Quality of Life as a Survival Predictor for Patients with Advanced Head and Neck Carcinoma Treated with Radiotherapy

BACKGROUND. Accumulating reports suggest that quality of life (QoL) may predict survival in patients with malignant disease. In the current study, the authors investigated if baseline QoL and changes in QoL during treatment were prognostic for patients with advanced head and neck squamous cell carcinoma (HNSCC) treated with radiotherapy. METHODS. The authors studied 102 consecutive new patients with HNSCC treated with primary radiotherapy. The Taiwan Chinese versions of the European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) and Head and Neck Quality of Life Questionnaire (EORTC QLQ-H&N35) were completed before and during radiotherapy. The Cox proportional hazards models were used to analyze the impact of clinical and QoL variables on survival. RESULTS. Clinical variables that were significant survival predictors included American Joint Committee on Cancer (AJCC) stage, N status, and Karnofsky performance status (KPS) after multivariate analysis. After introducing the QoL variables, baseline fatigue scale and N status emerged as the most significant survival predictors, whereas KPS lost its significance. Changes in the QoL scales during radiotherapy were not significantly correlated with survival. An increase in the baseline fatigue score of 10 points corresponded to a 17% reduction in the likelihood of survival (95% confidence interval: 8-27%). Significant correlations between baseline fatigue scale and KPS, comorbidity, hemoglobin level, AJCC stage, T status, and most QoL scales also were observed. CONCLUSIONS. The data support the correlation of patient reported QoL scales with survival. Pretreatment fatigue level was a significant survival predictor for patients with advanced HNSCC treated with radiotherapy.