Quality of Life and Patient Concerns in Oral Cancer
In this chapter the basic components of ‘quality of life’ assessment in oral cancer will be addressed in ten sections:1. Why is quality of life an important outcome in oral cancer? 2. What is quality of life? 3. What is health-related quality of life?
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Quality of Life and Patient Concerns in Oral Cancer Simon Rogers
In this chapter the basic components of ‘quality of life’ assessment in oral cancer will be addressed in ten sections: 1. Why is quality of life an important outcome in oral cancer? 2. What is quality of life? 3. What is health-related quality of life? 4. How is HRQOL measured? 5. Can HRQOL outcomes help decision-making? 6. What are the HRQOL outcomes following treatments? 7. What will I be like? 8. How to identify who is doing badly and might benefit from interventions? 9. What do patients wish to talk about: Patient Concerns Inventory? 10. What is the future for patient-reported outcomes in oral cancer?
7.1
hy Is Quality of Life an Important Outcome in W Oral Cancer?
The main priority for most patients diagnosed with oral cancer is cure and survival [1]. Depending on the extent of the cancer, treatment might have to be radical in order to achieve cure. The primary treatment for oral cancer is usually surgery. Depending on margins and neck node status, surgery might be followed by adjuvant radiotherapy or chemoradiotherapy. In terms of surgery, there is a variety of procedures ranging from primary closure or laser excision to extensive soft and bony resection necessitating composite free tissue transfer for reconstruction. S. Rogers Professor, Faculty of Health and Social Care, Edege Hill University and Oral and Maxillofacial Surgeon, Aintree University Hospital, Liverpool, UK e-mail: [email protected] © Springer International Publishing Switzerland 2017 M.A. Kuriakose (ed.), Contemporary Oral Oncology, DOI 10.1007/978-3-319-43857-3_7
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Resection can include mucosa, muscles, nerves and bone and this can result in substantial lifelong functional deficits. These functional deficits can result in limitations in chewing, speech, swallowing and appearance, trismus and xerostomia, and these can have a detrimental effect on social function and also emotional consequences [2]. Patient-perceived effects in the physical, social and emotional aspects are associated with poorer ‘quality of life’ [3]. Although most patients will cope and adapt remarkably well given the enormity of the oral cancer diagnosis, treatment and its aftermath, those with great functional problems find adaption to their ‘new self’ very difficult. Hence it is of critical importance for clinicians to be cognisant of the functional side effects of oral cancer treatments and how these impact on ‘quality of life’.
7.2
What Is Quality of Life?
Quality of life (QOL) is difficult to define and thus measure. The World Health Organisation defines the multidimensional concept as an ‘individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns’ [4]. It is influenced by several factors, including the person’s ‘physical health, psychological state, level of independence, social relationships, personal beliefs’ [5, 6] together with their c
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