Hammerlid E, Silander E, Hörnestam L, Sullivan M
Department of Otolaryngology and Head and Neck Surgery, Sahlgrenska University Hospital, Göteborg University, Sweden.
Head Neck. 2001 Feb;23(2):113-25. doi: 10.1002/1097-0347(200102)23:2<113::aid-hed1006>3.0.co;2-w.
To examine health-related quality of life (HRQL) of all head and neck cancer patients from diagnosis until 3 years later and to analyze its dependence on tumor site and other patient characteristics.
Two hundred thirty-two patients (mean age 61 years; 70% men) were included and followed with clinical measures and mailed standardized HRQL questionnaires (The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30), the EORTC QLQ-Head and Neck Cancer module (QLQ-H&N35), and the Hospital Anxiety and Depression Scale (HADS).
After 3 years 66% of the patients were alive and 88% of these completed the study. The HRQL was worse during treatment and returned slowly thereafter to pretreatment values with few exceptions. After 3 years the best improvement was found for mental distress, followed by a significant global quality of life improvement and reduced pain compared with diagnosis. A significant deterioration was found for problems with dry mouth, senses, and teeth, as well as for opening the mouth wide (ie, they seemed to be related to the treatment given). There were few significant improvements between the 1- and 3-year follow-ups. Depression and physical functioning at diagnosis were independent predictors for global quality of life at 3 years. Patients who died during the study had a worse HRQL at diagnosis compared with patients completing the study. Patients with advanced disease (stage III + IV) scored worse than patients with small tumors for most of the HRQL domains. These differences increased over time. Few differences were found relating to gender and age. The pharyngeal cancer group scored worse compared with the other tumor sites, and these patients would probably benefit from a rehabilitation program right from diagnosis, including treatment for malnutrition and pain.
The largest HRQL changes for head and neck cancer patients are seen within the first year after diagnosis, with a significant deterioration just after finishing treatment. Thereafter, most of the variables return to pretreatment values. The significant problems with dry mouth, senses, and teeth after treatment are constant over time.
研究所有头颈癌患者从确诊到3年后的健康相关生活质量（HRQL），并分析其对肿瘤部位和其他患者特征的依赖性。
纳入232例患者（平均年龄61岁；70%为男性），采用临床测量方法并邮寄标准化的HRQL问卷（欧洲癌症研究与治疗组织生活质量核心问卷30（EORTC QLQ-C30）、EORTC头颈癌模块问卷（QLQ-H&N35）以及医院焦虑抑郁量表（HADS））对其进行随访。
3年后，66%的患者存活，其中88%完成了研究。治疗期间HRQL较差，之后除少数例外情况外，缓慢恢复到治疗前水平。3年后，精神困扰改善最为明显，其次是总体生活质量显著提高以及与确诊时相比疼痛减轻。口干、感觉和牙齿问题以及张口困难（即似乎与所接受的治疗有关）出现了显著恶化。1年和3年随访之间几乎没有显著改善。确诊时的抑郁和身体功能是3年时总体生活质量的独立预测因素。与完成研究的患者相比，研究期间死亡的患者确诊时HRQL更差。在大多数HRQL领域，晚期疾病（III + IV期）患者的得分比小肿瘤患者更差。这些差异随时间增加。在性别和年龄方面几乎没有发现差异。与其他肿瘤部位相比，咽癌组得分更差，这些患者可能从确诊时就需要康复计划中获益，包括营养不良和疼痛治疗。
头颈癌患者HRQL的最大变化出现在确诊后的第一年，治疗刚结束后显著恶化。此后，大多数变量恢复到治疗前水平。治疗后口干、感觉和牙齿方面的显著问题随时间持续存在。
