2017 Section 7 Green Book

Original Article

TABLE 3. Characteristics Associated With Health-Related Quality of Life (HRQOL) Among Individuals Diag- nosed With Head and Neck Cancer in Which the Association With HRQOL Does Not Vary Significantly by Time From Diagnosis

Difference in HRQOL: D (95% CI)

Univariate Analysis a

Multivariate Analysis a,b

Characteristic

P

P

Age by quartile at diagnosis, y

< .001

.01

< 67

REF

REF

1.9 ( 2 0.1, 3.9) 1.0 ( 2 1.0, 3.0) 2 1.3 ( 2 3.4, 0.9)

68-72 73-77

3.9 (1.5, 6.3) 2.6 ( 2 0.1, 5.1) 2 2.0 ( 2 4.6, 0.5)

> 78

Sex

.006

Men

REF

2 2.6 ( 2 4.4, 2 0.7)

Women

Smoking status Former/never

< .001

REF

2 3.6 ( 2 5.5, 2 1.8)

Current

Marital status

.001

Married

REF

2 2.7 ( 2 4.4, 2 1.1)

Not married

Education

< .001

< High school

REF

High school graduate/GED

3.8 (1.9, 5.8) 7.1 (5.1, 9.1)

> High school

Household income, US$

< .001

< .001

< $19,999

REF

REF

$20,000-49,999

5.6 (3.9, 7.3) 12.3 (9.8, 14.9) 3.5 (1.6, 5.4)

3.7 (2.3, 5.2) 8.5 (6.3, 10.7) 3.9 (2.1, 5.8)

$50,000

Do not know/missing

Race

.008

White Other

REF

2 2.8 ( 2 4.9, 2 0.7)

No. of comorbidities

< .001

< .001

0-1 2-3

REF

REF

2 9.3 ( 2 10.9, 2 7.7) 2 17.9 ( 2 19.6, 2 16.1)

2 7.3 ( 2 8.8, 2 5.8)

2 14.9 ( 2 16.5, 2 13.2)

4

Depression in past year

< .001

< .001

No

REF

REF

2 20.2 ( 2 21.6, 2 18.8)

2 16.8 ( 2 18.2, 2 15.4)

Yes

Primary site

.03

Larynx/hypopharynx

REF

2 0.9 ( 2 3.0, 1.3) 2 0.6 ( 2 2.9, 1.8)

Oral cavity Oropharynx

Other c

2.9 (0.4, 5.3)

Abbreviations: D , absolute difference in HRQOL compared with reference category; CI, confidence interval; REF, reference category. a Models include cubic spline terms for time relative to head and neck squamous cell carcinoma diagnosis. b Model includes all characteristics for which multivariate analysis results are reported in Tables 3 and 4, survey by proxy, and calendar year of diagnosis. c Other sites include the nasopharynx, nasal cavity, paranasal sinuses, and lip.

was 48.9 months (95% CI, 38.5-54.6 months). The 2-year survival rate was 62.5% (95% CI, 58.7%-66.1%), and the 5-year survival rate was 43.9% (95% CI, 40.1%-47.7%). OS was compared by quartiles of prediagnosis HRQOL. Higher HRQOL was significantly associated with improved OS ( P < .001, P trend < .001) (Fig. 2). The median OS for the highest HRQOL quartile was 79.1 months (95% CI, 65.4-100.7 months) compared with only 22.5 months (95% CI, 14.8-36.3 months) for the lowest quartile. Higher prediagnosis PCS and MCS scores were also associated with improved OS (PCS: P < .001, P trend < .001; MCS: P 5 .003, P trend < .001).

MCS and PCS scores were analyzed separately (Sup- porting Tables 1 and 2; see online supporting information). Although similar patterns were observed for HRQOL over- all, radiotherapy was associated with MCS scores ( P < .001) but not PCS scores ( P 5 .36), whereas sex was associated with PCS scores ( P < .001) but not MCS scores ( P 5 .91). Survival Analysis Given the distinct trends in HRQOL by survival group, the prognostic implication of HRQOL for HNSCC was explored. The analysis was limited to individuals with sur- veys before HNSCC diagnosis (N 5 664). The median OS

Cancer

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