Long-term Quality of Life Outcomes in Head and Neck Cancer Survivors

Abstract

Aim: Understanding the impact of head and neck cancer on quality of life is crucial for enhancing survivor well-being. This study aims to explore regional-specific outcomes using patient-reported outcome measures (PROMS), which have not been extensively studied locally. It also seeks to provide a current perspective on quality of life amidst the evolving landscape of head and neck cancer. Head and neck cancer is a diverse disease with evolving etiological factors. As the population ages, age-related cancers will increase, posing challenges alongside comorbidities in cancer care. Unique challenges arise from younger patients with human papillomavirus (HPV)-related oropharyngeal cancer surviving longer with treatment-related toxicities, straining healthcare services. Method: This mixed-methods observational study includes a retrospective clinical records audit and a prospective cross-sectional online survey. Ethical approval was obtained from Auckland Health Research Ethics Committee (Application No. AH25628). Findings: In the Greater Wellington Region, the majority were male (72%) and over 50 years old, with 45% aged 51-70 and 42% over 71. New Zealand Europeans comprised 70%, followed by New Zealand Māori (9%). Many patients (44%) travelled over 50 kilometres for treatment, primarily referred by public medical professionals (94%). Predominant cancer sites included skin (36%), oral cavity (32%), and oropharynx (21%), often diagnosed at advanced stages. Treatment often involved multimodal approaches, with a high prevalence of P16+ positive oropharyngeal cancers treated with radiation (91%). Quality of life assessments revealed a mean score of 102 out of 148 on the FACT-HNC scale, indicating relatively good quality of life. Challenges persisted with voice disorders (mean VHI-10 score 6/40) and depression (HADS mean 18%). Fear related to physical appearance was evident (mean FNAES score 9/30). Utilisation of supportive services highlighted significant reliance on dental, dietetics, and speech-language therapy, with psychological support identified as the most desired service. Specialist cancer care providers were most frequently perceived as helpful. Conclusions: This study provides critical insights into challenges faced by head and neck cancer survivors in the Greater Wellington Region, Aotearoa New Zealand. Addressing these and advocating for tailored support services can enhance survivorship experiences and outcomes. Collaborative efforts across healthcare sectors are essential to meet evolving patient needs effectively.