Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Oropharyngeal cancer (OPC) has seen a rising incidence, particularly in HPV-associated cases, with advancements in treatment improving survival rates. However, given the crucial functions of the oropharyngeal region, treatment modalities such as surgery, radiation, and chemotherapy can significantly impact patients' posttreatment quality of life (QoL). This systematic review and meta-analysis aim to evaluate the QoL outcomes following the management of OPC and assess whether the treatment approach—surgical versus non-surgical—plays a role in these outcomes.
Methods: A comprehensive literature search was performed across major databases, including PubMed, Embase, and Cochrane Library, following PRISMA guidelines for studies published up to August 25, 2024. Studies reporting QoL outcomes in OPC patients’ post-treatment were included. QoL was assessed using validated instruments such as the EORTC QLQ-C30, QLQ-H&N35, and FACT-H&N questionnaires. The primary outcome was overall QoL post-treatment, while secondary outcomes included subdomains such as swallowing function, speech, pain, emotional well-being, and social functioning. A meta-analysis was conducted to compare QoL outcomes between surgical and non-surgical treatments, such as radiation and chemoradiation.
Results: A total of 176 studies, encompassing 200,000 patients with oropharyngeal cancer, met the inclusion criteria. The pooled analysis revealed that while overall survival rates did not significantly differ between surgical and non-surgical treatment groups, QoL outcomes were notably impacted by the choice of treatment. Patients undergoing surgery, particularly transoral robotic surgery (TORS), reported better swallowing function and speech outcomes compared to those receiving chemoradiation, where dysphagia and xerostomia were more prevalent. Conversely, non-surgical treatment approaches were associated with less physical disfigurement and improved emotional well-being. Both treatment groups showed a gradual improvement in QoL scores over time, but long-term deficits persisted in speech, swallowing, and pain in a subset of patients.
Conclusion: This systematic review and meta-analysis underscore that the choice of treatment for oropharyngeal cancer significantly impacts post-treatment QoL outcomes. Surgical approaches, particularly minimally invasive techniques like TORS, may offer better functional outcomes in swallowing and speech, while non-surgical treatments may preserve emotional well-being. These findings highlight the importance of individualized treatment plans that balance oncologic control with QoL considerations for patients with OPC