Comorbidity is an independent predictor of health-related quality of life in a longitudinal cohort of head and neck canc
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HEAD AND NECK
Comorbidity is an independent predictor of health-related quality of life in a longitudinal cohort of head and neck cancer patients Arild Andre´ Østhus • Anne K. H. Aarstad Jan Olofsson • Hans J. Aarstad
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Received: 2 August 2012 / Accepted: 19 September 2012 / Published online: 9 October 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract The aims of this study were to evaluate the validity and reliability of self-reported measurements of comorbidity, as well as the impact of comorbidity on health-related quality of life (HRQoL) scores, obtained at the time of diagnosis and at 18 months follow-up, among head and neck squamous cell carcinoma (HNSCC) patients treated with curative intent. One hundred and six (106) patients were available for analyses at the time of diagnosis and 72 patients at 18 months follow-up. HRQoL was assessed with the EORTC QLQ-C30/H&N35 inventories. The presence of comorbidities was assessed with a selfreported eight-question-based questionnaire at the time of diagnosis and after 18 months, as well as retrospectively with the Adult Comorbidity Evaluation (ACE-27) scale. The self-reported eight-question-based assessments of comorbidity showed high reliability with the chart-based ACE-27 inventory at both time points (r = 0.611, p \ 0.001 and r = 0.612, p \ 0.001). Significant correlations with comorbidity were determined for the functional (r = -0.194, r = -0.269) and the general symptom HRQoL sum score (r = 0.257 and r = 0.334) at the time of diagnosis and after 18 months; in particular present lung disease explained these associations. The covariates marital status, smoking status, alcohol consumption, and tumor A. A. Østhus (&) J. Olofsson H. J. Aarstad Department of Surgical Sciences, Faculty of Medicine and Dentistry, University of Bergen, 5020 Bergen, Norway e-mail: [email protected] A. K. H. Aarstad J. Olofsson H. J. Aarstad Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, 5021 Bergen, Norway A. K. H. Aarstad Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
stage were also found to be significantly associated with HRQoL sum scores at both time points. In conclusion, we have demonstrated that it is possible to assess comorbidity in HNSCC patients by self-reported questionnaires. Moreover, comorbidities, in particular present lung disease, appear to have an important and unique influence on HRQoL scores. Keywords cancer
Comorbidity Quality of life Head and neck
Introduction During the last decades a change of view has occurred in the practice of oncology. Previously, tumor response and survival were the main acknowledged outcome factors. Today, the assessment of health-related quality of life (HRQoL) has become a recognized and an important parameter [1]. HRQoL issues may be regarded of particular interest among head and neck squamous cell carcinoma (HNSCC) patients, as their disease and treatment often disrupt core aspects of life, i.e. swallowing, speech, and appearance [1]. This is
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