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HRQOL Before and After HNSCC/Rettig et al

The MCS score was significantly higher than the PCS score at all time points ( P < .001). To explore whether HRQOL is a proxy for survival, individuals were stratified by OS (Fig. 1b, Table 2). HRQOL trends were evaluated among < 2-year survivors (N 5 296), 2-year to 5-year survivors (N 5 209), and > 5-year survivors (N 5 1081). HRQOL declined over time for each group. Individuals with shorter survival had lower HRQOL 5 years before HNSCC diagnosis (87.3 for < 2-year survivors vs 92.8 for 2-year to 5-year survivors [ P 5 .16], and 96.4 for > 5-year survivors [ P 5 .004], respectively) and experienced greater declines in HRQOL around the time of diagnosis than those with longer sur- vival (from 24 months prediagnosis to 13 months postdiag- nosis: D , 2 16.6 [95% CI, 2 23.8, 2 9.4] for < 2-year survivors; D , 2 9.9 [95% CI, 2 15.8, 2 3.9] for 2-year to 5-year survivors; D , 2 0.9 [95% CI, 2 1.8, 0.08] for > 5-year survivors). It is noteworthy that the significant increase in HRQOL observed in the overall study popula- tion between 13 months and 5 years postdiagnosis was not observed in any group after stratification by survival. Determinants of HRQOL Associations between characteristics of interest and HRQOL were examined (Tables 3 and 4). In univariate analysis, fac- tors that were significantly associated with HRQOL included age at diagnosis, sex, smoking, marital status, edu- cation, household income, race, comorbidities, depression, tumor site, disease stage, and radiotherapy. In multivariable analysis, variables that were independently associated with HRQOL included age, household income, comorbidities, depression, disease stage, and radiotherapy ( P < .01 for all). Interactions between characteristics of significance and time from HNSCC diagnosis in association with HRQOL also were explored. In univariate analysis, signif- icant interactions with time from HNSCC diagnosis were observed for SEER stage ( P < .001) and radiotherapy ( P 5 .001). Individuals with late-stage disease experienced greater decreases in HRQOL around the time of diagnosis (from 24 months prediagnosis to 13 months postdiagno- sis) compared with individuals who had early stage disease ( D , 2 13.0 [95% CI, 2 16.8, 2 9.2] vs D , 2 2.6 [95% CI, 2 5.9, 0.7]; P < .001). Similarly, individuals who received radiotherapy had greater decreases in HRQOL than those who did not ( D , 2 10.3 [95% CI, 2 13.4, 2 7.2] vs D , 2 0.8 [95% CI, 2 4.6, 3.0]; P < .001). After adjustment for other factors, significantly greater declines in HRQOL around the time of diagnosis were still observed for indi- viduals with late-stage disease ( P 5 .002) or who received radiotherapy ( P < .001). TABLE 2. Trends in Health-Related Quality of Life at Various Times Relative to Head and Neck Cancer Diagnosis, Overall and Stratified by Sur- vival Group Overall, N 5 1653 < 2 Year Survivors, N 5 296 2-5 Year Survivors, N 5 209 > 5-Year Survivors, N 5 1081 Time HRQOL Score (95% CI) Change From Baseline: D (95% CI) HRQOL Score (95% CI) Change From Baseline: D (95% CI) HRQOL Score (95% CI) Change From Baseline: D (95% CI) HRQOL Score (95% CI) Change From Baseline: D (95% CI) Prediagnosis* 5 y (Baseline) 92.3 (89.3, 95.2) — 87.3 (92.7, 91.9) — 92.8 (85.1, 100.5) — 96.4 (91.8, 100.9) — 2 y 90.2 (88.4, 92.0) 2 2.1 ( 2 5.4, 1.3) 86.3 (83.4, 89.2) 2 1.0 ( 2 6.7, 4.8) 89.8 (85.3, 94.2) 2 3.1 ( 2 12. 4,6.3) 94.5 (91.9, 97.1) 2 1.9 ( 2 6.9, 3.1) Diagnosis : 0 y 85.0 (83.4, 86.6) 2 7.2 ( 2 10.4, 2 4.0) 73.9 (70.3, 77.6) 2 13.4 ( 2 18.6, 2 8.2) 82.9 (79.0, 86.9) 2 9.9 ( 2 18.3, 2 1.5) 91.5 (89.4, 93.5) 2 4.9 ( 2 9.8, 0.04) Postdiagnosis^ 13 mo 83.7 (82.0, 85.4) 2 8.5 ( 2 11.6, 2 5.4) 69.7 (62.8, 76.7) 2 17.6 ( 2 26.1, 2 9.0) 79.9 (76.1,83.7) 2 12.9 ( 2 20.9, 2 4.9) 90.1 (87.9, 92.2) 2 6.3 ( 2 11.1, 2 1.6) 2 y 84.1 (82.4, 85.8) 2 8.2 ( 2 11.2, 2 5.2) 63.8 (35.9, 91.7) 2 23.5 ( 2 51.6, 4.5) 78.0 (73.6, 82.5) 2 14.8 ( 2 23.2, 2 6.3) 89.2 (87.2, 91.2) 2 7.2 ( 2 11.7, 2 2.7) 5 y 88.0 (86.2, 89.7) 2 4.3 ( 2 7.5, 2 1.0) — — 52.1 (14.9, 89.3) 2 40.7 ( 2 79.1, 2 2.3) 88.6 (86.8, 90.3) 2 7.8 ( 2 12.5, 2 3.2) 10 y 84.6 (81.6, 87.6) 2 7.7 ( 2 11.9, 2 3.5) — — — — 84.2 (81.4, 87.1) 2 12.1 ( 2 17.5, 2 6.8)

Abbreviations: D , absolute changes in health-related quality of life over given time intervals; CI, confidence interval; HRQOL, health-related quality of life; *Time interval prediagnosis; ^Time interval postdiagnosis.

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