Association between late effects assessed by physicians and quality of life reported by head-and-neck cancer survivors

Figures & data

Table 1. DAHANCA morbidity ratings of selected physician-reported late effects.

DAHANCA late effect	Score	Description
Dysphagia	0	None
	1	Slight, normal food
	2	Moderate, soft food
	3	Considerable, liquid food
	4	Severe, despite liquid food
Xerostomia	0	None
	1	Slight
	2	Moderate
	3	Severe
Hoarseness	0	None
	1	Intermittent
	2	Intermittent but daily
	3	Persistent
	4	Total loss of voice
Fibrosis	0	None
	1	Just palpable
	2	Moderate
	3	Severe

Table 2. Sociodemographic and treatment-related characteristics of 136 HNC survivors.

Variable	n (%)
Sex
Male	105 (77)
Female	31 (23)
Age (years)
Range	41–90
Mean	63
<50	7 (5)
50–59	59 (43)
60–69	54 (40)
70–79	12 (9)
>80	4 (3)
Civil status
Married or cohabitating	103 (76)
Single, divorced or widowed	33 (24)
Education
Short	22 (16)
Medium	51 (38)
Higher	57 (42)
Other/unknown	6 (4)
Smoking
Never	30 (22)
Former	92 (68)
Current	14 (10)
Charlson Comorbidity Index
0	85 (63)
1–2	32 (23)
≥3	19 (14)
Tumor site
HPV-related cancers^a	100 (74)
Others^b	36 (26)
Disease stage
Early	47 (34)
Advanced	88 (65)
Unknown	1 (1)
Treatment
Concurrent chemoradiation	75 (55)
Radiation and surgery	14 (10)
Chemotherapy, radiation and surgery	2 (2)
Radiation only	37 (27)
Surgery only	8 (6)
Time since diagnosis (months)
Mean	21
Range	6–140
6–12	26 (19)
>12–18	45 (33)
>18–24	28 (21)
>24	37 (27)

^aCancers in oropharynx and oral cavity; ^bCancers in glottis larynx, other larynx, hypopharynx, salivary glands and lymph nodes of head, neck or face.

Table 3. Frequency of physician-observed late effects according to DAHANCA-recorded severity in 266 HNC survivors.

	n (%)
DAHANCA score	Dysphagia	Xerostomia	Hoarseness	Fibrosis
No symptoms	79 (30)	25 (9)	102 (38)	61 (23)
Mild	56 (21)	82 (31)	20 (8)	42 (16)
Moderate–severe	12 (4)	32 (12)	16 (6)	41 (15)
Missing	119 (45)	127 (48)	128 (48)	122 (46)

Table 4. Associations between moderate to severe late effects and EORTC QLQ-C30 functioning scales in HNC survivors up to 21 months after treatment.

		Hoarseness (n = 113)				Dysphagia (n = 114)
		Crude β (95% CI)		Adjusted β^a (95% CI)		Crude β (95% CI)		Adjusted β^a (95% CI)
	Mean^b	Mild^c	Moderate–severe^c	Mild^c	Moderate–severe^c	Mild^c	Moderate–severe^c	Mild^c	Moderate–severe^c
Overall quality of life	76	−7 (−19;5)	−15 (−30;0)	−7 (−20;5)	−14 (−32;4)	−13 (−21;−4)	−22 (−38;–7)	−12 (−21;−3)	−16 (−21;−3)
Physical functioning	91	−1 (−10;7)	−17 (−28;−7)	1 (−8;9)	−12 (−24;1)	−4 (−11;3)	−18 (−30;−6)	−1 (−7;6)	−11 (−24;1)
Role functioning	86	2 (−11;15)	−23 (−39;−7)	3 (−10;16)	−15 (−34;4)	−4 (−14;6)	−26 (−44;−8)	0 (−10;10)	−20 (−38;−2)
Emotional functioning	82	−3 (−14;7)	−12 (−26;2)	−3 (−14;8)	−12 (−28;4)	−6 (−14;1)	−21 (−35;−7)	−5 (−13;3)	−19 (−34;−4)
Cognitive functioning	85	−1 (−11;9)	−8 (−21;4)	−1 (−11;9)	−5 (−20;9)	−3 (−10;4)	−2 (−15;12)	−2 (−9;6)	1 (−13;15)
Social functioning	88	−2 (−12;8)	−31 (−44;−19)	−3 (−14;7)	−25 (−41;−10)	−6 (−14;2)	−30 (−44;−16)	−3 (−11;5)	−27 (−41;−13)
		Fibrosis (n = 111)				Xerostomia (n = 114)
		Crude β (95% CI)		Adjusted β^a (95% CI)		Crude β (95% CI)		Adjusted β^a (95% CI)
	Mean^b	Mild^c	Moderate–severe^c	Mild^c	Moderate–severe^c	Mild^c	Moderate–severe^c	Mild^c	Moderate–severe^c
Overall quality of life	76	3 (−7;12)	−10 (−21;1)	5 (−5;15)	−11 (−23;1)	−5 (−18;7)	−10 (−25;4)	−9 (−22;5)	−15 (−29;0)
Physical functioning	91	0 (−7;8)	−4 (−12;4)	1 (−6;9)	−2 (−11;6)	2 (−7;11)	−2 (−13;8)	2 (−8;11)	−1 (−12;10)
Role functioning	86	−2 (−13;9)	−8 (−20;4)	2 (−9;13)	−3 (−16;10)	0 (−14;14)	−3 (−19;14)	1 (−13;15)	0 (−17;16)
Emotional functioning	82	−1 (−9;8)	−3 (−13;7)	−1 (−10;8)	−4 (−15;7)	0 (−13;13)	3 (−8;15)	2 (−9;14)	−2 (−16;11)
Cognitive functioning	85	−4 (−13;4)	−2 (−11;7)	−7 (−15;2)	−4 (−14;6)	−3 (−13;7)	−4 (−15;8)	−3 (−14;8)	−5 (−17;7)
Social functioning	88	−5 (−14;4)	7 (−17;3)	−2 (−12;7)	−5 (−16;6)	1 (−10;12)	−11 (−24;1)	3 (−8;14)	−11 (−24;1)

^aAdjusted for sex, age, education, cohabitation status, time since diagnosis, smoking habits, comorbidity, tumor site, stage of disease, treatment modality, and HPV status; ^bAmong the 136 patients with full data; ^cIn comparison with reference group (no problems).

Mild has a score of 1 on the DAHANCA scoring sheet, and moderate–severe has scores of 2, 3 and 4. The results in bold are significant (p ≤ 0.05).