Structured assessment of the consequences of composite resection

A structured quality of life questionnaire was developed as an instrument for the assessment of the functional, physical, psychosocial, and counselling problems in patients treated surgically for an oropharyngeal cancer. The questionnaire was tested in a pilot study in a relatively homogeneous group of 15 selected patients (all of whom had a comparable surgical defect, i.e. a composite resection of the oropharynx and neck, and had undergone an identical reconstruction method, i.e. a pedicled pectoralis major myocutaneous flap). All but two patients were irradiated as well. A high reliability (Crombach's alpha) was found in most of the applied subscales, indicating good internal consistency of the different questions. Significant correlations were found between several quality of life dimensions. The most frequently reported complaints concerned problems related to eating, speaking, and facial disfigurement. Problems with mastication, oral transport, and swallowing prohibited 11 patients returning to their normal diet. Regarding speech, 11 patients reported decreased intelligibility, in eight this was due to some degree of rhinolalia aperta. A significant association was found between moderate intelligibility and anxiety about speaking in public (P < 0.05). Eleven patients felt that the surgery had caused considerable facial disfigurement. For five of them this had a negative influence on their social interactions and activities outdoors. Thus, the consequences of the surgical treatment of oropharyngeal cancer can be assessed in a systematic and formal way with this specially designed structured questionnaire. Despite the small sample size, the selection of a homogeneous patient group appeared to give significant information, and to establish meaningful correlations.