Health-related Quality of Life, Distress and Psychosocial Factors in Head and Neck and Renal Cancer Patients. Quality of Life in HNSCC and RCC patients
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Cancer represents a major health challenge worldwide, and affects a substantial proportion of the human population. Studies of cancer treatment has traditionally assessed endpoints such as overall survival and progression free survival. In order to better understand and evaluate the overall impact of the disease and its treatment, researchers eventually also included evaluation of health related quality of life (HRQoL) after cancer treatment. Knowledge of patient’s HRQoL and what affects cancer patients' psychological adaptation to treatment and survival has become increasingly important considering the growing number of cancer patients who survive.
In this thesis, we have studied the relationship between HRQoL and psychosocial factors such as personality, choice of coping, and distress (GHQ) in patients treated for Head and Neck Squamous Cell Carcinoma (HNSCC). Except for distress, we have studied the same factors in patients treated for Renal Cell Carcinoma (RCC). We have also examined the importance of comorbidity, some aspects of cancer biology and other treatment-related factors.
HNSCC and RCC occurs about equally as frequently in Norway. The two cancer diagnosis groups have an approximately equal risk of recurrence and death. The big difference between the two patient groups is according to the conditions of treatment. HNSCC patients often receive an extensive treatment consisting of radiation therapy, chemotherapy and surgery, which may lead to sequelae of a potentially great impact on daily functioning. RCC patients are normally treated with one surgical procedure only. The groups are therefore interesting to compare in terms of what determines the perceived HRQoL. Is it the cancer prevalence, treatment related factors, risk of recurrence and death, sequelae -or other more personality-related qualities that are decisive.
In HNSCC patients, we found that presence of the personality trait neuroticism and use of avoidance- coping, were both associated with and predicts increased distress with much the same pattern as for HRQoL. Furthermore we suggested that distress may possibly be regarded a HRQoL variable in HNSCC patients.
The personality trait of neuroticism showed up to 30% common variance with HRQoL. Large extent of primary tumor (T- stage), predicted increased distress in HNSCC patients. Utilized coping strategy was also important, partly as mediator between personality and HRQoL, and associated to HRQoL. Distress was found to be stable when measured over a four-year follow-up period in the HNSCC patient group.In our sample of RCC patients we made similar findings. Almost all HRQoLindices were significantly negatively correlated with the personality trait neuroticism and to use of avoidance- coping. RCC patients treated with a flank incision and to some extent with open abdomen approach, reported impaired HRQoL in several indexes, while those treated with minimal- invasive surgery, reported HRQoL in line with the general population. In some areas, the flank treated RCC patients reported a decreased HRQoL compared to a group of laryngectomized HNSCC patients. Considering the patients HRQoL, selection of surgical access in nephron- sparing surgery (NSS) should be viewed in the light of this finding. Comorbidity and particularly whether the patient had diabetes or were on lung medication or not, seems to be associated with impaired HRQoL in patients surgically treated for RCC.
The “European Organization for Research and Treatment of Cancer” (EORTC) has developed several general and disease-specific quality of life questionnaires for cancer patients, but a disease-specific questionnaire for RCC patients have so far been lacking. We have therefore developed an EORTC-compatible RCC-specific quality of life questionnaire. Our proposed form adds important disease-specific information about RCC- patients' HRQoL. By adding four general questions about pain, mobility and social functioning, our form also has the potential as a stand- alone HRQoL questionnaire that can be clinically used among surgically treated RCC patients.
Surprisingly similar patterns of self-reported HRQoL and distress (only in head/neck cancer patients) on the one hand, and personality and coping on the other side, between the head/neck and renal cancer patients were found in this study. For both groups, it appears that the relationship between psychosocial factors and HRQOL is three to four times as strong as the correlation between sequelae of treatment and reported HRQOL. Comorbidity was associated with lower self-reported HRQoL.