EORTC Quality of Life Questionnaire Head and Neck (H&N)-35 scores from H&N squamous cell carcinoma patients obtained at diagnosis and at 6, 9 and 12 months following diagnosis predict 10-year overall survival.

PURPOSE: To study the 10-year overall survival predictions, and mechanisms behind, of head and neck (HN) quality of life (QoL) scores obtained at diagnosis and 6, 9, and 12 months following diagnosis in a cohort of HN squamous cell carcinoma (HNSCC) patients. METHODS: Consecutive HNSCC patients (N = 109) subjected to standard workup and treatment self-reported their QoL measured by the EORTC Quality of Life Questionnaire (QLQ) H&N-35 between November 2002 and June 2005. Each QoL index was calculated and additionally aggregated to one sum score. The included patients were at diagnosis younger than 78 years, judged adequately cognitive functioning, and scheduled for curative treatment. Self-reported smoking, alcohol consumption, and socio-demographic information were registered. Twenty-two patients were high-risk (hr)-HPV DNA tumor positive. If the treatment goal was changed to palliative, no new QoL information was collected. All living patients were followed until 10 years after diagnosis. RESULTS: Median survival was 105 months. Significant overall survival predictions were found from the EORTC H&N-35 QLQ sum scores continuously measured at diagnosis (p = 0.006) and obtained at 6 (p = 0.02), 9 (p = 0.002) and 12 (p = 0.05) months. Lower QoL predicted lower overall survival. These sum score survival predictions were in part independent of TNM stage, hr-HPV status, gender, age, alcohol and smoking status. The indices "pain", "swallowing", "social eating", and "feeling ill" were predictive of survival at 3 out of 4 measuring points (diagnosis, 6, 9 and 12 months) in univariate analyses. CONCLUSION: EORTC H&N-35 QLQ scores at diagnosis and throughout the first year thereafter harbor prognostic power.

Health-related quality of life in long-term survivors after renal cancer treatment.

OBJECTIVE: The most important outcome of renal cell carcinoma (RCC) treatment is survival. However, all cancer treatment should evaluate the health-related quality of life (HRQoL) outcome of the treatment. This has not been sufficiently documented in RCC. The aim of this investigation was therefore to document the HRQoL outcome of RCC. MATERIAL AND METHODS: All 413 RCC patients treated with radical or partial nephrectomy at Haukeland University Hospital, Norway, during the period 1997--2010 were included. After exclusions, invitations to participate were mailed to 260 patients; 185 patients (71%) returned the questionnaires. In addition, a cohort of general head and neck squamous cell carcinoma (HNSCC) patients, a cohort of laryngectomized HNSCC patients, and a cohort from the general population of Norway, were used to compare the RCC patients' HRQoL scores. RESULTS: Performance status as measured by the American Society of Anesthesiologists (ASA) score and Eastern Cooperative Oncology Group (ECOG) classification at diagnosis showed an inverse relation to HRQoL [maximum coefficient of variation (CVmax) = 5.3%, p < 0.05]. Flank and open transabdominal approaches to RCC tumour resection were followed by reduced HRQoL compared with a general cohort of Norwegian citizens. However, the laparoscopically treated RCC patients had HRQoL scores at the level of the population. The indices "general health/QoL", the functional indices, and the symptom indices "fatigue", "pain", "sleep", "nausea and vomiting", "constipation" and "diarrhoea" were particularly affected. CONCLUSION: The results show that RCC patients, and in particular those treated by a flank approach but not those treated by minimal invasive surgery, have a multifacetedly reduced HRQoL compared to a general population cohort.

Prediction of 5 year survival from level of perceived distress in newly diagnosed head and neck squamous cell carcinoma patients.

OBJECTIVES: To evaluate the predictive effect of level of perceived distress on survival in a cohort of newly diagnosed head and neck squamous cell carcinoma (HNSCC) patients. MATERIALS AND METHODS: One hundred and one (N=101) consecutive HNSCC patients self-reported their levels of distress, measured with the general health questionnaire 30 (GHQ-30) at the time of diagnosis. All included patients were younger than 78years of age, cognitive adequate functioning, and scheduled for curative treatment. At the time of diagnosis self-reported levels of neuroticism, problem and avoidance focused coping, smoking and alcohol consumption, and sociodemographic information were registered. Clinical characteristics and comorbidities were determined from the patient hospital records. RESULTS: The 5-year overall survival of the cohort was 68.3%. Thirty-two deaths occurred during the 5-year observation period. The Likert analyzed GHQ sum score, as well as a dichotomized GHQ score were found to predict survival in univariate Cox proportional hazards regression analyses. The hazard ratios were 1.04 (p=.04) and 2.78 (p=.01), respectively. The predictive effect of the GHQ scores remained significant throughout sequential multivariate analyses with adjustments for all the above mentioned covariates. Even a post hoc analysis including all covariates demonstrated an evident survival prediction. CONCLUSION: Self-reported distress measured pretreatment in newly diagnosed HNSCC patients predict survival. Further studies are warranted to elucidate mechanisms and possible interventions.

Mood, anxiety and sense of humor in head and neck cancer patients in relation to disease stage, prognosis and quality of life.

CONCLUSION: At diagnosis, control patients had the lowest depression levels and anxiety scores, followed by those with limited HNSCC disease and these with extended HNSCC disease. Anxiety and depression levels at diagnosis predicted prognosis via an association with extent of disease. Sense of humor, but not anxiety or depression level, predicted lower QoL and depression levels at follow-up. OBJECTIVE: To study the association between anxiety score, depression level at sense of humor at diagnosis in head and neck squamous cell carcinoma (HNSCC) patients versus TNM stage, prognosis and depression level/quality of life (QOL) 6 years following diagnosis. A control group of patients with benign HN disease was also included. MATERIAL AND METHODS: Male patients with newly diagnosed HNSCC (n =78) or benign HN (n =61) disease completed the following questionnaires: the Beck Depression Inventory, the Spielberger Trait Anxiety Inventory (state) and the Svebak humor questionnaire. Patients with cachexia or those aged >80 years were excluded. In the HNSCC patients, TNM stage, prognosis and QOL/depression level (n =27) were determined following successful therapy. RESULTS: HNSCC patients reported high anxiety scores and lower depression levels than control patients, although there was overlap between the groups. N stage was associated with high anxiety scores and depression levels, whereas T stage was only associated with depression levels. Both anxiety scores and depression levels at diagnosis predicted prognosis through an association with TNM stage. Sense of humor, but not depression levels or anxiety scores, at diagnosis predicted QoL and depression levels at follow-up.

Personality traits in head and neck squamous cell carcinoma patients in relation to the disease state, disease extent and prognosis.

OBJECTIVE: We aimed to study whether personality scores, as measured using the Eysenck Personality Inventory (EPI), are associated with the risk and prognosis of head and neck squamous cell carcinoma (HNSCC). MATERIAL AND METHODS: A total of 78 male patients with newly diagnosed HNSCC and 61 male patients with benign HN disease completed the EPI, which assesses the following: neuroticism, extraversion and lie score. The TNM stage, prognosis, diagnostic delay, level of education and smoking and alcohol consumption histories of the patients were also recorded. Patients with cachexia and those aged > 80 years were excluded. RESULTS: The cancer patients had higher neuroticism scores (10.7 +/- 0.5 vs 8.3 +/- 0.6; p < 0.01) than the control patients. This association was shown to be secondary to the fact that neuroticism is associated with increased alcohol consumption. The personality trait scores were not associated with the length of diagnostic delay. It was also suggested that a low lie score predicted disease-specific death in the HNSCC patients (p = 0.02). Total survival also seemed to be predictable (p < 0.05). CONCLUSION: Neuroticism is probably associated with a risk of HNSCC as a result of increased alcohol consumption. If the prognostic results can be replicated, a potentially important association between this personality trait and the prognosis of HNSCC is suggested.