Quality of life and salivary output in patients with head-and-neck cancer five years after radiotherapy

Abstract

Background: To describe long-term changes in time of quality of life (QOL) and the relation with parotid salivary output in patients with head-and-neck cancer treated with radiotherapy.

Methods: Forty-four patients completed the EORTC-QLQ-C30(+3) and the EORTC-QLQ-H&N35 questionnaires before treatment, 6 weeks, 6 months, 12 months, and at least 3.5 years after treatment. At the same time points, stimulated bilateral parotid flow rates were measured.

Results: There was a deterioration of most QOL items after radiotherapy compared with baseline, with gradual improvement during 5 years follow-up. The specific xerostomia-related items showed improvement in time, but did not return to baseline. Global QOL did not alter significantly in time, although 41% of patients complained of moderate or severe xerostomia at 5 years follow-up. Five years after radiotherapy the mean cumulated parotid flow ratio returned to baseline but 20% of patients had a flow ratio <25%. The change in time of xerostomia was significantly related with the change in flow ratio (p = 0.01).

Conclusion: Most of the xerostomia-related QOL scores improved in time after radiotherapy without altering the global QOL, which remained high. The recovery of the dry mouth feeling was significantly correlated with the recovery in parotid flow ratio.

Figure 1

Distribution of the mean dose (Gy) of the different glands presented as the percentage of patients. Abbreviations: RPG = right parotid gland; LPG = left parotid gland; RSG = right submandibular gland; LSG = left submandibular gland.

Figure 2

Mean scores over time of the single items dry mouth, sticky saliva, swallowing and senses (QOL-H&N35). High scores imply a high level of symptoms.

Figure 3

Stimulated parotid flow rates (mean value) at different timings after radiotherapy. Time 0 means before radiotherapy. The cumulated flow rates are expressed as the percentage of the pre-radiotherapy flow rates. Note: the x-axis is non-linear.

Figure 4

Mean scores over time of the single item dry mouth (QOL-H&N35). High scores imply a high level of symptoms. A division has been made between patients with and without a complication, defined as stimulated cumulated parotid flow rate <25% of the pre-radiotherapy flow rate.