Mastication in health-related quality of life in patients treated for oral cancer: A systematic review.

INTRODUCTION: Treatment for oral cancer can impair oral functions such as mastication, which may negatively affect quality of life (QoL). In this review, an overview is provided of masticatory ability in patients treated for oral cancer. METHODS: The PubMed (MEDLINE), Embase and Cochrane databases were systematically searched for scientific literature on masticatory ability in relation to QoL in patients treated for oral cancer. Studies were included when oral cancer treatment was provided, and the University of Washington Quality of Life (UW-QoL) questionnaire was used. Risk of bias (MINORS) was independently assessed by two authors. RESULTS: The PubMed (MEDLINE), Embase and Cochrane search yielded 575 unique records of which 111 were assessed full text, and 27 studies were included. The UW-QoL mastication scores ranged from 31.9 to 97.4. There was a wide variety in methodology, patient groups, tumour site, treatment and assessment moment, to such a degree that outcome scores are difficult to compare. CONCLUSION: The wide variety in studies exploring health-related QoL in relation to mastication in oral cancer patients prevents the identification of possible relations between treatment, masticatory ability and QoL. Our findings underline the limitations in currently available literature and indicate the necessity for more comparable research.

Health-related quality of life: a retrospective study on local vs. microvascular reconstruction in patients with oral cancer.

BACKGROUND: New medicinal and surgical oncological treatment strategies not only improve overall survival rates but continually increase the importance of Health-Related Quality of Life (HRQOL). The purpose of this retrospective cross-sectional study was to analyze HRQOL of patients with oral squamous cell carcinoma after ablative surgery and to evaluate predictive factors for HRQOL outcome. METHODS: The study included 88 patients with histologically confirmed oral squamous cell carcinoma of whom 42 had undergone local reconstruction (LR) and 46 microvascular reconstruction (MVR). During follow-up, all patients completed the University of Washington Quality of Life Questionnaire (UW-QOL) containing 12 targeted questions about the head and neck. Descriptive analyses were made for the tumor site, the T-stage, and adjuvant therapies. HRQOL was compared between the LR and the MVR group with parametric tests. Further analyses were impact of the tumor site, the T-status, and the time from surgery to survey on HRQOL. Statistics also included multivariate correlations and different interaction effects. RESULTS: HRQOL in the LR group was 'very good' with 84.3 ± 13.7 and 'good' in the MVR group with 73.3 ± 16.5 points. The physical domains swallowing (p = 0.00), chewing (p = 0.00), speech (p = 0.01), taste (p = 0.01), and pain (p = 0.04) were significantly worse in the MVR group. An increase in the T-status had a significant negative effect on swallowing (p = 0.01), chewing (p = 0.01), speech (p = 0.03), recreation (p = 0.05), and shoulder (p = 0.01) in both groups. Regarding the tumor site and subsequent loss of HRQOL, patients with squamous cell carcinoma on the floor of the mouth had significantly worse results in the categories pain (p = 0.002), speech (p = 0.002), swallowing (p = 0.03), activity (p = 0.02), and recreation (p = 0.01) than patients with tumors in the buccal mucosa. Speech (p = 0.03) and pain (p = 0.01) had improved 1 year after surgery. CONCLUSION: Patients with flap reconstruction because of oral squamous cell carcinoma showed very good overall HRQOL. Outcomes for microvascular reconstruction were good, even in the case of larger defects. The T-status is a predictor for HRQOL. Swallowing, chewing, speaking, taste, and pain were the most important issues in our cohort. Implementing HRQOL questionnaires for the assessment of quality of life could further increase the treatment quality of patients with oral cancer.

Health-related quality of life in patients with major salivary gland carcinoma.

PURPOSE: To evaluate the health-related quality of life (QOL) in patients with major salivary gland carcinoma (MSGC). METHODS: 45 patients with MSGC completed the University of Washington Quality of Life (UWQOL) questionnaire. Results and factors influencing quality of life were analyzed using Mann-Whitney U test. RESULTS: 24 patients were male, 21 patients were female, and median age was 57 years. 33 patients presented with early stage (UICC stage I or II) cancer. All patients had surgery as initial therapy. The UWQOL domains with the worst results were 'appearance', 'activity' and 'anxiety'. Factors influencing QOL were sex, tumor stage, comorbidities, follow-up time, tumor grade, postoperative radiation therapy and facial nerve dysfunction. CONCLUSIONS: Diagnosis and treatment of MSGC has influence on overall QOL. Postoperative radiation has the greatest impact on QOL. This is one of the largest study evaluating QOL in patients with salivary gland carcinoma using the UWQOL.

Quality of Life after Mandibular Reconstruction Using Free Fibula Flap and Customized Plates: A Case Series and Comparison with the Literature.

A single-center retrospective study was conducted to assess health-related quality of life (HRQoL) in 23 consecutive patients undergoing mandibular reconstruction using the computer-aided design (CAD) and computer-aided manufacturing (CAM) technology, free fibula flap, and titanium patient-specific implants (PSIs). HRQoL was evaluated after at least 12 months of surgery using the University of Washington Quality of Life (UW-QOL) questionnaire for head and neck cancer patients. In the 12 single question domains, the highest mean scores were found for "taste" (92.9), "shoulder" (90.9), "anxiety" (87.5), and "pain" (86.4), whereas the lowest scores were observed for "chewing" (57.1), "appearance" (67.9), and "saliva" (78.1). In the three global questions of the UW-QOL questionnaire, 80% of patients considered that their HRQoL was as good as or even better than it was compared to their HRQoL before cancer, and only 20% reported that their HRQoL had worsened after the presence of the disease. Overall QoL during the past 7 days was rated as good, very good or outstanding by 81% of patients, respectively. No patient reported poor or very poor QoL. In the present study, restoring mandibular continuity with free fibula flap and patient-specific titanium implants designed with the CAD-CAM technology improved HRQoL.

Quality of life in patients with oral hard or soft tissue defects after reconstructive microsurgery.

With current advances in medicine, many surgical methods have emerged for the reconstruction of soft and hard tissue defects of the head and neck. Current literature provides only a limited amount of evidence in studies addressing differences in quality of life for specific therapeutic measures in microvascular reconstruction. The validated University of Washington quality of life questionnaire version 4 (UW-QoL v4), a distress thermometer, and two questions addressing donor-site morbidity were sent to 134 patients at a tertiary care centre. All participants had undergone a type of microvascular reconstructive surgery of the head and neck. They were distributed into three groups according to the defect and type of treatment: defects reconstructed by soft-tissue microvascular tissue transfer, defects involving the hard tissue and treated by alloplastic reconstruction, and hard tissue defects receiving microvascular osseous reconstruction. A total of 82 patients completed the questionnaire in full and returned it. Patients from all the groups showed improved distress thermometer values postoperatively. Those who underwent osseous microvascular reconstruction had better functional items than those who had alloplastic reconstruction plates. Donor-site morbidity was rated low in all groups. Microvascular osseous reconstructive surgery might help to improve functional outcomes in patients with osseous defects more than alloplastic reconstruction.

Mapping the University of Washington Quality of life questionnaire onto EQ-5D and HUI-3 indices in patients with head and neck cancer.

BACKGROUND: There is no mechanism to predict health utility (HU) values from the University of Washington Quality of Life Questionnaire (UWQoL) scores. We sought to develop a mapping algorithm capable of using UWQoL data to approximate HU scores. METHODS: Outpatients with head and neck cancer completed the UWQoL, EQ-5D, and the Health Utilities Index-Mark 3 (HUI-3). Results of the UWQoL were mapped onto both EQ-5D and HUI-3 scores using ordinary least-squares regression models. Two-part models were explored. The predictive power of the model was assessed using 10-fold cross-validation. RESULTS: A total of 209 patients were recruited. The reduced model converting UWQoL data into EQ-5D scores performed best (adjusted R2 = 0.628, root mean square error = 0.076). Both models demonstrated construct validity by discriminating between clinical indices of disease severity. CONCLUSIONS: The abovementioned algorithms enable researchers to perform health economic evaluations with existing UWQoL data in cases where prospectively collected HU values are not available.

Quality of Life of Patients with Oral Cavity Cancer.

INTRODUCTION: In recent years the quality of life of patients is very important in monitoring the treatment and therapeutic procedure success. It has become a significant factor in assessing the therapeutic procedure accomplishment, and for the first time the patient alone can access the success of the respective therapy. Cancer of the oral cavity is one of the most common cancers of the head and neck, and is one of the ten most common causes of death in the world. In the majority of cases, cancer of the oral cavity is detected in an advanced stage when therapeutic options are reduced, and the prognosis is much worse. Cancer of the oral cavity is 10 times more common in men. Assessment of quality of life should be an indicator of the multidisciplinary treatment success and it should point to areas in which the affected person requires support. AIM OF THE STUDY: To examine the quality of life of patients with oral cavity cancer. MATERIALS AND METHODS: The study was conducted at the Clinic of Maxillofacial Surgery of the Clinical Center University of Sarajevo (CCUS), through a survey on patients with verified oral cavity cancer, questionnaire related to socio-demographic characteristics of the patients and the University of Washington Quality of Life Questionnaire (UW-QOL). The results were included in the database and statistically processed in the SPSS program, 19.0 version for Windows. Afterwards, the results were thoroughly analyzed and documented, presented in absolute numbers and statistical values using statistical indicators in simple and understandable tables and figures. RESULTS: The study results showed that out of the total score of 100, the median value of quality of life of patients with oral cavity cancer, for the physical health component in the definition of quality was M=69.75 ±29.12 and for social-emotional health M=65.11 ± 27.47. CONCLUSION: This could be considered as satisfactory quality of life, in the sphere above half of the rating scale, although both values significantly deviate from the UW-QOL scale norm. Physical and socio-emotional health components are in a strong positive correlation, R2=0.750, p=0.0001.

The Validation and Reliability of the Chinese Version of the Speech Handicap Index for Patients With Oral and Oropharyngeal Cancer.

OBJECTIVES: The purpose of this study was to investigate the validity and reliability of the translated Chinese version of the Speech Handicap Index (SHI) questionnaire for Chinese-speaking patients with oral and oropharyngeal cancer. METHODS: The original English version of the SHI was translated into Chinese. Forty-two consecutive patients with oral and oropharyngeal cancer were included in the study. All subjects were asked to complete the Chinese version of the SHI and the University of Washington Quality of Life Questionnaire (UWQOL V.04). Fifteen patients were randomly retested on both questionnaires 2 weeks later. The internal consistency, test-retest reliability, construct validity, and group validity of the Chinese version of the SHI were tested using Cronbach α, Spearman correlation coefficient (r), and Mann-Whitney U tests. Descriptive and bivariate statistics were computed, and the P value was set to 0.05. RESULTS: The Cronbach α for the total SHI, the speech domain, and the psychosocial domain were 0.96, 0.90, and 0.92, respectively. The test-retest reliability scores for the total SHI, the speech domain, the psychosocial domain, and the overall question were 0.94, 0.97, 0.90, and 0.83, respectively. To measure construct validity, Spearman correlation coefficients between different items of the SHI and the UWQOL were all >0.4, which signified a moderate to significant correlation. There were significant differences between patient groups when divided by age, clinical stage, educational level, radiotherapy, and reconstruction, on all or on parts of the various SHI domains. CONCLUSIONS: The Chinese version of the SHI is a valid and reliable tool for the speech assessment of patients with oral and oropharyngeal cancer.

Quality-of-life scores compared to objective measures of swallowing after oropharyngeal chemoradiation.

OBJECTIVES/HYPOTHESIS: To compare objective measures of swallowing function with patient reports of swallowing-related quality of life 1 year after treatment of oropharyngeal cancer with chemoradiation therapy. STUDY DESIGN: Patients seen for follow-up at least 1 year after treatment of oropharyngeal carcinoma with chemoradiation therapy were sequentially approached and asked to participate in the study. METHODS: Maximum pharyngeal constriction, hyoid elevation, upper esophageal sphincter opening size, and bolus pharyngeal transit time were measured from modified barium swallowing studies in a group of 31 patients at least 1 year after chemoradiation therapy for the treatment of oropharyngeal carcinoma. Measures were made for a liquid 1-mL, 3-mL, and 20-mL bolus. Objective measure results were compared to scores from the MD Anderson Dysphagia Inventory and The University of Washington Swallowing Quality of Life Questionnaire results from the same patients. RESULTS: No strong correlation was identified between any of the objective measures of swallowing physiology and quality-of-life scores. CONCLUSIONS: Patient perception of the impact of swallowing function on quality of life does not correlate well with actual physiologic functioning.

Prospective evaluation of the quality of life of oral tongue cancer patients before and after the treatment.

BACKGROUND: This prospective study was to evaluate the changes in quality of life (QOL) after 12 months post treatment from their pre-treatment levels, using specific questionnaires of well-known acceptability, responsiveness, and validity, with special emphasis on domains such as chewing, swallowing, speech, psychological aspects (mood and anxiety) and pain. METHODS: This prospective analytical study included a total of 72 patients affected by oral tongue cancer (T1-2N0M0) who underwent treatment [wide local excision with selective + radiotherapy (RT)] from 2009 to 2012 at the Department of Oncosurgery and Otorhinolaryngology-Head and Neck Surgery, Sir Ganga Ram Hospital, New Delhi. RESULTS: A total of 39 (54.2%) patients were eligible for the study. Death occurred in 12 patients, four patients had disease recurrence and 17 patients lost to follow up. QOL in five domains was improved, there was significant improvement in pain scores [mean difference (-)17.94], overall activity of the patient was significantly improved (-13.46), recreational activities were also significantly improved (-8.33) and mental status of patient which included the mood and anxiety level were also significantly improved (-13.71 and -11.53) respectively. In seven domains which included the appearance of the patient (32.05), swallowing (16.41), chewing (24.35), speech (29.48), shoulder pain and discomfort (6.92), taste (35.12) and saliva production scores (20.51) were significantly worse. CONCLUSIONS: By our study we can strongly recommend that oral tongue cancers if diagnosed at early stages and without any neck node (T1-2N0M0) can be easily managed without compromising the QOL of the patients significantly.