161 / 220
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.
HRQOL Before and After HNSCC/Rettig et al
Cancer
June 15, 2016
141