Impact of Neck Disability on Health-Related Quality of Life among Head and Neck Cancer Survivors

Objective Although neck impairment has been described following surgical resection, limited studies have investigated its prevalence in nonsurgical treatment. The purpose of this study is to determine the prevalence and predictors of neck disability following head and neck cancer (HNC) treatment and...

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Published in:	Otolaryngology-head and neck surgery 2020-01, Vol.162 (1), p.64-72
Main Authors:	Nilsen, Marci L., Lyu, Lingyun, Belsky, Michael A., Mady, Leila J., Zandberg, Dan P., Clump, David A., Skinner, Heath D., Peddada, Shyamal Das, George, Susan, Johnson, Jonas T.
Format:	Article
Language:	eng
Subjects:	Academic Medical Centers Adult Aged Confidence Intervals Conservative Treatment - adverse effects Cross-Sectional Studies Databases, Factual Disability Evaluation Female head and neck cancer Head and Neck Neoplasms - mortality Head and Neck Neoplasms - pathology Head and Neck Neoplasms - therapy Humans Linear Models Male Middle Aged Multivariate Analysis neck disability Neck Dissection - adverse effects Otorhinolaryngologic Surgical Procedures - adverse effects Otorhinolaryngologic Surgical Procedures - methods Patient Reported Outcome Measures Quality of Life Retrospective Studies Survivors survivorship United States
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Summary:	Objective Although neck impairment has been described following surgical resection, limited studies have investigated its prevalence in nonsurgical treatment. The purpose of this study is to determine the prevalence and predictors of neck disability following head and neck cancer (HNC) treatment and to explore its association with quality of life (QOL). Study Design Cross-sectional study. Setting HNC survivorship clinic. Subjects and Methods We identified 214 survivors who completed treatment ≥1 year prior to evaluation in the clinic. Self-reported neck impairment was measured using the Neck Disability Index. QOL was measured using the University of Washington QOL Questionnaire, with physical and social subscale scores calculated. Regression analysis and trend tests were employed to explore associations. Results Over half of survivors (54.2%) reported neck disability. The odds of neck disability in survivors who received nonsurgical treatment and those who received surgery plus adjuvant treatment were 3.46 and 4.98 times higher compared to surgery alone (P = .008, P = .004). Survivors who underwent surgery only had higher physical and social QOL than those who received nonsurgical treatment (physical QOL: P < .001, social QOL: P = .023) and those who received surgery plus adjuvant treatment (physical QOL: P < .001, social QOL: P = .039). Conclusion This study revealed a high prevalence of neck disability following nonsurgical treatment. While neck disability is an established sequela of surgical resection, the impact of nonsurgical treatment has gone unrecognized. Early identification and intervention to prevent progression of neck disability are crucial to optimize QOL.
ISSN:	0194-5998 1097-6817