2017 Section 7 Green Book

TABLE II. ( Continued)

Social Well-Being Mean (SE)

Functional Well-Being Mean (SE)

Physical Well-being Mean (SE)

Emotional Well-Being Mean (SE)

H&N Cancer Mean (SE)

Demographic or Clinical Characteristic

Time (Diagnosis to Survey)

Not a significant predictor

Lymph Nodes No

Quad time

Yes

Quad time

Feeding Tube No

21.47 (0.20)

Quad time

19.16 (0.24)

23.77 (0.26)

Yes

18.52 (0.51)

Quad time

15.37 (0.57)

17.79 (0.60)

Received Radiation No

Quad time

Linear time

Quad time

Yes

Quad time

Linear time

Quad time

Received Surgery No

20.54 (0.33)

21.97 (0.29)

Yes

21.69 (0.27)

22.99 (0.25)

Received Chemotherapy

Not a significant predictor

*Adjusted mean scores are only provided for variables significantly related to the outcome measure ( P < .05). Final model was obtained based on back- ward variable selection procedures. Adjusted means were calculated at 2 years postdiagnosis, with the covariates taking the values at the proportions pre- sented in Table I. For the time-dependent feeding tube usage and tobacco/alcohol usage, the proportions were held at the follow-up 1 visit values. Linear or quad time indicates that the interaction with time is significant in linear or quadratic form, respectively. Higher scores on all FACT scales represent better health-related quality of life. FACT 5 Functional Assessment of Cancer Therapy; H&N 5 head and neck; HRQOL 5 Health-Related Quality of Life; quad 5 quadratic form; SE 5 Standard Error.

use and better physical and role functioning; better global HRQOL; and fewer symptoms of fatigue, pain, problems swallowing, dry mouth, and feelings of illness. Without an in-depth study assessing frequency and quantity of alcohol drinking, it is difficult to speculate if moderate alcohol drinking is promoting better HRQOL or resulting from it. 16

financial burden from cancer care and has been found to be associated with poorer HRQOL. 40 African Americans reported better emotional and functional well-being than non-Hispanic whites. For HNC symptoms, African Amer- icans had similar symptom levels during the treatment period, but symptoms improved more dramatically over time compared to whites. These findings are consistent with our initial study of the 3-month postdiagnosis data. 32 Although not all outcomes can be explained, bet- ter mental well-being may be the result of better coping strategies, including close-knit friends and family and more spirituality. 23,41,42 Both current tobacco and alcohol use are risk fac- tors for HNC, and both appear to be factors associated with HRQOL for survivors but have different relation- ships. Current tobacco use was associated with decre- ments in all measures of HRQOL and increased symptom experiences. This finding is consistent with the literature, 11–15 including a study by Duffy of 81 HNC patients in which smoking was negatively associated with Health Survey Short Form-36 measures of Physical Functioning, General Health, Vitality, Social Function- ing, and Role-Emotional health. 10 Together, our studies reinforce the need for smoking cessation services for HNC patients who continue to smoke after diagnosis. Current alcohol use was statistically associated with bet- ter physical well-being and HNC symptoms; however, the differences in means between drinkers and non- drinkers did not exceed minimally important differences threshold. Several studies 10,12,13,15,17 found no associa- tion between alcohol use and HRQOL, whereas some studies found alcohol abusers had poorer HRQOL. 17,18 Allison et al. 16 did find an association between alcohol

Fig. 1. FACT-G Emotional Well-Being scores over time for those who needed a feeding tube and those who never needed a feed- ing tube. The adjusted means were calculated with the covariates taking the values at the proportions presented in Table I. For the time-dependent feeding tube usage and tobacco/alcohol usage, the proportions were held at the follow-up 1 visit values. The out- side lines are 95% confidence interval lines. FACT-G 5 Functional Assessment of Cancer Therapy-General.

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