Implications of the Quality of Life Metric in head and neck cancer.

Across England the NHS (National Health Service) has set in place a national survey that invites cancer patients to report their quality of life around 18 months after their diagnosis. The two questionnaires are the EQ-5D-5L and EORTC C30. For head and neck cancer (HNC) several factors will affect patients' characteristics and response rates at the 18-month window. There were three aims of this study: to account for drop-out over the first 18 months, to report the characteristics of responders in comparison with the whole cohort, and to summarise the health-related quality of life (HRQoL) outcomes (EQ-5D-5L and EORTC QLQ-C30). Patients treated with curative intent who were cancer-free at 15 months were sent a postal survey 16 months after diagnosis, with a second reminder at 18 months. Of the 256 patients analysed, 187 were alive at the 15-month follow-up window, 20 of whom were living with recurrence. Survival was related to tumour stage, treatment intent, and mode of treatment. A total of 109 (67%) responded and the response rate was better from older patients. Older patients reported better HRQoL across all measures apart from EQ-5D-5L mobility and EORTC physical functioning, while patients living in more deprived neighbourhoods reported worse HRQoL across all measures apart from loss of appetite. Other than a tendency for a worse HRQoL in patients having surgery with free-flap transfer, there were no obvious consistent differences by tumour stage, site, or treatment. In conclusion, when reflecting on the findings of the National QoL Metric (QoLM) in HNC, it will be important to consider the influence of survivorship and response rates.