Health-related quality of life at 3 months following head and neck cancer treatment is a key predictor of longer-term outcome and of benefit from using the patient concerns inventory

Abstract

Introduction: During clinical follow-up it can be difficult to identify those head and neck cancer (HNC) patients who are coping poorly and could benefit from additional support. Health-related quality of life (HRQOL) questionnaires and prompt lists provide a means by which patients can express their perceived outcomes and raise concerns. The first aim of this secondary analysis following a randomized trial was to explore which patient characteristics, at around 3 months following treatment completion (baseline), best predict HRQOL 12 months later. The second aim was to attempt to ascertain which patients were most likely to benefit from using prompt list.

Methods: Cluster-controlled pragmatic trial data were analyzed. HRQOL was measured by the University of Washington Quality of life questionnaire (UW-QOLv4). The prompt list was the Patient Concerns Inventory (PCI-HN).

Results: The trial involved 15 eligible consultants and a median (inter-quartile range) of 16 (13-26) primary HNC patients per consultant, with 140 PCI patients and 148 controls. Baseline HRQOL was the dominant predictor of 12-month HRQOL with other predictors related to social, financial, and lifestyle characteristics as well as clinical stage and treatment. Although formal statistical tests for interaction were non-significant the trend in analyses over a range of outcomes suggested that patients with worse baseline HRQOL could benefit more from the PCI-HN.

Discussion: HRQOL early post-treatment is a key predictor of longer-term outcome. Measuring and using HRQOL and the PCI-HN are not only surrogates for predicting HRQOL at 15 months post-treatment, but also tools to help guide interventions.

Trial registration: ClinicalTrials.gov NCT03086629.

Keywords: head and neck cancer; health-related quality of life; patient concerns inventory.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Figures

FIGURE 1

Main trial HRQOL outcomes at 12 months, by predictions of HRQOL and trial arm. *From stepwise logistic regression (overall QOL & DT) and linear regression (subscale scores) analyses of outcome on the predictor variables of Table 1 (omitting unknowns apart from income). For the subscale scores an asterisk * represents a value more than 3 box lengths from the upper or lower edge of the box, while a circle O marks a value between 1.5 and 3 box lengths away from the box. 95% CI, approximate 95% confidence interval; DT, Distress Thermometer; HRQOL, health‐related quality of life

FIGURE 2

Number of 12‐month UWQOL dysfunction outcomes by baseline status and trial arm. From linear regression analysis using bootstrapping methods (5000 replications) the PCI effect was significant (p = 0.013) on the number of dysfunctional domains per patient at 12 months after adjusting for baseline number of dysfunctional domains (0, 1, 2, 3–4, 5–12). 95% CI: approximate 95% confidence interval number of patients at baseline with: 0 dysfunctional domains (27 PCI, 30 no PCI), 1 dysfunction (33 PCI, 33 no PCI), 2 dysfunctions (18 PCI, 17 no PCI), 3–4 dysfunctions (15 PCI, 12 no PCI), and 5–12 dysfunctions (7 PCI, 13 no PCI). PCI, Patient Concerns Inventory; UW‐QOLv4, University of Washington Quality of life questionnaire

FIGURE 3

Main trial HRQOL outcomes at 12 months, by number of PCI items selected at baseline. For the subscale scores a circle O marks a value between 1.5 and 3 box lengths away from the box. 95% CI, approximate 95% confidence interval; HRQOL, health‐related quality of life; PCI, Patient Concerns Inventory