The quality of life for patients following a diagnosis of squamous cell carcinoma of the head and neck can be greatly affected by the choice of treatment modality. This finding may determine the recommended plan for selected patients.
An article in the latest issue of Plastic and Aesthetic Research examines a series of 45 studies which rate the patient's perspective on quality of life following various treatment modalities. It is suggested that the subsequent impact on quality of life can be a useful tool in individualizing treatment for selected patients. The author, Dr. Cristina Hernández-Vila, is a maxillofacial surgeon in the Department of Oral and Maxillofacial Surgery at the University Hospital Infanta Cristina in Badajoz, Spain.
Squamous cell carcinoma of the head and neck is one of the most common cancers worldwide. The survival rate has improved dramatically over the past 20 years secondary to the development of specialized surgical techniques, including microvascular reconstruction and transoral robotic surgery, and adjuvant therapy, including chemotherapy and radiation treatment. While microsurgical reconstruction in particular has allowed an increasing number of salvage cases to be performed, its effect on the patient's quality of life remains controversial.
Health-related quality of life (HRQOL) is defined by the Centers for Disease Control (CDC) as an individual's or a group's perceived physical and mental health over time. Assessing the HRQOL is valuable in that it allows the physician to potentially select the optimal treatment for an individual patient based not only on efficacy, but also on any associated side effects. Survivors of head and neck cancer in particular can face debilitating side effects from treatment, including difficulty swallowing, airway obstruction, speech impediments, chronic infections, fistulae (connections between the oral mucosa and skin), aspiration, and the need for a permanent tracheostomy.
Various tools have been developed to collect patient-reported quality of life outcomes. The University of Washington (UW) Quality of Life Instrument, for example, assesses 12 domains: pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder symptoms, taste, saliva, mood, and anxiety. The evaluated studies generally demonstrated that the sensation of taste is frequently affected by the combination of chemotherapy and radiotherapy, while mouth dryness and dental problems tend to occur following radiation therapy alone. Both surgical patients and those treated with radiation alone note post-treatment difficulty with chewing and taste. Newer techniques, such as transoral robotic surgery, have shown better preservation of quality of life while achieving the same long-term results.
While not every patient will be a candidate for conservative treatment or robotic surgery, Dr. Hernández-Vila has demonstrated that considering treatment alternatives for patients diagnosed with squamous cell cancer of the head and neck may have significant ramifications on their quality of life.
Article: State of the Art in the Management of Oral Squamous Cell Carcinoma, Cristina Hernández-Vila, Plastic and Aesthetic Research, doi: 10.20517/2347-9264.2016.20, published 24 June 2016.