Immediate Impact of Primary Surgery on Health-Related Quality of Life of Hospitalized Patients With Oral and Oropharyngeal Cancer
Purpose
Oral and oropharyngeal tumor resection may be associated with disfigurement and dysfunctions that affect essential domains of life. This study aimed at assessing the immediate impact of primary surgery on the health-related quality of life for these patients.
Patients and Methods
Forty-seven patients with squamous cell carcinoma of the lips, oral cavity, or oropharynx, and undergoing treatment in the head and neck surgery center of a large general hospital in the city of São Paulo, Brazil, from October 2005 to September 2006, completed the University of Washington Quality of Life questionnaire pre- and postoperatively (before hospital discharge). A paired t test evaluated differences between assessments; Poisson regression estimated ratios of ratings attributed to each domain (pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder pain, taste, saliva, mood, and anxiety) per patient stratified by sociodemographic, clinical, and behavioral characteristics.
Results
The immediate impact of surgery on health-related quality of life corresponded to a 31.1% reduction in the overall rating. The most affected domains were chewing (−73.5%), taste (−61.4%), swallowing (−57.3%), speech (−46.0%), and pain (−42.3%). Anxiety (+65.5%) was the sole domain that improved immediately after surgery. Comparisons involving subgroups of patients indicated that different clinical conditions (regional metastasis, tumor size, and location) were not associated with discrepant health-related quality of life immediately after surgery.
Conclusions
The routine pre- and postoperative assessment of health-related quality of life may contribute to evaluate treatment effectiveness, which would otherwise rely exclusively on assessing end-point results such as survival and tumor relapse. This information is relevant to attenuate the prejudicial impact of surgery on the physical and psychosocial functioning of patients.
⁎Postdoctoral Student, School of Dentistry, University of São Paulo, São Paulo, Brazil.
†Professor, Department of Social Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
‡Undergraduate Student, School of Dentistry, University of São Paulo, São Paulo, Brazil.
§Postgraduate Student, School of Dentistry, University of São Paulo, São Paulo, Brazil.
∥Professor, Hospital Heliópolis, São Paulo State Health Department, São Paulo, Brazil.
¶Professor, Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
Address correspondence and reprint request to Dr Antunes: School of Dentistry, University of São Paulo, Av Prof Lineu Prestes, 2227 Cidade Universitária, 05508-900 São Paulo, SP, Brazil
This study was sponsored by Foundation for the Support of Research in the State of São Paulo (Fundação de Amparo à Pesquisa do Estado de São Paulo) – FAPESP, grant No. 2005/03367-6; and the Brazilian Council for the Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq), Grant No. 302541/2004-7.
ABSTRACT