Top

Annals of Surgical Oncology

Published in:

01-08-2014 | Head and Neck Oncology

Minimal Clinically Important Differences in Quality of Life Scores of Oral Cavity and Oropharynx Cancer Patients

Authors: Yoav Binenbaum, MD, Moran Amit, MD, Salem Billan, MD, Jacob T. Cohen, MD, Ziv Gil, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2014

Abstract

Background

The minimal clinically important difference (MCID) is defined as the smallest difference in quality of life (QOL) that patients perceive as beneficial and that mandates a change in management. We aimed to determine the MCID among patients with oral cavity and oropharyngeal cancer and to identify domains that are significantly affected during treatment.

Methods

The cohort consisted of 1,011 patients analyzed by a metaanalysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MCID values for the University of Washington Quality of Life Questionnaire (UW-QOLQ) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC C-30) and Head and Neck-35 questionnaires were calculated by using the distribution-based method.

Results

The mean MCID for Global QOL was 13.07 points for the UW-QOLQ and 9.43 in the EORTC C-30 questionnaire. High consistency in the MCID values was found between the two questionnaires examined. Heat map analysis indicated a clinically significant improvement in head and neck-associated domains and in domains associated with general cancer treatment 1 year or more after treatment relative to 3 months after treatment (p < 0.001 and p = 0.016, respectively). In contrast, improvement in general and functional domains was not evident 1 year or more after treatment (p = 0.69).

Conclusions

This study suggests benchmark values for MCID and variation in QOL scores of oral and oropharyngeal cancer patients after treatment. Improvement in head and neck- and general cancer-associated domains may not be translated into a general and functional improvement during the first year of recovery.

Available only for authorised users

GLOBOCAN 2012: Country Fast Stat. http://globocan.iarc.fr/old/summary_table_site-html.asp?selection=13010&selection=21030&title=Lip%2C+oral+cavity%2C+Other+pharynx&sex=0&type=0&window=1&africa=1&america=2&asia=3&europe=4&oceania=5&build=6&sort=0&submit=%C2%A0Execute. Accessed Apr 2014.

Bessell A, Glenny AM, Furness S, et al. Interventions for the treatment of oral and oropharyngeal cancers: surgical treatment (review). Cochrane Database Syst Rev. 2011;9:CD006205.PubMed

Chandu A, Smith ACH, Rogers SN. Health-related quality of life in oral cancer: a review. J Oral Maxillofac Surg. 2006;64:495–502.PubMedCrossRef

Khafif A, Posen J, Yagil Y, et al. Quality of life in patients older than 75 years following major head and neck surgery. Head Neck. 2007;29:932–9.PubMedCrossRef

Lowe D, Rogers SN. University of Washington quality of life questionnaire. Seattle: University of Washington; 2012, pp. 1–14.

Bjordal K, Hammerlid E, Ahlner-Elmqvist M, et al. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. J Clin Oncol. 1999;17:1008–19.PubMed

Torres-Carranza E, Infante-Cossío P, Hernández-Guisado JM, Hens-Aumente E, Gutierrez-Pérez JL. Assessment of quality of life in oral cancer. Med Oral Patol Oral Cir Bucal 2008;13:E735–41.PubMed

Ronis DL, Duffy SA, Fowler KE, Khan MJ, Terrell JE. Changes in quality of life over 1 year in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2008;134:241–8.PubMedCrossRef

Gritz ER, Carmack CL, de Moor C. et al. First year after head and neck cancer: quality of life. J Clin Oncol. 1999;17:352–60.PubMed

10.

Jaeschke R, Singer J, Guyatt GH. Measurement of health status: ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10:407–15.PubMedCrossRef

11.

Cella D, Hahn EA, Dineen K. Meaningful change in cancer-specific quality of life scores: differences between improvement and worsening. Qual Life Res. 2002;11:207–21.PubMedCrossRef

12.

Crosby RD, Kolotkin RL, Williams GR. Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol. 2003;56:395–407.PubMedCrossRef

13.

Speer DC. Clinically significant change: Jacobson and Truax (1991) revisited. J Consult Clin Psychol. 1992;60:402–8.PubMedCrossRef

14.

Ringash J, Bezjak A. A structured review of quality of life instruments for head and neck cancer patients. Head Neck. 2001;23:201–13.PubMedCrossRef

15.

Scott NW et al. EORTC QLQ-C30 Sprangers on behalf of the EORTC Quality of Life Group. 2008.

16.

The 2011 Oxford CEBM Levels of Evidence: introductory document. 2011:1–3.

17.

Miller GA. The magic number seven, plus or minus two: some limits on our capacity for processing information. Psychol Rev. 1956;63:81–97.PubMedCrossRef

18.

Norman GR. Point/counterpoint: interpretation of changes in health-related quality of life—the remarkable universality of half a standard deviation. Med Care. 2003;41:582–92.

19.

Juniper EF, Guyatt GH, Willan A, Griffith LE. Determining a minimal important change in a disease-specific Quality of Life Questionnaire. 1994;47:81–7.

20.

Sloan J, Symonds T, Vargas-Chanes D, Fridley B. Practical guidelines for assessing the clinical significance of health-related quality of life changes within clinical trials. Drug Inf J. 2003;37:23–31.

21.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. doi:10.1371/journal.pmed1000097.

22.

Chandu A, Sun KCV, DeSilva RN, Smith ACH. The assessment of quality of life in patients who have undergone surgery for oral cancer: a preliminary report. J Oral Maxillofac Surg. 2005;63:1606–12.PubMedCrossRef

23.

Oates J, Clark JR, Read J, Reeves N, Gao K, O’Brien CJ. Integration of prospective quality of life and nutritional assessment as routine components of multidisciplinary care of patients with head and neck cancer. ANZ J Surg. 2008;78:34–41.PubMedCrossRef

24.

Bekiroglu F, Ghazali N, Laycock R, Katre C, Lowe D, Rogers SN. Adjuvant radiotherapy and health-related quality of life of patients at intermediate risk of recurrence following primary surgery for oral squamous cell carcinoma. Oral Oncol. 2011;47:967–73.PubMedCrossRef

25.

Rogers SN, Lowe D, Brown JS, Vaughan ED. A comparison between the University of Washington Head and neck disease-specific measure and the medical short form 36, EORTC QOQ-C33 and EORTC head and neck 35. Oral Oncol. 1998;34:361–72.PubMedCrossRef

26.

Zwahlen RA, Dannemann C, Grätz KW, et al. Quality of life and psychiatric morbidity in patients successfully treated for oral cavity squamous cell cancer and their wives. J Oral Maxillofac Surg. 2008;66:1125–32.PubMedCrossRef

27.

Kessler PA, Bloch-Birkholz A, Leher A, Neukam FW, Wiltfang J. Evaluation of quality of life of patients with oral squamous cell carcinoma. Comparison of two treatment protocols in a prospective study. Radiother Oncol. 2004;70:275–82.PubMedCrossRef

28.

Airoldi M, Garzaro M, Raimondo L, et al. Functional and psychological evaluation after flap reconstruction plus radiotherapy in oral cancer. Head Neck. 2011;33:458–68.PubMedCrossRef

29.

Kazi R, Johnson C, Prasad V, et al. Quality of life outcome measures following partial glossectomy: assessment using the UW-QOL scale. J Cancer Res Ther. 2012;4:116–20.CrossRef

30.

Hsing CY, Wong YK, Wang CP, et al. Comparison between free flap and pectoralis major pedicled flap for reconstruction in oral cavity cancer patients: a quality of life analysis. Oral Oncol. 2011;47:522–7.PubMedCrossRef

31.

Girod DA, Sykes K, Jorgensen J, Tawfik O, Tsue T. Acellular dermis compared to skin grafts in oral cavity reconstruction. Laryngoscope. 2009;119:2141–9.PubMedCrossRef

32.

Feng FY, Kim HM, Lyden TH, et al. Intensity-modulated chemoradiotherapy aiming to reduce dysphagia in patients with oropharyngeal cancer: clinical and functional results. J Clin Oncol. 2010;28:2732–8.PubMedCentralPubMedCrossRef

33.

Li W, Yang Y, Xu Z, et al. Assessment of quality of life of patients with oral cavity cancer who have had defects reconstructed with free anterolateral thigh perforator flaps. Br J Oral Maxillofac Surg. 2013;51:10–4.

34.

Iwase M, Takemi T, Manabe M, Nagumo M. Hypercalcemic complication in patients with oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2003;32:174–80.PubMedCrossRef

35.

Klug C, Neuburg J, Glaser C, Schwarz B, Kermer C, Millesi W. Quality of life 2–10 years after combined treatment for advanced oral and oropharyngeal cancer. Int J Oral Maxillofac Surg. 2002;31:664–9.PubMedCrossRef

36.

Rogers SN, Miller RD, Ali K, Minhas AB, Williams HF, Lowe D. Patients’ perceived health status following primary surgery for oral and oropharyngeal cancer. Int J Oral Maxillofac Surg. 2006;35:913–9.PubMedCrossRef

37.

Borggreven PA, Verdonck-de Leeuw IM, Muller MJ, et al. Quality of life and functional status in patients with cancer of the oral cavity and oropharynx: pretreatment values of a prospective study. Eur Arch Otorhinolaryngol. 2007;264:651–7.

38.

Devine JC, Rogers SN, McNally D, Brown JS, Vaughan ED. A comparison of aesthetic, functional and patient subjective outcomes following lip-split mandibulotomy and mandibular lingual releasing access procedures. Int J Oral Maxillofac Surg. 2001;30:199–204.PubMedCrossRef

39.

Schünemann HJ, Akl EA, Guyatt GH. Interpreting the results of patient reported outcome measures in clinical trials: the clinician’s perspective. Health Qual Life Outcomes. 2006;4:62.PubMedCentralPubMedCrossRef

40.

Kanatas AN, Mehanna HM, Lowe D, Rogers SN. A second national survey of health-related quality of life questionnaires in head and neck oncology. Ann R Coll Surg Engl. 2009;91:420–5.PubMedCentralPubMedCrossRef

41.

Bonnetain F, Dahan L, Maillard E, et al. Time until definitive quality of life score deterioration as a means of longitudinal analysis for treatment trials in patients with metastatic pancreatic adenocarcinoma. Eur J Cancer. 2010;46:2753–62.PubMedCrossRef

42.

Maringwa J, Quinten C, King M, et al. Minimal clinically meaningful differences for the EORTC QLQ-C30 and EORTC QLQ-BN20 scales in brain cancer patients. Ann Oncol. 2011;22:2107–12.PubMedCrossRef

43.

Amit M, Abergel A, Fliss DM, Gil Z. The clinical importance of quality-of-life scores in patients with skull base tumors: a meta-analysis and review of the literature. Curr Oncol Rep. 2012;14:175–81.PubMedCrossRef

44.

So WK, Chan RJ, Chan DN, et al. Quality-of-life among head and neck cancer survivors at one year after treatment: a systematic review. Eur J Cancer. 2012;48:2391–408.PubMedCrossRef

45.

Ware JE, Snow K, K. M. SF-36 Health Survey: manual and interpretation guide. 1993.

Title: Minimal Clinically Important Differences in Quality of Life Scores of Oral Cavity and Oropharynx Cancer Patients
Authors: Yoav Binenbaum, MD
Moran Amit, MD
Salem Billan, MD
Jacob T. Cohen, MD
Ziv Gil, MD, PhD
Publication date: 01-08-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 8/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3656-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Minimal Clinically Important Differences in Quality of Life Scores of Oral Cavity and Oropharynx Cancer Patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2014

The Role of Omentectomy and Random Peritoneal Biopsies as Part of Comprehensive Surgical Staging in Apparent Early-Stage Epithelial Ovarian Cancer

Transoral Endoscopic Resection of Low-Grade, Cricoid Chondrosarcoma

Laparoscopic Intragastric Surgery for Early Gastric Cancer and Gastrointestinal Stromal Tumors

Thyroglobulin Antibodies Could be a Potential Predictive Marker for Papillary Thyroid Carcinoma

Toxicity of Oxaliplatin Plus Fluorouracil/Leucovorin Adjuvant Chemotherapy in Elderly Patients with Stage III Colon Cancer: A Population-Based Study

Gastric Stump Cancer After Distal Gastrectomy for Benign Disease: Clinicopathological Features and Surgical Outcomes