Does quality of life predict long-term survival in patients with head and neck cancer?

To assess whether pretreatment and posttreatment quality of life (QOL) is associated with long-term survival in patients with head and neck cancer.

Ten-year follow-up of an inception cohort.

Regional tertiary referral center.

The study included 200 consecutive patients with primary epithelial head and neck cancer.

Quality of life and several recognized risk factors for death were assessed prospectively using the Auckland QOL questionnaire before treatment and 12 months after treatment; survival was determined at 10 years.

Survival and odds of death (hazards ratio) were measured.

At 10 years, 136 patients (68%) were deceased, 48 patients (24%) were alive, and the status of 16 patients (8%) was unknown. Median survival was 6 years (interquartile range, 4.4-7.7). Before treatment, patients with low QOL had no significantly increased odds of death (hazard ratio, 1.4; 95% confidence interval, 0.8-2.4). In contrast, after treatment, patients with low QOL at 1 year had significantly increased odds of death (2.5; 95% confidence interval, 1.4-4.3; P = .001) even after adjustment for covariates.

Findings suggest potential survival benefits from improvements in QOL. However, the observed associations between survival benefit and QOL at 1 year may be confounded by comorbidity, which was not measured and deserves further investigation.