Indian Journal of Palliative Care
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Table of Contents 
Year : 2014  |  Volume : 20  |  Issue : 3  |  Page : 169-170

Is Quality of Life "The Heart of The Issue" In Head and Neck Cancers?

Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India

Date of Web Publication8-Aug-2014

Correspondence Address:
Sarbani Ghosh Laskar
Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1075.138382

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How to cite this article:
Laskar SG, Lewis S. Is Quality of Life "The Heart of The Issue" In Head and Neck Cancers? . Indian J Palliat Care 2014;20:169-70

How to cite this URL:
Laskar SG, Lewis S. Is Quality of Life "The Heart of The Issue" In Head and Neck Cancers? . Indian J Palliat Care [serial online] 2014 [cited 2021 Apr 14];20:169-70. Available from:

Head and neck cancers distinctly differ from other cancers with regards to symptom burden, psychosocial issues, and quality of life. Physiological dysfunction and anatomical disfigurement are commonly seen in advanced head and neck cancer, which could be disease or treatment associated. Impairment of basic physiology of living such as eating, speaking, and breathing as well as issues associated with structural disfigurement like body image issues, social isolation, anxiety, and depression have a major impact on physical symptoms and quality of life. [1] Head and neck cancer is one of the most common cancers seen in India with around 80% patients presenting with advanced stage of illness with only 50% being amenable to curative/definitive intent treatment. Hence the prospective observational study conducted by All India Institute of Medical Sciences (AIIMS), New Delhi, is very pertinent in our setting and addresses important issues in patients with advanced head and neck cancer.

The study by Gandhi et al., published in this issue reveals that most patients were middle aged, hailing from a low socio-economic strata, having only basic primary education and with history of substance abuse. Majority of the patients studied had T4, N2/N3 disease. Two-thirds of patients in the study had pain and required strong analgesics at initial presentation. The other symptoms noted were insomnia, fatigue, anorexia, dryness of mouth, and trismus. Anatomic disfigurement and physiologic dysfunction were assessed using EORTC-HN35 questionnaire and quality of life was assessed using EORTC QLQ-C15-PAL which is a 15 item abbreviated version derived from EORTC QLQ-C-30 specifically for use in the palliative care setting. QLQ-C15-PAL scores are directly comparable with scores derived from the parent instrument, the QLQ-C30. [2] Quality of life assessment showed diminished emotional and physical functioning in the patients studied. This is important baseline data, from the Indian population which has several distinctive features which maybe different from Western studies. [3]

Terrel et al., identified 13 demographic and clinical characteristics that are predictors of QOL in patients with advanced head and neck cancers of which advanced nature of disease, presence of comorbid conditions, presence of tracheostomy tube, chemotherapy and neck dissection were associated with significant decrement in QOL. [4] This is supported by studies by Pandey et al., and Lewis et al., who have correlated distress and quality of life in patients with advanced head and neck cancer. [5],[6] Educational status, occupation, tumor, and nodal stage, pain scores and presence of physical symptoms were associated with higher distress and poor quality of life. Lopez-Jornet et al., emphasized the use of EORTC-HN35 and EORTC QLQ-C-30 for assessment of quality of life in advanced cancer patients as it enables health practitioners to discover in which areas and to what extent patients find their lives affected by disease, the treatment they receive, its consequences and its impact on overall well being. [7] Study by So et al., stressed the need for periodic monitoring for physical symptoms and QOL of life even in head and neck cancer survivors. [8]

Research on quality of life and symptom burden in head and neck cancers are extensively studied and published in the world literature. These studies use instruments like generic, disease specific, site specific and symptom specific instruments. [9],[10] As QOL has multifactorial association, at times data correlating QOL with functional outcome and symptom burden fails to demonstrate a consistent relationship. This may be ascribed to methodological issues in study design or the patient's ability to adapt to functional and symptom control problems. Nevertheless considering the magnitude of head and neck cancer patients in India, this is an important area of research and the study from AIIMS is an important contribution to this knowledge base.

This study is particularly important as most of the patients studied were in the twilight zone in relation to further disease modifying treatment and had poorly controlled symptoms and quality of life. Knowledge and anticipation of symptom burden and quality of life issues will help in developing disease specific symptom control algorithms and early introduction of palliative care. Integrated model and simultaneous and shared care model of palliative care delivery ensures assessment of symptoms early in the course of illness trajectory, continued input throughout treatment and after treatment phase and smooth transition towards palliative care when disease modifying treatment is no more relevant. [11],[12]

  References Top

1.De Boer MF, McCormick LK, Pruyn JF, Ryckman RM, van den Borne BW. Physical and psychosocial correlates of head and neck cancer: A review of the literature. Otolaryngol Head Neck Surg 1999;120:427-6.  Back to cited text no. 1
2.Groenvold M, Petersen MA, Aaronson NK, Arraras JI, Blazeby JM, Bottomley A, et al. The development of the EORTC QLQ-C15-PAL: A shortened questionnaire for cancer patients in palliative care. Eur J Cancer 2006;42:55-64.  Back to cited text no. 2
3.Oliveira KG, von Zeidler SV, Podestá JR, Sena A, Souza ED, Lenzi J, et al. Influence of pain severity on the quality of life in patients with head and neck cancer before antineoplastic therapy. BMC Cancer 2014;14:39.  Back to cited text no. 3
4.Terrell JE, Ronis DL, Fowler KE, Bradford CR, Chepeha DB, Prince ME, et al. Clinical predictors of quality of life in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 2004;130:401-8.  Back to cited text no. 4
5.Pandey M, Devi N, Ramdas K, Krishnan R, Kumar V. Higher distress relates to poor quality of life in patients with head and neck cancer. Int J Oral Maxillofac Surg 2009;38:955-9.  Back to cited text no. 5
6.Lewis S, Salins N, Kadam A, Rao R. Distress screening using distress thermometer in head and neck cancer patients undergoing radiotherapy and evaluation of causal factors predicting occurrence of distress. Indian J Palliat Care 2013;19:88-92.  Back to cited text no. 6
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7.López-jornet P, Camacho-alonso F, López-tortosa J, Palazon T, Rodríguez-gonzales MA. Assessing quality of life in patients with head and neck cancer in Spain by means. J Craniomaxillofacial Surg 2012;40:614-20.  Back to cited text no. 7
8.So WK, Chan RJ, Chan DN, Hughes BG, Chair SY, Choi KC, et al. Quality-of-life among head and neck cancer survivors at one year after treatment-A systematic review. Eur J Cancer 2012;48:2391-408.  Back to cited text no. 8
9.Ojo B, Genden EM, Teng MS, Milbury K, Misiukiewicz KJ, Badr H. A systematic review of head and neck cancer quality of life assessment instruments. Oral Oncol 2012;48:923-37.  Back to cited text no. 9
10.Murphy BA, Ridner S, Wells N, Dietrich M. Quality of life research in head and neck cancer: A review of the current state of the science. Crit Rev Oncol Hematol 2007;62:251-67.  Back to cited text no. 10
11.Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM, et al. American society of clinical oncology provisional clinical opinion: The integration of palliative care into standard oncology care. J Clin Oncol 2012;30:880-7.  Back to cited text no. 11
12.Greer JA, Jackson VA, Meier DE, Temel JS. Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA Cancer J Clin 2013;63:349-63.  Back to cited text no. 12


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