“Eating problems due to poor oropharyngeal functioning and persistent pain are the most prevalent problems” faced by patients 5 years after being treated for head and neck cancer, according to a study published online by the Archives of Otolaryngology–Head & Neck Surgery.1 More than 50% of 5-year survivors reported problems eating and 17.3% reported substantial pain.
The study included 337 patients diagnosed with head and neck cancer and who completed surveys measuring health-related quality of life (HRQOL) as part of the Outcomes Assessment Project at the University of Iowa College of Medicine Department of Otolaryngology–Head and Neck Surgery. The mean age of patients at time of diagnosis was 57 years, and more than 50% were initially diagnosed as having advanced disease. The long-term general health of the study participants was similar to that of age-matched norms from the general population.
The authors pointed out that the oral deficits among 5-year survivors “may be due to neuromuscular changes, anatomic deficits following surgery, soft-tissue fibrosis, xerostomia, pain, and dental deficits.” Poor swallowing function may affect more than HRQOL, they added. “Unrecognized aspiration following chemoradiation to treat [head and neck cancer] may also contribute to mortality. Aspiration pneumonia may add substantially to the morbidity and mortality associated with … treatment, although this long-term adverse effect may not be easily identified as a result of cancer therapy.”
The best predictors of 5-year HRQOL outcomes were reports by patients at 1 year of pain and type of diet—full, soft/liquid, or nil per os/minimum oral intake. These were stronger predictors than pretreatment variables such as stage, site, and age. “Previous studies have noted that HRQOL scores tend to increase after treatment, then level off at 1 year with little subsequent improvement. But the findings in the present study speak to the need for very early intervention done concurrently with treatment to maximize the early swallowing function and to address pain,” the researchers stated.
Findings that 13.6% of the survivors continued to smoke and 38.9% drank alcohol “suggest that aggressive smoking and alcohol use education and interventions are warranted,” the authors added. “This is important not only from an oncologic standpoint but also from a comorbid illness and general health maintenance perspective.” ■
1. Funk GF, Karnell LH, Christensen AJ: Long-term health-related quality of life in survivors of head and neck cancer. Arch Otolaryngol Head Neck Surg 138:123-133, 2012.