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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
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
TABLE II.
(
Continued)
Demographic or Clinical Characteristic
Physical
Well-being
Mean (SE)
Emotional
Well-Being
Mean (SE)
Social
Well-Being
Mean (SE)
Functional
Well-Being
Mean (SE)
H&N Cancer
Mean (SE)
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.
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.
Reeve et al.: Factors Associated With Quality of Life
134