164 / 220
HNSCC diagnosis has prognostic significance that was
not previously appreciated; these large population-based
data provide compelling evidence that prediagnosis
HRQOL independently predicts survival.
These findings have relevance to patient care.
Although most studies to date have reported a decline in
HRQOL after diagnosis followed by a recovery toward
baseline after treatment,
23-25
these data demonstrate that
such recovery is not observed after stratification by sur-
vival group and actually may represent an artifact of earlier
deaths among individuals with lower HRQOL. There-
fore, to counsel patients that overall HRQOL will cer-
tainly improve after therapy, as suggested by previous
studies, is likely inaccurate; instead, perhaps providers
should emphasize the importance of acclimatization to a
new standard of emotional and physical health. Further-
more, the finding that individuals with the lowest prediag-
nosis HRQOL suffer a worse prognosis independent of
other prognostic indicators should lend added gravity to
treatment decisions for this subset of patients, such as
when considering potentially morbid, life-prolonging
interventions versus high-quality palliative care.
TABLE 5.
Risk Factors for Mortality Among 664 Individuals for Whom Health-Related Quality of Life Was
Assessed Within 5 Years Before Head and Neck Cancer Diagnosis
HR [95% CI]
Characteristic
No. of Patients (%)
Univariate Analysis
Multivariate Analysis
a
Prediagnosis HRQOL score per
10-point increase: Median/IQR
90.1/74.4-106.0
0.86 [0.82-0.91]
0.91 [0.85-0.97]
Age at diagnosis: Mean
6
SD, y
75.2
6
7.5
1.04 [1.03-1.06]
1.07 [1.05-1.09]
Sex
Men
466 (70)
REF
Women
198 (30)
1.12 [0.92-1.37]
Smoking status
Former/never
405 (68)
REF
REF
Current
190 (32)
1.24 [1.02-1.52]
1.48 [1.15-1.91]
Marital status
Married
369 (57)
REF
REF
Not married
279 (43)
1.41 [1.17-1.69]
1.18 [0.92-1.50]
Education
<
High school
205 (32)
REF
High school graduate/GED
204 (32)
0.86 [0.68-1.08]
>
High school
235 (36)
0.77 [0.61-0.96]
Household income, US$
<
$19,999
241 (36)
REF
REF
$20,000-49,999
220 (33)
0.74 [0.60-0.92]
1.08 [0.83-1.42]
$50,000
73 (11)
0.50 [0.35-0.71]
0.64 [0.42-0.97]
Do not know/missing
130 (20)
0.86 [0.66-1.11]
0.83 [0.59-1.17]
Race
White
530 (80)
REF
Other
134 (20)
1.14 (0.89-1.44]
No. of comorbidities
0-1
215 (33)
REF
REF
2-3
237 (37)
1.11 [0.88-1.39]
0.99 [0.76-1.31]
4
196 (30)
1.46 [1.16-1.82]
1.19 [0.89-1.59]
Primary site
Larynx, hypopharynx
267 (40)
REF
REF
Oral cavity
170 (26)
1.24 [0.99-1.56]
0.98 [0.73-1.30]
Oropharynx
131 (20)
1.59 [1.25-2.03]
1.08 [0.79-1.46]
Other
b
96 (14)
1.48 [0.90-2.41]
0.88 [0.61-1.28]
Stage
Early
338 (54)
REF
REF
Late
284 (46)
2.30 [1.90-2.79]
2.50 [1.95-3.19]
Radiotherapy
No
257 (39)
REF
REF
Yes
397 (61)
1.20 [1.00-1.45]
1.20 [0.94-1.54]
Abbreviations: CI, confidence interval; GED, General Educational Development; HR, hazard ratio; HRQOL, health-related quality of life; IQR, interquartile range;
REF, reference category; SD, standard deviation.
a
The model includes all characteristics for which multivariate analysis results are reported and survey by proxy.
b
Other sites include the nasopharynx, nasal cavity, paranasal sinuses, and lip.
Original Article
Cancer
June 15, 2016
144