In recent years there has been an increase in the rate of oropharyngeal cancers. This is attributed to the human papillomavirus (HPV) epidemic. Though the survival rate of those with HPV-related oropharyngeal cancer (OPC) is better than those with OPC related to tobacco and alcohol use, what is the quality of life (QoL) for those that survive? A systematic review and meta-analysis published in 2017 in the European Journal of Cancer aimed to review current literature regarding “patient-reported QoL at follow-up at least 1 year after treatment for OPC” as well as determine which QoL domains are affected by treatment.1
The literature search provided 4959 studies of which 41 met the criteria for inclusion. Among the 41 studies the authors used the studies with the four most frequently used QoL instruments. . The authors ended up with 39 QoL questionnaires from 25 different studies, based in 12 countries that were published no earlier than 1997.
The most commonly reported impairments in QoL were eating, saliva (lack of and consistency; sticky saliva), chewing, swallowing, speech, taste, and appearance. Though some questionnaires/methods showed QoL scores were not much different from OPC survivors and the general population, this is attributed to “response shift” which is defined as “the subjective reconceptualization of life quality.” Patients may reprioritize QoL over the course of disease. Other studies caution that this should not be considered equivalent to the sum of individual scores. These studies point to the statistic that the suicide rate among patients with OPC is five times higher than that of the general population.
Further areas identified as deteriorating QoL after 12 months post treatment included problem with senses, appetite loss, fatigue, pain, and physical limitations. Financial difficulties, though not as significant as the previous mentioned parameters, it was more significant than many of the other parameters evaluated regarding QoL.
Additionally, many patients recently diagnosed with OPC experience high levels of emotional distress, therefore a return to “pre-treatment” QoL may not reflect the same QoL as “pre-disease” QoL. The authors cite several limitations as well stating many of the studies excluded patients with recurrence which could have inflated QoL scores, limited number of studies available for comparison, small sample sizes and follow-up response rate, as well as treatment changes through the years.
He authors conclude by stating, ”QoL at least 1 year after treatment for OPC is comprised by several clinically important problems centered on xerostomia, dysphagia and chewing. Patients nevertheless show a capacity for achieving a self-rated global QoL comparable to that of the general population, potentially because of response-shift. As of yet, there is insufficient evidence in the literature to meta-analyze the role of HPV-positivity on QoL. Inter-study comparisons are currently restricted by the heterogeneity of disease parameters, treatment methods and outcome measures, but randomized, multi-center trials are being established that stratify patients based on HPV-status and include QoL as an endpoint in the evaluation of treatment modalities.”
Have you had patients that are survivors of OPC? What is their QoL? Do they struggle with xerostomia, dysphagia and chewing? How do you help these patients manage these issues?
- Høxbroe Michaelsen S, Grønhøj C, Høxbroe Michaelsen J, Friborg J, von Buchwald C. Quality of life in survivors of oropharyngeal cancer: A systematic review and meta-analysis of 1366 patients. Eur J Cancer. 2017 Jun;78:91-102. doi: 10.1016/j.ejca.2017.03.006. Epub 2017 Apr 18. PMID: 28431302.