quality of Life in Oral Cancer: A Review

PURPOSE

Health-related quality of life (HRQOL) has now become an important outcome measure in the assessment of patients treated for oral cancer. We summarize the influence of various factors in the treatment of oral cancer on HRQOL after surgery.

METHODS

A review of the current literature was carried out.

RESULTS

Site-specific assessment of HRQOL should be encouraged, rather than assessment of head and neck cancer as a whole. In general the long-term HRQOL of oral cancer patients seems good with HRQOL at 1 year being equivalent to long-term HRQOL. A number of different patient and treatment factors were identified that affect HRQOL. These include age, gender, site, stage, emotional status, smoking and alcohol, marital status and income, performance status, method of reconstruction, access, mandibular resection, neck dissection, percutaneous endoscopic gastrostomy, and post-operative radiotherapy.

CONCLUSIONS

HRQOL should be considered as part of the overall process of care for oral cancer patients.

The Assessment of Quality of Life in Patients Who Have Undergone Surgery for Oral Cancer: A Preliminary Report

PURPOSE

The outcome of management strategies for the treatment of oral cancer has always been in terms of disease-specific survival. Modern assessment of outcome now also includes assessment of quality of life (QOL). Little has been done previously in Australia to assess the QOL of patients treated primarily by surgery for oral cancer.

MATERIALS AND METHODS

Twenty-two patients who had undergone primary surgical management for oral cancer underwent assessment of QOL using the European Organization for Research and Treatment of Cancer QOL questionnaire version 3 (EORTC QLQ-C30) and the University of Washington Head and Neck QOL questionnaire version 4 (UWQOL). Similar emotional domains were compared and factors affecting QOL were determined.

RESULTS

Fifty-five percent of patients were male and 45% were female. The mean age was 61.8 years (range, 38 to 86 years) with a mean review time of 24.6 months (SD, 20.3 months) postoperatively. Good QOL scores were experienced by most patients. A new addition to the UWQOL version 4 was the mood and anxiety domains, and these correlated well with the emotional domains of the EORTC QLQ-C30 using Spearman rank correlations. Factors significantly affecting survival included age, overall stage, neck dissection, free flap, and postoperative radiotherapy using Mann-Whitney tests (P < .05). No significant difference in QOL was found in patients reviewed at either less than or greater than 1 year.

CONCLUSIONS

This study confirms previous reports in the literature. It has provided us with the foundation for further investigation of QOL in patients who have been and who will be treated for oral cancer. It also gives us a new measure of outcome to compare against survival rates.

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.

Patient's response using freetext in the University of Washington Quality of Life Scale

BACKGROUND

The University of Washington Quality of Life Scale is the only validated head-and-neck-specific questionnaire that invites patients to write comments in the form of freetext. Freetext allows the questionnaire to record issues raised by the patient.

METHOD

Two hundred seventy-eight consecutive patients treated between 1995 and 1999 by primary surgery for oral and oropharyngeal squamous cell carcinoma completed the UWQOL. Freetext from these patients was independently assessed by the authors.

RESULTS

Comments were made by 61% of patients at some time. Completion was independent of clinicodemographic characteristics. Comments were predominantly head and neck (39%) and medical (35%). In 55% of cases, the overall tone was negative. Around a quarter of issues was not part of a validated health-related quality-of-life questionnaire.

CONCLUSIONS

Freetext gives the multidisciplinary team a better insight into the concerns of the patient and can be used to promote a holistic approach.

The addition of mood and anxiety domains to the University of Washington quality of life scale

BACKGROUND

There are numerous head and neck specific quality of life questionnaires, each having its own merits and disadvantages. The University of Washington questionnaire has been widely used and is notable by the inclusion of a shoulder dysfunction domain, domain importance ratings, and patient free text. It is short, simple to process, and provides clinically relevant information. However, it has lacked any psychological dimension of quality of life. The aim of this study was to report the inclusion of two psychological domains (mood, anxiety) to the most recent refinement of the questionnaire (version 3).

METHOD

A cross-sectional survey was performed in April 2000. Questionnaires were sent to 183 patients alive and disease free after surgery for oral and oro-pharyngeal malignancy. Replies were received from 145 patients (79% response rate).

RESULTS

The new domains (mood and anxiety) correlated significantly with the emotional functioning domains from the EORTC C30 and with the pain and appearance domains of UW-QOL. There were also significant correlations between the "global quality of life" item and the two new domains. Mood (p =.005) and anxiety (p <.001) scores were associated with patient age but with no other clinicodemographic variable.

CONCLUSION

The addition of mood and anxiety domains makes the UW-QOL version 4 a single broad measure suitable for effective health-related quality of life evaluation in the routine clinical setting.