Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec:123:105574.
doi: 10.1016/j.oraloncology.2021.105574. Epub 2021 Oct 26.

Surgical factors associated with patient-reported quality of life outcomes after free flap reconstruction of the oral cavity

Joaquin E Jimenez  1 , Marci Lee Nilsen  2 , William E Gooding  3 , Jennifer L Anderson  1 , Nayel I Khan  1 , Leila J Mady  4 , Tamara Wasserman-Wincko  1 , Umamaheswar Duvvuri  1 , Seungwon Kim  1 , Robert L Ferris  5 , Mario G Solari  6 , Mark W Kubik  6 , Jonas T Johnson  1 , Shaum Sridharan  7
Affiliations

Surgical factors associated with patient-reported quality of life outcomes after free flap reconstruction of the oral cavity

Joaquin E Jimenez et al. Oral Oncol. 2021 Dec.

Abstract

Objectives: To determine which surgical factors are associated with quality-of-life (QOL) outcomes in oral cavity cancer survivors after free flap reconstruction of the oral cavity.

Patients and methods: A cross-sectional study was conducted from a multidisciplinary head and neck cancer (HNC) survivorship clinic. Oral cavity cancer survivors with at least 6-months of postoperative follow-up from ablation and free flap reconstruction were included. Primary outcome measures were validated patient-reported outcome measures (PROMs) including the Eating Assessment Tool-10 (EAT-10) measure of swallowing-specific QOL, University of Washington Quality of Life (UW-QOL) physical and social-emotional subscale scores and feeding tube dependence.

Results: Extent of tongue resection was associated with EAT-10 and the UW-QOL Physical subscale scores. Patients with oral tongue defects reported worse scores than with composite defects in the EAT-10 and UW-QOL physical domain (p = 0.0004, 0.0025, respectively). This association no longer applies when controlling for differences in extent of tongue resection. Patients with anterior composite resections reported worse EAT-10 scores than lateral resections (p = 0.024). This association no longer applies when controlling for extent of tongue resection (p = 0.46). Gastric tube dependence demonstrates similar trends to PROMs.

Conclusion: Extent of tongue resection was strongly associated with poor QOL outcomes after free tissue reconstruction of the oral cavity and mediates the associations between other defect characteristics and QOL. These findings demonstrate the need for emphasis on expected oral tongue defects when counseling patients and highlight the need to address QOL in a multidisciplinary fashion post-operatively.

Keywords: Free flap; Head and neck cancer; Oral cavity; Quality-of-life; Survivorship.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
The association between resection type and PROMs is conditional on the extent of tongue resection. A) Bar graph demonstrating differences in the extent of tongue resected between the composite and oral tongue groups. B) Univariate models demonstrating an association between PROMs and resection type or extent of tongue resection. C) Bivariate models demonstrating that the association between resection type and PROMs is conditionalon the extent of tongue resection.
Figure 2.
Figure 2.
The association between anterior defects and PROMs is conditional on the extent of tongue resection in patients who underwent composite resections. A) Bar graph demonstrating differences in the extent of tongue resected between patients with anterior and lateral composite defects. B) Univariate models demonstrating an association between PROMs and composite site or extent of tongue resection. C) Bivariate model demonstrating that the association between composite resection site and PROMs is conditional on the extent of tongue resection.
Figure 3.
Figure 3.
Bar graph demonstrating that gastric tube dependence demonstrates a similar trend to PROMs. The proportion of patients with gastric tube dependence increases with extent of tongue resection.
See this image and copyright information in PMC

References

    1. Meier JK, Schuderer JG, Zeman F, et al. Health-related quality of life: a retrospective study on local vs. microvascular reconstruction in patients with oral cancer. BMC Oral Health. 2019;19(1):62. - PMC - PubMed
    1. Chandu A, Smith AC, Rogers SN. Health-related Quality of Life in Oral Cancer: A Review. J Oral Maxillofac Surg. 2006;64(3):495–502. - PubMed
    1. Nilsen MN, Mady LJ, Hodges J, Wasserman-Wincko T, Johnson JT. Burden of Treatment: Reported Outcomes in a Head and Neck Cancer Survivorship Clinic. Laryngoscope. 2019;129(12):E437–44. - PubMed
    1. Rogers SN, Devine J, Lowe D, Shokar P, Brown JS, Vaugman ED. Longitudinal health-related quality of life after mandibular resection for oral cancer: a comparison between rim and segment. Head Neck. 2004;26(1):54–62. - PubMed
    1. Nilsen MN, Lyu L, Belsky MA, et al. Impact of Neck Disability on Health-Related Quality of Life among Head and Neck Cancer Survivors. Otolaryngol Head Neck Surg. 2020;162(1):64–72. - PMC - PubMed

Publication types