Clinical and psychosocial factors associated with quality of life in patients with head and neck cancer: an analytical cross-sectional study from a lower-middle-income country

Abstract

Introduction The disease course of head and neck (H&N) cancer can severely impair patients’ quality of life (QoL). In Pakistan, a South Asian lower-middle-income country (LMIC), psychosocial factors may impact QoL. We aimed to assess QoL and associated factors amongst patients with H&N cancer in Pakistan. Methods An analytical cross-sectional study was conducted amongst adult (≥ 18 years) patients with H&N cancer who were ≥ 4 weeks post-initiation of treatment. The survey assessed QoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaires), anxiety and depression (Hospital Anxiety and Depression Scale), and social support (Enriched Social Support Instrument). Multivariable linear regression was performed for analysis. Results A total of 250 patients (mean age: 51.6 years) were included. The majority of patients were married (87%) and living with multigenerational/extended family households (53%). On multivariable linear regression, ongoing cancer treatment (beta coefficient: -13.93), having a tracheostomy (-10.02), and receiving adjuvant chemoradiotherapy (-8.17) were significantly associated with poorer global QoL. Additionally, poorer QoL was associated with depression (-24.37) and anxiety (-13.34). However, having more household family members was associated with better global QoL (0.34). Conclusion The QoL of patients with H&N cancer in Pakistan is affected by both the nature of cancer treatment as well as sociocultural factors such the number of household family members. Given that poorer QoL is associated with worse mental health outcomes, there is a need to develop and implement psychosocial interventions to improve the QoL of patients with H&N cancer in Pakistan, particularly during active treatment.

Oral health related quality of life in head and neck cancer survivors within the first year following treatment: a cross-sectional study in Karachi, Pakistan

“…These findings were consistent with a study conducted to evaluate the OHRQoL using the OHIP tool, which reported a significant difference in the OHRQoL score in patients with varying degrees of oral mucositis compared to patients without it 26 Nevertheless, it is noteworthy that 52% of the patients experiencing moderate to severe OM symptoms had concluded their cancer treatment over six months ago. This finding is unexpected, given the studies have reported that symptoms of OM typically abate or become mild within a three-month period following cancer treatment 19 , 36 . A significant association between the oral mucositis severity and use of fluoride was also observed, suggesting improvement in the OHRQoL due to decrease in the severity of mucositis by the use of fluoride toothpaste, this is also supported by 37 which recommended that the use of high fluoride tooth paste, fluoride gel or fluoride mouthwash prescribed to patients during and after their cancer treatment could reduce the severity of mucosal inflammation.…”