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Comparative Study
. 2020 Jan;162(1):64-72.
doi: 10.1177/0194599819883295. Epub 2019 Oct 15.

Impact of Neck Disability on Health-Related Quality of Life among Head and Neck Cancer Survivors

Marci L Nilsen  1   2 , Lingyun Lyu  3 , Michael A Belsky  2 , Leila J Mady  2 , Dan P Zandberg  4 , David A Clump 2nd  5 , Heath D Skinner  5 , Shyamal Das Peddada  3 , Susan George  6 , Jonas T Johnson  2
Affiliations
Comparative Study

Impact of Neck Disability on Health-Related Quality of Life among Head and Neck Cancer Survivors

Marci L Nilsen et al. Otolaryngol Head Neck Surg. 2020 Jan.

Abstract

Objective: Although neck impairment has been described following surgical resection, limited studies have investigated its prevalence in nonsurgical treatment. The purpose of this study is to determine the prevalence and predictors of neck disability following head and neck cancer (HNC) treatment and to explore its association with quality of life (QOL).

Study design: Cross-sectional study.

Setting: HNC survivorship clinic.

Subjects and methods: We identified 214 survivors who completed treatment ≥1 year prior to evaluation in the clinic. Self-reported neck impairment was measured using the Neck Disability Index. QOL was measured using the University of Washington QOL Questionnaire, with physical and social subscale scores calculated. Regression analysis and trend tests were employed to explore associations.

Results: Over half of survivors (54.2%) reported neck disability. The odds of neck disability in survivors who received nonsurgical treatment and those who received surgery plus adjuvant treatment were 3.46 and 4.98 times higher compared to surgery alone (P = .008, P = .004). Survivors who underwent surgery only had higher physical and social QOL than those who received nonsurgical treatment (physical QOL: P < .001, social QOL: P = .023) and those who received surgery plus adjuvant treatment (physical QOL: P < .001, social QOL: P = .039).

Conclusion: This study revealed a high prevalence of neck disability following nonsurgical treatment. While neck disability is an established sequela of surgical resection, the impact of nonsurgical treatment has gone unrecognized. Early identification and intervention to prevent progression of neck disability are crucial to optimize QOL.

Keywords: head and neck cancer; neck disability; quality of life; survivorship.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1.
Figure 1.
Consolidated Standards of Reporting Trials (CONSORT) flow diagram. NDI, Neck Disability Index.
Figure 2.
Figure 2.
Probability of having neck disability for each treatment type. Probabilities were obtained after adjusting for age, marital status, tumor site, American Joint Committee on Cancer stage, and time since treatment completion at their average values.
Figure 3.
Figure 3.
(a, b) Association between neck disability and quality of life (QOL). (c, d) Association between treatment type and QOL. (Both physical QOL and social QOL were obtained after adjusting for age, marital status, tumor site, AJCC stage, and time since treatment completion.
See this image and copyright information in PMC

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