Rehabilitation and Quality of Life Assessment in Head and Neck Cancer

BHUVANESH SINGH, MD

In 1947, the World Health Organization (WHO) expanded its definition of health beyond the "absence of disease and infirmity," to include the "state of physical, mental, and social being." This milestone change in connotation elevated the study of health-related quality of life to an accepted endpoint for clinical studies and promulgated investigator interest.1,2 Reflecting its increased use in medical studies, quality of life was introduced as a category in the Index Medicus in 1966.1 Since then, the number of health-related quality of life publications had grown exponentially in the medical literature (Figure 23-1).

Of all disease states, the role of quality of life (QOL) assessment is most persuasively essential in patients with cancer. Stressing this importance, the National Institutes of Health and the Food and Drug Administration implemented several initiatives to encourage the more routine inclusion of the QOL assessment in oncology trials. As a result, the number of quality of life related studies in oncology burgeoned in the medical literature (see Figure 23-1). In sequence, QOL also became important in the management of head and neck cancer (HNC), particularly given the multitude of QOL-associated problems and the absence of survival differences between therapeutic modalities used in the treatment of these patients.3-5 The comment made by Hays Martin in the 1940s remains valid today: "In deciding a method of treatment we should not, in our eagerness to achieve cure, lightly disregard the crippling that may result from our surgical endeavors."3-5

In conformity with this statement, studies have shown that patients are willing to sacrifice survival in favor of QOL issues.6 List and colleagues have shown that in order of preference, patients with head and neck cancer rank being cured first, followed by living as long as possible, having no pain, being able to swallow, and having a normal amount of energy at the top end of their desired outcomes from cancer treatment.7 This chapter presents an overview of QOL assessment in patients with HNC and reviews its impact on treatment, rehabilitation, and support policies in head and neck cancer management.

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