162 / 220
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
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).
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)
Characteristic
Univariate Analysis
a
P
Multivariate Analysis
a,b
P
Age by quartile at diagnosis, y
<
.001
.01
<
67
REF
REF
68-72
3.9 (1.5, 6.3)
1.9 (
2
0.1, 3.9)
73-77
2.6 (
2
0.1, 5.1)
1.0 (
2
1.0, 3.0)
>
78
2
2.0 (
2
4.6, 0.5)
2
1.3 (
2
3.4, 0.9)
Sex
.006
Men
REF
Women
2
2.6 (
2
4.4,
2
0.7)
Smoking status
<
.001
Former/never
REF
Current
2
3.6 (
2
5.5,
2
1.8)
Marital status
.001
Married
REF
Not married
2
2.7 (
2
4.4,
2
1.1)
Education
<
.001
<
High school
REF
High school graduate/GED
3.8 (1.9, 5.8)
>
High school
7.1 (5.1, 9.1)
Household income, US$
<
.001
<
.001
<
$19,999
REF
REF
$20,000-49,999
5.6 (3.9, 7.3)
3.7 (2.3, 5.2)
$50,000
12.3 (9.8, 14.9)
8.5 (6.3, 10.7)
Do not know/missing
3.5 (1.6, 5.4)
3.9 (2.1, 5.8)
Race
.008
White
REF
Other
2
2.8 (
2
4.9,
2
0.7)
No. of comorbidities
<
.001
<
.001
0-1
REF
REF
2-3
2
9.3 (
2
10.9,
2
7.7)
2
7.3 (
2
8.8,
2
5.8)
4
2
17.9 (
2
19.6,
2
16.1)
2
14.9 (
2
16.5,
2
13.2)
Depression in past year
<
.001
<
.001
No
REF
REF
Yes
2
20.2 (
2
21.6,
2
18.8)
2
16.8 (
2
18.2,
2
15.4)
Primary site
.03
Larynx/hypopharynx
REF
Oral cavity
2
0.9 (
2
3.0, 1.3)
Oropharynx
2
0.6 (
2
2.9, 1.8)
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.
Original Article
Cancer
June 15, 2016
142