Quality of Life Measures in Head and Neck Cancer

  • C. D. Llewellyn
Reference work entry


Quality of life (QOL) is an important patient reported outcome (PRO) in head and neck cancer (HNC) where survival rates remain at approximately 50% overall. HNC specific  Health Related Quality of Life (HR-QOL) instruments typically measure aspects of communication, swallowing, chewing, nutrition and cosmesis. Nine disease specific HR-QOL instruments have been published for patients with HNC focusing on a range of treatments and outcomes. Treatment for HNC results in medium term morbidity and depression, much of which has been shown to improve within 1 year. There is no clear evidence for the impact of disease and treatment on PROs such as QOL. The emotional sequelae and perception of physical limitations may be more important to the patient than the actual limitations resulting from HNC and treatment. This chapter highlights the insensitivity of general measures of HR-QOL to accurately illustrate HNC specific problems or treatment related effects. The majority of published studies do not interpret HR-QOL scores in terms of clinical relevance. Using a global or total score for examining effects of treatment induced change may not be appropriate for this patient group. Further research is needed into the potentially modifiable aspects of QOL or modifiable factors related to PROs in order to design appropriate interventions.


Neck Dissection Sticky Saliva 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:


cancer rehabilitation evaluation system – short form


the center for epidemiologic studies depression scale


The European Organisation for Research into Treatment of Cancer


The European Organisation for Research into Treatment of Cancer Quality of Life Questionnaire & Head and Neck Cancer specific module


the functional assessment of cancer therapy general scale


the functional assessment of cancer therapy head and neck scale


general health questionnaire


head and neck


head and neck cancer


the head and neck radiotherapy questionnaire


The University of Michigan head and neck quality of life questionnaire


health related quality of life


International Classification of Diseases


nodal status


 neck dissection


patient generated index


patient reported outcome


performance status scale for head & neck cancer


the quality of life instrument for head and neck cancer


the quality of life questionnaire for advanced head and neck cancer


quality of life


the quality of life – radiation therapy instrument/head and neck module




short form health survey (12-item)


short form health survey (36-item)


tumor stage


The University of Washington quality of life questionnaire


World Health Organisation


  1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JCJM, Kaasa S, Klee M, Osaba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F. (1993). J Natl Cancer Inst. 85: 365–376.PubMedCrossRefGoogle Scholar
  2. Allal AS, Nicoucar K, Mach N, Dulguerov P. (2003). Head Neck. 25: 833–840.PubMedCrossRefGoogle Scholar
  3. Allison PJ, Locker D, Wood-Dauphinee S, Black M, Feine JS. (1998). Qual Life Res. 7:713–722.Google Scholar
  4. Bjordal K, Ahlner-Elmqvist M, Hammerlid E, Boysen M, Evensen JF, Biorklund A, Jannert M, Westin T, Kaasa S. (2001). Laryngoscope. 111: 1440–1452.PubMedCrossRefGoogle Scholar
  5. Bjordal K, Ahlner-Elmqvist M, Tollesson E, Jensen AB, Razavi D, Maher EJ, Kaasa S. (1994a). Acta Oncol. 33: 879–885.PubMedCrossRefGoogle Scholar
  6. Bjordal K, de Graeff A, Fayers PM, Hammerlid E, van Pottelsberghe C, Curran D, Ahlner-Elmqvist M, Maher EJ, Meyza JW, Brédart A, Söderholm AL, Arraras JJ, Feine JS, Abendstein H, Morton RP, Pignon T, Huguenin P, Bottomly A, Kaasa S. (2000). Eur J Cancer. 36: 1796–1807.PubMedCrossRefGoogle Scholar
  7. Bjordal K, Hammerlid E, Ahlner-Elmqvist M, de Graeff A, Boysen M, Evensen JF, Biorklund A, de Leeuw RJ, Fayers PM, Jannert M, Westin T, Kaasa S. (1999). J Clin Oncol. 17: 1008–1019.PubMedGoogle Scholar
  8. Bjordal K, Kaasa S. (1995). Brit J Cancer. 71: 592–597.PubMedCrossRefGoogle Scholar
  9. Bjordal K, Kaasa S, Mastekaasa A. (1994b). Int J Radiat Oncol. 28: 847–856.CrossRefGoogle Scholar
  10. Browman GP, Levine MN, Hodson DI, Sathya J, Russell R, Skingley P, Cripps C, Eapen L, Girard A. (1993). J Clin Oncol. 11: 863–872.PubMedGoogle Scholar
  11. Cancer Statistics. (2004). Registrations of cancer diagnosed in 2004, England. Series MB1, (Rep. No. 35). HMSO, London.Google Scholar
  12. Carvalho AL, Nishimoto IN, Califano JA, Kowalski LP. (2005). Int J Cancer. 114: 806–816.PubMedCrossRefGoogle Scholar
  13. Cella DF. (1994). Manual for the Functional Assessment of Cancer Therapy (FACT) Measurement system Rush Medical Center, Chicago.Google Scholar
  14. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J. (1993). J Clin Oncol. 11: 570–579.PubMedGoogle Scholar
  15. D’Antonio LL, Zimmerman GJ, Cella DF, Long SA. (1996). Arch Otolaryngol. 122: 482–487.Google Scholar
  16. De Boer MF, McCormick LK, Pruyn JF, Ryckman RM, van den Borne BW. (1999). Otolaryng Head Neck. 120: 427–436.CrossRefGoogle Scholar
  17. De Boer MF, Pruyn JFA, Van den BB, Knegt PP, Ryckman RM, Verwoerd CDA. (1995). Head Neck. 17: 503–515.PubMedCrossRefGoogle Scholar
  18. de Graeff A, de Leeuw JR, Ros WJ, Hordijk GJ, Blijham GH, Winnubst JA. (1999). Oral Oncol. 35: 27–32.PubMedCrossRefGoogle Scholar
  19. de Graeff A, de Leeuw JR, Ros WJ, Hordijk GJ, Blijham GH, Winnubst JA. (2000). Laryngoscope. 110: 98–106.PubMedCrossRefGoogle Scholar
  20. Deleyiannis FW, Weymuller EA Jr, Coltrera MD, Futran N. (1999). Head Neck. 21: 319–324.PubMedCrossRefGoogle Scholar
  21. Deleyiannis FWB, Weymuller EA, Coltrera MD. (1997). Head Neck. 19: 466–473.PubMedCrossRefGoogle Scholar
  22. Derks W, de Leeuw JR, Hordijk G, Winnubst JA. (2003). Clin Otolaryngol All. 28: 399–405.CrossRefGoogle Scholar
  23. Dropkin MJ. (1998). ORL Head Neck Nurs. 16: 22–23.PubMedGoogle Scholar
  24. Epstein JB, Emerton S, Kolbinson DA, Le ND, Phillips N, Stevenson-Moore P, Osoba D. (1999). Head Neck. 21: 1–11.PubMedCrossRefGoogle Scholar
  25. Goldberg D, Williams P. (1988). A user’s guide to the General Health Questionnaire. NFER-NELSON Publishing Company Ltd, Windsor, Berkshire.Google Scholar
  26. Gotay CC, Moore TD. (1992). Qual Life Res. 1: 5–17.PubMedCrossRefGoogle Scholar
  27. Gritz E, Carmack C, de Moor C, Coscarelli A, Schacherer C, Meyers E, Abemayor E. (1999). J Clin Oncol. 17: 352–360.PubMedGoogle Scholar
  28. Hammerlid E, Bjordal K, Ahlner-Elmqvist M, Boysen M, Evensen JF, Biorklund A, Jannert M, Kaasa S, Sullivan M, Westin T. (2001). Laryngoscope. 111: 669–680.PubMedCrossRefGoogle Scholar
  29. Hammerlid E, Taft C. (2001). Br J Cancer. 84: 149–156.PubMedCrossRefGoogle Scholar
  30. Hassan SJ, Weymuller EA Jr. (1993). Head Neck. 15: 485–496.PubMedCrossRefGoogle Scholar
  31. Henson BS, Inglehart MR, Eisbruch A, Ship JA. (2001). Oral Oncol. 37: 84–93.PubMedCrossRefGoogle Scholar
  32. Hjermstad M, Fayers P. (1998a). J Clin Oncol. 16: 1188–1196.PubMedGoogle Scholar
  33. Hjermstad M, Fayers P. (1998b). Eur J Cancer. 34: 1381–1389.PubMedCrossRefGoogle Scholar
  34. Kohda R, Otsubo T, Kuwakado Y, Tanaka K, Kitahara T, Yoshimura K, Mimura M. (2005). Psychooncol. 14: 331–336.CrossRefGoogle Scholar
  35. Kuntz AL, Weymuller EA Jr. (1999) Larynygoscope. 109:1334–1338.Google Scholar
  36. Ledeboer QCP, van der Velden LA, De Boer MF, Feenstra L, Pruyn JFA. (2005). Clin Otolaryngol. 30: 303–319.PubMedCrossRefGoogle Scholar
  37. Lin A, Hyungjin MK, Terrell JE, Dawson LA, Ship JA, Eisbruch A. (2003). Int J Radiat Oncol. 57: 61–70.CrossRefGoogle Scholar
  38. List MA, D’Antonio LL, Cella DF, Siston A, Mumby P, Haraf D, Vokes E. (1996). Cancer. 77: 2294–2301.PubMedCrossRefGoogle Scholar
  39. List MA, Siston A, Haraf D, Schumm P, Kies M, Stenson K, Vokes EE. (1999). J Clin Oncol. 17: 1020–1028.PubMedGoogle Scholar
  40. List MA, Stracks J. (2000). Curr Opin Oncol. 12: 215–220.PubMedCrossRefGoogle Scholar
  41. List MA, Stracks J, Colangelo L, Butler P, Ganzenko N, Lundy D, Sullivan P, Haraf D, Kies M, Goodwin W, Vokes EE. (2000). J Clin Oncol. 18: 877–884.PubMedGoogle Scholar
  42. Llewellyn CD, McGurk M, Weinman J. (2005). Oral Oncol. 41: 440–454.PubMedCrossRefGoogle Scholar
  43. Llewellyn CD, McGurk M, Weinman J. (2006). Brit J Oral Max Surg. 44: 351–357.CrossRefGoogle Scholar
  44. Lloyd S, Devesa-Martinez P, Howard DJ, Lund VJ. (2003). Clin Otolaryngol. 28: 524–532.PubMedCrossRefGoogle Scholar
  45. Long SA, D’Antonio LL, Robinson EB, Zimmerman G, Petti G, Chonkich G. (1996). Laryngoscope. 106: t-8.CrossRefGoogle Scholar
  46. McNeil BJ, Weichselbaum R, Pauker SG. (1981). New Engl J Med. 305: 982–987.PubMedCrossRefGoogle Scholar
  47. Morton RP. (2003). Laryngoscope. 113: 1091–1103.PubMedCrossRefGoogle Scholar
  48. Morton RP, Witterick IJ. (1995). Am J Otolaryngol. 16: 284–293.PubMedCrossRefGoogle Scholar
  49. National Statistics Online. (2007). Cancer Incidence and mortality in the UK 2002–2004, office for National Statistics (ONS), United Kingdom.Google Scholar
  50. Pourel N, Peiffert D, Lartigau E, Desandes E, Luporsi E, Conroy T. (2002). Int J Radiat Oncol. 54: 742–751.CrossRefGoogle Scholar
  51. Rathmell AJ, Ash DV, Howes M, Nicholls J. (1991). Clin Oncol. 3: 10–16.CrossRefGoogle Scholar
  52. Ringash J, Bezjak A. (2001). Head Neck. 23: 201–213.PubMedCrossRefGoogle Scholar
  53. Rogers SN, Ahad SA, Murphy AP. (2007). Oral Oncol. 43: 843–868.PubMedCrossRefGoogle Scholar
  54. Rogers SN, Fisher SE, Woolgar JA. (1999a). Int J Oral Max Surg. 28: 99–117.CrossRefGoogle Scholar
  55. Rogers SN, Hannah L, Lowe D, Magennis P. (1999b). J Cranio Maxillofac Surg. 27: 187–191.CrossRefGoogle Scholar
  56. Rogers SN, Laher SH, Overend L, Lowe D. (2002). J Cranio Maxillofac Surg. 30: 125–132.CrossRefGoogle Scholar
  57. Rogers SN, Lowe D, Brown JS, Vaughan ED. (1998). Oral Oncol. 34: 361–372.PubMedCrossRefGoogle Scholar
  58. Rogers SN, Lowe D, Humphris G. (2000). Oral Oncol. 36: 529–538.PubMedCrossRefGoogle Scholar
  59. Ruta D, Garratt A, Russell I. (1999). Qual Health Care. 8: 22–29.PubMedCrossRefGoogle Scholar
  60. Schwartz S, Patrick DL, Yueh B. (2001). Arch Otolaryngol. 127: 673–678.Google Scholar
  61. Sehlen S, Hollenhorst H, Lenk M, Schymura B, Herschbach P, Aydemir U, Duhmke E. (2002). Int J Radiat Oncol. 52: 779–783.CrossRefGoogle Scholar
  62. Slevin ML, Stubbs L, Plant HJ. (1990). BMJ. 300: 1458–1460.PubMedCrossRefGoogle Scholar
  63. Stoeckli SJ, Guidicelli M, Schneider A, Huber A, Schmid S. (2001). Eur Arch Oto-Rhino-Laryngol. 258: 96–99.CrossRefGoogle Scholar
  64. Taylor RJ, Chepeha JC, Teknos TN, Bradford CR, Sharma PK, Terrell JE, Hogikyan ND, Wolf GT, Chepeha DB. (2002). Arch Otolaryngol. 128: 44–49.Google Scholar
  65. Terrell JE. (1999). Hematol Oncol Clin North Am. 13: 849–865.PubMedCrossRefGoogle Scholar
  66. Terrell JE, Nanavati K, Esclamado RM, Bradford CR, Wolf GT. (1999). Otolaryngol Head Neck. 120: 852–859.CrossRefGoogle Scholar
  67. Terrell JE, Nanavati KA, Esclamado RM, Bishop JK, Bradford CR, Wolf GT. (1997). Arch Otolaryngol. 123: 1125–1132.Google Scholar
  68. Terrell JE, Welsh DE, Bradford CR, Chepeha DB, Esclamado RM, Hogikyan ND, Wolf GT. (2000). Laryngoscope. 110: 620–626.PubMedCrossRefGoogle Scholar
  69. Trotti A, Johnson DJ, Gwede C, Casey L, Sauder B, Cantor A, Pearlman J. (1998). Int J Radiat Oncol. 42: 257–261.Google Scholar
  70. Ware JE, Kosinski M, Keller SD. (1996). Med Care. 34: 220–233.PubMedCrossRefGoogle Scholar
  71. Ware JE, Sherbourne DC. (1992). Med Care. 30: 473–483.PubMedCrossRefGoogle Scholar
  72. Welsh Cancer Intelligence and Surveillance Unit. (2005). Publication SA6/02 Cancer Incidence in Wales 2001–2005.Google Scholar
  73. Weymuller EA Jr, Yueh B, Deleyiannis FW, Kuntz AL, Alsarraf R, Coltrera MD. (2000). Laryngoscope. 110: t-7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • C. D. Llewellyn

There are no affiliations available

Personalised recommendations