Head and neck cancer, quality of life, and determinant factors: a novel approach using decision tree analysis.

OBJECTIVE The goal of the present study was to investigate health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL) in patients under treatment for head and neck cancer and to identify the associated factors. STUDY DESIGN A cross-sectional study was conducted with 102 patients undergoing treatment for head and neck cancer at 2 medical centers. Participants answered a sociodemographic questionnaire and the Brazilian versions of the Medical Outcomes Study 36 (SF-36) and the Oral Health Impact Profile (OHIP-14) questionnaires to assess HRQoL and OHRQoL, respectively. Clinical aspects, cancer staging, and treatment approach were also investigated. Descriptive and multivariate analyses were performed by using decision tree analysis with the Chi-square Automatic Interaction Detector (CHAID) algorithm. RESULTS The decision tree revealed that reduced quality of life is associated with the clinical staging (adjusted P value = .035), patient's gender (adjusted P value = .028), and treatment approach (adjusted P value = .032). Female patients who are diagnosed with advanced head and neck cancer and undergo radiotherapy or chemotherapy are more likely to exhibit lower rates of quality of life. CONCLUSIONS The results suggested that sociodemographic characteristics, clinical staging, and treatment approach can exert a significant influence on the quality of life of patients with head and neck cancer.

[1]  J. Hilgert,et al.  Comparison of two assessment instruments of quality of life in older adults. , 2013, Revista brasileira de epidemiologia = Brazilian journal of epidemiology.

[2]  S. Rogers,et al.  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. , 1998, Oral oncology.

[3]  Rozana Mesquita Ciconelli,et al.  Validação da versão brasileira do questionário genérico de qualidade de vida short-form 6 dimensions (SF-6D Brasil) , 2011 .

[4]  J. Stemple,et al.  A Multidimensional Study of Vocal Function Following Radiation Therapy for Laryngeal Cancers , 2017, The Annals of otology, rhinology, and laryngology.

[5]  A. Wienke,et al.  The impact of oral rehabilitation on oral health-related quality of life in patients receiving radiotherapy for the treatment of head and neck cancer , 2016, Clinical Oral Investigations.

[6]  Renata de Souza Coelho Soares,et al.  Quality of life related to oral health of patients undergoing hemodialysis and associated factors , 2017, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[7]  M. Bernal-Sprekelsen,et al.  Prognostic factors of quality of life after transoral laser microsurgery for laryngeal cancer , 2015, European Archives of Oto-Rhino-Laryngology.

[8]  M. Karamouzis,et al.  Head and neck cancer , 2008, The Lancet.

[9]  D. Forman,et al.  Head and neck cancer burden and preventive measures in Central and South America. , 2016, Cancer epidemiology.

[10]  A. Jemal,et al.  Cancer statistics, 2011 , 2011, CA: a cancer journal for clinicians.

[11]  E. Hammerlid,et al.  Health-related quality of life in long-term head and neck cancer survivors: a comparison with general population norms , 2001, British Journal of Cancer.

[12]  C. Eiser,et al.  A review of measures of quality of life for children with chronic illness , 2001, Archives of disease in childhood.

[13]  A. Dietz,et al.  Quality of Life Measurements: Any Value for Clinical Practice? , 2017, Current Treatment Options in Oncology.

[14]  Lior Rokach,et al.  Data Mining with Decision Trees - Theory and Applications , 2007, Series in Machine Perception and Artificial Intelligence.

[15]  C. Mathers,et al.  Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012 , 2015, International journal of cancer.

[16]  Alan D. Lopez,et al.  Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study , 2017, JAMA oncology.

[17]  J. Hair.  Multivariate data analysis , 1972 .

[18]  A. Arthur,et al.  Nutrition impact symptoms and associated outcomes in post-chemoradiotherapy head and neck cancer survivors: a systematic review , 2018, Journal of Cancer Survivorship.

[19]  A. Forastiere,et al.  Head and neck cancer: changing epidemiology, diagnosis, and treatment. , 2008, Mayo Clinic proceedings.

[20]  Fangfei Liu,et al.  Chi-squared Automatic Interaction Detection Decision Tree Analysis of Risk Factors for Infant Anemia in Beijing, China , 2016, Chinese medical journal.

[21]  G. Funk,et al.  Psychological factors associated with head and neck cancer treatment and survivorship: evidence and opportunities for behavioral medicine. , 2013, Journal of consulting and clinical psychology.

[22]  R. L. Coleman,et al.  Patient-reported outcomes as end points and outcome indicators in solid tumours , 2015, Nature Reviews Clinical Oncology.

[23]  J. Thariat,et al.  Oral complications of cancer and cancer therapy , 2012, CA: a cancer journal for clinicians.

[24]  C. Abnet,et al.  Alcohol and head and neck cancer risk in a prospective study , 2007, British Journal of Cancer.

[25]  C. Leemans,et al.  Cordectomy by CO2 laser or radiotherapy for small T1a glottic carcinomas: Costs, local control, survival, quality of life, and voice quality , 2007, Head & neck.

[26]  C. Albala,et al.  Aging, Gender and Quality of Life (AGEQOL) study: factors associated with good quality of life in older Brazilian community-dwelling adults , 2014, Health and Quality of Life Outcomes.

[27]  Q. Le,et al.  Higher incidence of head and neck cancers among Vietnamese American men in California , 2010, Head & neck.

[28]  M. Naghavi,et al.  Exclusion of Kaposi Sarcoma From Analysis of Cancer Burden-Reply. , 2017, JAMA oncology.

[29]  F. Demarco,et al.  Oral health-related quality of life and associated factors in Southern Brazilian elderly. , 2015, Gerodontology.

[30]  W. Kuo,et al.  Health-related quality of life for nasopharyngeal carcinoma patients with cancer-free survival after treatment. , 2002, International journal of radiation oncology, biology, physics.

[31]  S. Singer,et al.  Mundgesundheitsbezogene Lebensqualität bei Krebspatienten , 2018, Laryngo-Rhino-Otologie.

[32]  P. Lambin,et al.  The impact of late treatment-toxicity on generic health-related quality of life in head and neck cancer patients after radiotherapy. , 2011, Oral oncology.

[33]  L. Goldman,et al.  Gender differences in 1-year survival and quality of life among patients admitted with congestive heart failure. , 1998, Medical care.

[34]  M. Bandeira,et al.  Qualidade de vida e dimensão ocupacional na esquizofrenia: uma comparação por sexo , 2006 .

[35]  A. Jemal,et al.  Global cancer statistics, 2012 , 2015, CA: a cancer journal for clinicians.

[36]  S. Saxena,et al.  The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. , 1995, Social science & medicine.

[37]  L. M. da Nóbrega,et al.  Pattern of oral‐maxillofacial trauma from violence against women and its associated factors , 2017, Dental traumatology : official publication of International Association for Dental Traumatology.

[38]  C. Bradford,et al.  Predictors of pain among patients with head and neck cancer. , 2012, Archives of otolaryngology--head & neck surgery.

[39]  Andréa Maria Duarte Vargas,et al.  Perfil das perdas dentárias em adultos segundo o capital social, características demográficas e socioeconômicas , 2014 .

[40]  C. Mathers,et al.  Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008 , 2010, International journal of cancer.

[41]  V. Araujo,et al.  [Psycometrics properties of subjetive indicator in children]. , 2004, Revista de saude publica.

[42]  S. Warnakulasuriya.  Global epidemiology of oral and oropharyngeal cancer. , 2009, Oral oncology.

[43]  Fei Liu,et al.  Measures of health-related quality of life and socio-cultural aspects in young patients who after mandible primary reconstruction with free fibula flap , 2013, World Journal of Surgical Oncology.

[44]  Marcos Bossi Ferraz,et al.  Qualidade de vida em pacientes portadores de doença inflamatória intestinal: tradução para o português e validação do questionário "Inflammatory Bowel Disease Questionnaire" (IBDQ) , 2004 .

[45]  C. Leles,et al.  Factors associated with the quality of life of subjects with facial disfigurement due to surgical treatment of head and neck cancer , 2018, Medicina oral, patologia oral y cirugia bucal.

[46]  A. Carvalho,et al.  Questionários para a avaliação de Qualidade de Vida em pacientes com câncer de cabeça e pescoço validados no Brasil , 2007 .

[47]  C. Cleeland,et al.  The symptom burden of treatment‐naive patients with head and neck cancer , 2015, Cancer.

[48]  Ying Huang,et al.  Analysis of dosimetric factors associated with temporal lobe necrosis (TLN) in patients with nasopharyngeal carcinoma (NPC) after intensity modulated radiotherapy , 2013, Radiation oncology.

[49]  A. McMillan,et al.  A longitudinal study of quality of life outcomes in older adults requesting implant prostheses and complete removable dentures. , 2003, Clinical oral implants research.