Head and Neck Cancer 711 Epidemiology

Surveys have been done in convenience samples and in patients with specific malignancies. In a survey of 71 survivors 3 years out, participants completed the University of Washington Quality of Life Scale86 and other quality of life instruments. The most common cancer sites were the larynx, oral cavity, oropharynx, and hypopharynx. Patients who underwent combined surgery and radiation had significantly worse scores for pain than patient treated with radiation or surgery alone (p < 0.01) Patients who experienced pain or disfigurement were more likely (RR 2.18, p < 0.05) to have concerns about cancer recurrence.87 In another survey of 135 survivors 3 years out who completed the SF-3688 and the EORTC QLQ C H&N 35,89 patient data was compared to population norms. The most common tumor sites were the oral cavity (40 patients), pharynx (35 patients), and larynx (28 patients). Overall SF-36 bodily pain was similar for the two groups. However, the cancer survivors were significantly worse compared to the population for the H&N35 scales for local pain, swallowing, senses, and social eating.90

In a study of 182 patients with nasopharyngeal carcinoma who had lived for more than 2 years, responses to the Chinese version of the SF-3691 were compared to 182 age-matched controls who did not have cancer. Half of the patients had been treated with conformal therapy, 18% received concurrent chemotherapy, and the median survival was 6 years. There was no difference in the frequency of bodily pain between the survivors and population controls, although functional domains were impaired for survivors.92

In a survey of 113 patients who had been treated for oropharyngeal carcinoma, no difference in pain or other symptoms, as measured by the EORTC QLQ-C30 H&N35 symptom scale score, was seen between patients who had received surgery plus RT(27) to treatment with radiation,86 T stage, localization of tumor, or time from treatment to quality of life evaluation. Patients with T4 disease and who had developed second primary cancers were excluded, and median follow-up was 62 months. The sample represented 73% of the initial cohort.93

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