Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Oral Health
Published in: BMC Oral Health 1/2019

Open Access 01-12-2019 | Oral Cancer | Research article

Health-related quality of life: a retrospective study on local vs. microvascular reconstruction in patients with oral cancer

Authors: J. K. Meier, J. G. Schuderer, F. Zeman, Ch. Klingelhöffer, M. Hullmann, G. Spanier, T. E. Reichert, T. Ettl

Published in: BMC Oral Health | Issue 1/2019

Login to get access

Abstract

Background

New medicinal and surgical oncological treatment strategies not only improve overall survival rates but continually increase the importance of Health-Related Quality of Life (HRQOL). The purpose of this retrospective cross-sectional study was to analyze HRQOL of patients with oral squamous cell carcinoma after ablative surgery and to evaluate predictive factors for HRQOL outcome.

Methods

The study included 88 patients with histologically confirmed oral squamous cell carcinoma of whom 42 had undergone local reconstruction (LR) and 46 microvascular reconstruction (MVR). During follow-up, all patients completed the University of Washington Quality of Life Questionnaire (UW-QOL) containing 12 targeted questions about the head and neck. Descriptive analyses were made for the tumor site, the T-stage, and adjuvant therapies. HRQOL was compared between the LR and the MVR group with parametric tests. Further analyses were impact of the tumor site, the T-status, and the time from surgery to survey on HRQOL. Statistics also included multivariate correlations and different interaction effects.

Results

HRQOL in the LR group was ‘very good’ with 84.3 ± 13.7 and ‘good’ in the MVR group with 73.3 ± 16.5 points. The physical domains swallowing (p = 0.00), chewing (p = 0.00), speech (p = 0.01), taste (p = 0.01), and pain (p = 0.04) were significantly worse in the MVR group. An increase in the T-status had a significant negative effect on swallowing (p = 0.01), chewing (p = 0.01), speech (p = 0.03), recreation (p = 0.05), and shoulder (p = 0.01) in both groups. Regarding the tumor site and subsequent loss of HRQOL, patients with squamous cell carcinoma on the floor of the mouth had significantly worse results in the categories pain (p = 0.002), speech (p = 0.002), swallowing (p = 0.03), activity (p = 0.02), and recreation (p = 0.01) than patients with tumors in the buccal mucosa. Speech (p = 0.03) and pain (p = 0.01) had improved 1 year after surgery.

Conclusion

Patients with flap reconstruction because of oral squamous cell carcinoma showed very good overall HRQOL. Outcomes for microvascular reconstruction were good, even in the case of larger defects. The T-status is a predictor for HRQOL. Swallowing, chewing, speaking, taste, and pain were the most important issues in our cohort.
Implementing HRQOL questionnaires for the assessment of quality of life could further increase the treatment quality of patients with oral cancer.
Literature
1.
Bakas T, Mclennon SM, Carpenter JS, et al. Systematic review of health-related quality of life models. Health Qual Life Outcomes. 2012;10(1):134.CrossRef
2.
Chandu A, Smith AC, Rogers SN. Health-related quality of life in Oral Cancer: a review. J Oral Maxillofac Surg. 2006;64(3):495–502.CrossRef
3.
Renneberg B, Lippke S. Lebensqualität. In: Renneberg B, Hammelstein P, editors. (Hrsg.) Gesundheitspsychologie. Heidelberg: Springer Medizin verlag; 2012. p. 29–33.
4.
Rogers SN, Hannah L, Lowe D, Magennis PJ. Quality of life 5-10 years after primary surgery for oral and oro-pharyngeal cancer. J Craniomaxillofac Surg. 1999;27(3):187–91.CrossRef
5.
Borggreven PA, Aaronson NK, IMV-D L, et al. Quality of life after surgical treatment for oral and oropharyngeal cancer: a prospective longitudinal assessment of patients reconstructed by a microvascular flap. Oral Oncol. 2007;43(10):1034–42.CrossRef
6.
Cella DF, Tulsky DS. Measuring quality of life today: methodologic aspects. Oncology. 1990;4(5):29–38.PubMed
7.
Rogers SN, Lowe D, Brown JS, Vaughan ED. The University of Washington head and neck cancer measure as a predictor of outcome following primary surgery for oral cancer. Head Neck. 1999;21(5):394–401.CrossRef
8.
Murphy BA, Ridner S, Wells N, et al. Quality of life research in head and neck cancer: a review of the current state of the science. Crit Rev Oncol Hematol. 2007;62(3):251–67.CrossRef
9.
Canis M, Weiss BG, Ihler F, Hummers-Pradier E, Matthias C, Wolff HA. Quality of life in patients after resection of pT3 lateral tongue carcinoma: microvascular reconstruction versus primary closure. Head Neck. 2015;38(1):89–94.CrossRef
10.
Schliephake H, Jamil M. Prospective evaluation of quality of life after oncologic surgery for oral cancer. Int J Oral Maxillofac Surg. 2002;31(4):427–33.CrossRef
11.
Hanasono MM, Friel MT, Klem C. Impact of reconstructive microsurgery in patients with advanced oral cavity cancers. Head Neck. 2009;31:1289–96.CrossRef
12.
Mcconnel FMS, Pauloski BR, Logemann JA, et al. Functional results of primary closure vs flaps in Oropharyngeal reconstruction. Arch Otolaryngol Head Neck Surg. 1998;124(6):625.CrossRef
13.
Peisker A, Raschke G, Guentsch A, Roshanghias K, Eichmann F, Schultze-Mosgau S. Longterm quality of life after oncologic surgery and microvascular free flap reconstruction in patients with oral squamous cell carcinoma. Med Oral Patol Oral Cir Bucal. 2016;21(4):e420–4.PubMedPubMedCentral
14.
Urken ML, Moscoso JF, Lawson W, Biller HF. A systematic approach to functional reconstruction of the Oral cavity following partial and Total Glossectomy. Arch Otolaryngol Head Neck Surg. 1994;120(6):589–601.CrossRef
15.
Nakatsuka T, Harii K, Asato H, et al. Analytic review of 2372 free flap transfers for head and neck reconstruction following cancer resection. J Reconstr Microsurg. 2003;19:363–36.CrossRef
16.
Sobin LH, Compton CC. TNM seventh edition: Whats new, whats changed. Cancer. 2010;116(22):5336–9.CrossRef
17.
AWMF. Leitlinienprogramm Onkologie; Deutsche Krebsgesellschaft e.V., deutsche Krebshilfe e.V., S3 Leitlinie Mundhöhlenkarzinom. 2012.
18.
Rogers S, Laher S, Overend L, Lowe D. Importance-rating using the University of Washington Quality of life questionnaire in patients treated by primary surgery for oral and oro-pharyngeal cancer. J Cranio-Maxillofac Surg. 2002;30(2):125–32.CrossRef
19.
Rogers SN, Gwanne S, Lowe D, Humphris G, Yueh B, Weymuller EA. The addition of mood and anxiety domains to the University of Washington quality of life scale. Head Neck. 2002;24(6):521–9.CrossRef
20.
21.
Chinn SB, Myers JN. Oral cavity carcinoma: current management, controversies, and future directions. J Clin Oncol. 2015;33(29):3269–79.CrossRef
22.
De Witt CA, de Bree R, Verdonck-de Leeuw IM, Quak JJ, Leemans CR. Donor site morbidity of the fasciocutaneous radial forearm flap: what does the patient really bother? Eur Arch Otorhinolaryngol. 2007;264(8):929–34.CrossRef
23.
Arganbright JM, Tsue TT, Girod DA, et al. Outcomes of the Osteocutaneous radial forearm free flap for mandibular reconstruction. JAMA Otolaryngol Head Neck Surg. 2013;139(2):168–72.CrossRef
24.
Kim D, Orron DE, Skillman JJ. Surgical significance of popliteal arterial variants. A unified angiographic classification. Ann Surg. 1989;210:776–81.CrossRef
25.
Momoh AO, Yu P, Skoracki RJ, Liu S, Feng L, Hanasono MM. A prospective cohort study of fibula free flap donor-site morbidity in 157 consecutive patients. Plast Reconstr Surg. 2011;128(3):714–20.CrossRef
26.
Ling XF, Peng X. What is the price to pay for a free fibula flap? A systematic review of donor-site morbidity following free fibula flap surgery. Plast Reconstr Surg. 2012;129:65774.CrossRef
27.
Zuydam A, Lowe D, Brown J, Vaughan E, Rogers S. Predictors of speech and swallowing function following primary surgery for oral and oropharyngeal cancer. Clin Otolaryngol. 2005;30:428–37.CrossRef
28.
Dwivedi RC, Chisholm EJ, Khan AS, et al. An exploratory study of the influence of clinico-demographic variables on swallowing and swallowing-related quality of life in a cohort of oral and oropharyngeal cancer patients treated with primary surgery. Eur Arch Otorhinolaryngol. 2012;269:1233.CrossRef
29.
Kim IH, Myoung H. Squamous cell carcinoma of the buccal mucosa involving the masticator space: a case report. J Korean Assoc Oral Maxillofac Surg. 2017;43(3):191–6.CrossRef
30.
McConnel FM. Analysis of pressure generation and bolus transit during pharyngeal swallowing. Laryngoscope. 1988;98(1):71–8.CrossRef
31.
Pierre CS, Dassonville O, Chamorey E, Poissonnet G, Ettaiche M, Santini J, Peyrade F, Benezery K, Sudaka A, Bozec A. Long-term quality of life and its predictive factors after oncologic surgery and microvascular reconstruction in patients with oral or oropharyngeal cancer. Eur Arch Otorhinolaryngol. 2014;271(4):801–7.CrossRef
32.
Colangelo LA, Logemann JA, Pauloski BR, Pelzer JR, Rademaker AW. T stage and functional outcome in oral and oropharyngeal cancer patients. Head Neck. 1996;18(3):259–68.CrossRef
33.
Connor NP, Cohen SB, Kammer RE, Sullivan PA, Brewer KA, Hong TS, Chappell RJ, Harari PM. Impact of conventional radiotherapy on health-related quality of life and critical functions of the head and neck. Int J Radiat Oncol Biol Phys. 2006;65(4):1051–62.CrossRef
34.
Epstein JB, Robertson M, Emerton S, Phillips N, Stevenson-Moore P. Quality of life and oral function in patients treated with radiation therapy for head and neck cancer. Head Neck. 2001;23(5):389–98.CrossRef
35.
Squaquara R, Kim Evans KF, Spanio di Spilimbergo S, Mardini S. Intraoral reconstruction using local and regional flaps. Semin Plast Surg. 2010;24(2):198–211.CrossRef
36.
Djan R, et al. A systematic review of questionnaires to measure the impact of appearance on quality of life for head and neck cancer patients. J Plast Reconstr Aesthet Surg. 2013;66(5):647–59.CrossRef
37.
Markkanen-Leppänen M, Mäkitie AA, Haapanen ML, Suominen E, Asko-Seljavaara S. Quality of life after free-flap reconstruction in patients with oral and pharyngeal cancer. Head Neck. 2006;28(3):210–6.CrossRef
38.
Suh JD, Sercarz JA, Abemayor E, Calcaterra TC, Rawnsley JD, Alam D, Blackwell KE. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg. 2004;130(8):962–6.CrossRef
39.
40.
Zhang X, Li MJ, Fang QG, Sun CF. A comparison between the pectoralis major myocutaneous flap and the free anterolateral thigh perforator flap for reconstruction in head and neck cancer patients: assessment of the quality of life. J Craniofac Surg. 2014;25(3):868–71.CrossRef
41.
Li W, Xu Z, Liu F, Huang S, Dai W, Sun C. Vascularized free forearm flap versus free anterolateral thigh perforator flaps for reconstruction in patients with head and neck cancer: assessment of quality of life. Head Neck. 2013;35(12):1808–13.CrossRef
Metadata
Title
Health-related quality of life: a retrospective study on local vs. microvascular reconstruction in patients with oral cancer
Authors
J. K. Meier
J. G. Schuderer
F. Zeman
Ch. Klingelhöffer
M. Hullmann
G. Spanier
T. E. Reichert
T. Ettl
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2019
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-019-0760-2

Other articles of this Issue 1/2019

BMC Oral Health 1/2019 Go to the issue

Research article

WIF1 enhanced dentinogenic differentiation in stem cells from apical papilla

Research article

Three-dimensional photographic analysis of the face in European adults from southern Spain with normal occlusion: reference anthropometric measurements

Research article

Materials for pulpotomy in immature permanent teeth: a systematic review and meta-analysis

Case report

Peripheral giant cell granuloma associated with a dental implant

Research article

Impact of toothpaste on oral health-related quality of life in people with dentine hypersensitivity

Research article

A randomized, double-blind, placebo-controlled multicenter study for evaluating the effects of fixed-dose combinations of vitamin C, vitamin E, lysozyme, and carbazochrome on gingival inflammation in chronic periodontitis patients