Elsevier

European Journal of Cancer

Volume 48, Issue 15, October 2012, Pages 2391-2408
European Journal of Cancer

Quality-of-life among head and neck cancer survivors at one year after treatment – A systematic review

https://doi.org/10.1016/j.ejca.2012.04.005Get rights and content

Abstract

Background

The importance of quality-of-life (QoL) research has been recognised over the past two decades in patients with head and neck (H&N) cancer. The aims of this systematic review are to evaluate the QoL status of H&N cancer survivors one year after treatment and to identify the determinants affecting their QoL.

Methods

Pubmed, Medline, Scopus, Sciencedirect and CINAHL (2000–2011) were searched for relevant studies, and two of the present authors assessed their methodological quality. The characteristics and main findings of the studies were extracted and reported.

Results

Thirty-seven studies met the inclusion criteria, and the methodological quality of the majority was moderate to high. While patients of the group in question recover their global QoL by 12 months after treatment, a number of outstanding issues persist – deterioration in physical functioning, fatigue, xerostomia and sticky saliva. Age, cancer site, stage of disease, social support, smoking, feeding tube placement and alcohol consumption are the significant determinants of QoL at 12 months, while gender has little or no influence.

Conclusions

Regular assessments should be carried out to monitor physical functioning, degree of fatigue, xerostomia and sticky saliva. Further research is required to develop appropriate and effective interventions to deal with these issues, and thus to promote the patients’ QoL.

Introduction

The diagnosis of head and neck (H&N) cancer and associated treatment can have a disproportionately severe impact on patients’ quality-of-life (QoL). H&N cancers include those originating in the oral cavity, salivary glands, larynx, paranasal sinuses, nasal cavity and pharynx (nasopharynx, oropharynx or hypopharynx).1 In 2008, the age-adjusted incidence and mortality rates in the United States were 10.6 and 2.5 per 1,000,000 respectively, and both have been decreasing.2 With the improvement in cancer detection and intensive multi-model treatments, the prognosis of cancer survivors is relatively favourable, and the population of survivors is increasing.2 However, the side-effects of treatment cannot be underestimated.3

Treatments for H&N cancer include surgery, radiotherapy (RT), chemotherapy, targeted therapy or a combination of these modalities. However, these treatments often lead to undesirable consequences that have a marked effect on both physical and psychosocial aspects of the patient’s life.1 Quality-of-life is a broad concept, concerning an individual’s perceptions, physical and psychosocial state, personal beliefs and relationship to the environment.4 With the importance of QoL being recognised in recent years, it has been increasingly used as an outcome measure in cancer research. A recent review reported a number of potential determinants influencing QoL in patients with H&N cancer.5 However, the significance of the relationship between QoL and the potential determinants was not fully indicated. The factors were summarised regardless of their temporal relationship to the patient’s treatment, and their effects on short- or long-term QoL were not distinguished or discussed.

Patients with H&N cancer usually show a deterioration in global QoL scores immediately after treatment, but there is generally a return to baseline scores by one year after treatment.5, 6 Appropriate interventions are therefore important in improving patient status during this critical period. Quality-of-life at one year after treatment has been an important predictor of long-term survival5, 7, 8 and of QoL at 5 years.9 Understanding the relationships between QoL and potential determinants may assist with designing interventions aimed at improving QoL, and the purpose of this systematic review is thus to evaluate patient QoL status and to identify the determinants affecting it among H&N cancer survivors, at one year after the completion of treatment.

Section snippets

Search strategies

A comprehensive search of the literature was carried out in December 2011. Electronic databases – Pubmed, Medline, Scopus, Sciencedirect and CINAHL – were used to identify relevant studies published from 2000 to December 2011. Bearing in mind the rapid advances that have been made in the treatment of H&N cancer over the past decade, we have limited the inclusion of studies to those carried out since 2000. A combination of keywords – head and neck cancer, quality-of-life, health-related

Literature search results

A total of 4338 citations were identified through five databases. Of these, 1872 duplicates were removed, leaving 2466. Following a scan of the titles and abstracts, 80 potential studies were identified and after a detailed examination of the full texts, 39 were found to meet all inclusion criteria and were critically appraised. Two were further excluded because of their generally poor quality. Fig. 1 illustrates the search and the inclusion of studies. The scores for the methodological

Discussion

With recent advances in treatment and cancer care services, this review focuses on published studies investigating QoL in H&N cancer survivors over the past decade, and provides updated information on the QoL of this population, with 37 relatively high-quality studies involving over 4000 H&N cancer patients. Although previous research findings have suggested that QoL and treatment-related morbidities return to baseline after treatment in H&N cancer survivors,49 our review suggests that some

Conclusion

This review paper examines the QoL of patients one year after treatment, and seeks to identify the determinants affecting the QoL of H&N cancer survivors. While patients’ global QoL recovers by 12 months after treatment in this group, problems with physical functioning, fatigue, xerostomia and sticky saliva persist. Regular monitoring should be carried out to identify the presence of these potential outstanding problems. Various determinants of QoL at 12 months were identified, and further

Conflict of interest statement

None declared.

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