Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Quality of life (QoL) and patient satisfaction in head and neck cancer (HNC) patients have been widely studied, though primarily among those receiving chemoradiation or radiotherapy. However, there is limited research on patients requiring long-term feeding tubes after HNC treatment, despite the significant impact on post-treatment QoL. Our study addresses this gap by assessing long-term feeding tube and QoL at 6-months and 1-year post-treatment.
Methods: This is a retrospective study of patients diagnosed with HNC (between 2015 and 2022) who engaged in psychosocial evaluation with psych-oncology at a tertiary care center. All patients were offered FACT-HN at baseline, and 6 months to 1 year after completion of treatment. Patients that had completed FACT-HN at their 6-month or 1-year time point were included. The FACT-HN (the outcome variable) is a patient reported outcome measure for well-being that consists of two subscales: 27 items that assess the patient's general quality of life issues in the physical, social/family, emotional, and functional domains and 12 items that assess HNC-specific quality of life issues. Higher scores indicate better quality of life. The exposure variable is the presence of a feeding tube at 6-months to 1-year after completion. Kruskal-Wallis tests were used to compare QoL at 6-months to 1-year according to the presence or absence of feeding tube.
Results: A total of 178 patients were included in the study, of whom 23 (12.9%) had a feeding tube present at the time of QoL assessment. The median age was 63 years, 75.8% were male, and most were White (80.9%). The median physical well-being was 24 (IQR=20 to 26), social well-being was 25 (IQR=21 to 28), emotional well-being was 20 (IQR=17 to 22), functional well-being was 21 (IQR=16 to 26), and head and HNC specific well-being was 27 (IQR=20 to 32). On bivariate analyses, there were significant differences between patients with or without feeding tube terms in functional well-being (16.5 vs. 22.0; P=0.037), HNC specific well-being ((19.0 vs. 28.0; P=0.021), and total FACT-HN score (98 vs 122; P=0.035) with patients having feeding tubes demonstrating worse quality of life for these domains.
Conclusion: In patients with HNC, continued presence of a feeding tube 6-months to 1-year following treatment was associated with worse functional well-being, HNC specific well-being, and overall QoL. The results provide additional insights into the functional outcomes and well-being in patients with longer feeding tube necessity following HNC treatment. Additionally, these findings demonstrate the areas of continued need for patients with longer feeding tube necessity and can help guide future areas of intervention to improve QoL in patients with swallowing dysfunction following treatment of HNC.