Changes in quality of life over 1 year in patients with head and neck cancer

Objectives: To characterize and compare quality of life (QOL) in patients with head and neck cancer shortly before initial treatment and I year later and to study the predictors of changes in QOL over 1 year. Design: Prospective cohort study. Setting: Three otolaryngology clinics. Patients: Three hundred sixteen patients having newly diagnosed squamous cell head and neck cancer. Main Outcome Measure: Health-related QOL was assessed using the 36-item Short-Form Health Survey and a head and neck cancer-specific QOL scale. Results: Over I year, QOL decreased for physical functioning measures and eating but improved for mental health QOL. Depression and smoking were major predictors of poor QOL at baseline. Major predictors of change in QOL from baseline to I year were treatment factors, especially feeding tube placement (9 scales), chemotherapy (3 scales), and radiation therapy Q scales). Baseline smoking and depressive symptoms also remained significant predictors of several QOL scales at I year. Conclusions: Health-related physical QOL tended to decline over I year and mental health QOL improved. The major predictors of change in QOL were treatment factors, smoking, and depressive symptoms. Physicians should alert patients to the relative effects on QOL one may experience with different treatments.