Pretreatment quality of life carries prognostic information in head and neck cancer

Design

Systematic review and meta-analysis of 32 longitudinal studies

Population

Patients with head and neck cancer with pretreatment patient-reported quality of life

Primary outcome

Overall survival by quality-of-life domain

Effect

Per 10-point worsening: global QoL HR 1.11 (95% CI 1.08 to 1.14); physical functioning HR 1.16 (1.13 to 1.20)

This meta-analysis pooled 32 independent longitudinal studies (40 publications) examining validated patient-reported quality of life before treatment as a prognostic factor for overall survival in head and neck cancer. Hazard ratios were harmonised to a 10-point worsening in each domain.

Worse global quality of life (HR 1.11, 95% CI 1.08 to 1.14), physical functioning (1.16, 1.13 to 1.20), role functioning (1.09, 1.07 to 1.11) and social functioning (1.09, 1.06 to 1.12) were consistently linked to higher mortality and stable on leave-one-out testing. Swallowing (HR 1.15, 1.02 to 1.29) was sensitive to a single study, and dyspnoea (1.16, 1.01 to 1.33) was heterogeneous and unstable.

These are adjusted associations, and the authors caution that findings from the less stable domains should not be treated as actionable targets. The practical use is identifying patients who need supportive-care assessment before treatment starts, not predicting an individual's survival.

• Record a validated quality of life measure before treatment starts.
• Use poor physical or role functioning to prompt supportive-care assessment, such as nutrition, speech and swallowing and psychological review.
• Do not use a quality-of-life score alone to decide whether to offer treatment.
• Treat swallowing and dyspnoea findings as provisional.

Why it matters

Patient-reported function before treatment appears to say something about survival that stage alone does not capture.

Don't overread it

These are prognostic associations, not evidence that improving a score improves survival.

The statistics, in plain English

A hazard ratio of 1.16 per 10 points means that each 10-point worsening in physical functioning went with about 16% higher hazard of death, after adjustment. It is an average across studies and says little about any one patient.

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