Pre- and Post-Operative Quality of Life in Patients with Osteoradionecrosis of the Jaw

Abstract

Osteoradionecrosis of the jaw (ORNJ) is a feared complication following radiation therapy performed for oncological treatment of head and neck cancers (HNC). To date, there is no clear evidence regarding the impact of surgical treatment of ORNJ on the quality of life (QoL) of affected patients. However, understanding the significance of the surgical treatment approach and its effects on QoL is an essential factor in the decision-making process for optimal, individualized therapy. In this prospective clinical study, QoL was assessed in relation to health related QoL (HRQoL) and oral health related QoL (OHQoL) before and after surgical treatment of ORNJ using standardized questionnaires (EORTC QLQ-C30, QLQ-HN35, OHIP-14). The overall QoL scores as well as individual domains of the collected scales regarding functional and symptom-related complaints were statistically analyzed. Subgroups concerning age, gender, different risk factors and type of ORNJ therapy were compared using Kruskal Wallis test. In addition, clinical and demographic patient data were collected and analyzed. QoL improvement correlated with the type of surgical ORNJ and the length of hospitalization. Better QoL scores were achieved post-operatively regarding different symptoms like pain, swallowing and mouth opening. Long-term effects of radiation therapy remained visibly restrictive to QoL and worsen over time.

Keywords: head and neck cancer; health-related quality of life; oral health quality of life; osteoradionecrosis of the jaw (ORNJ); quality of life.

Figure 1

Therapy and Risk Factors of ORNJ: (a) Therapy conducted for the treatment of osteoradionecrosis: 15 patients underwent local mandibula resection without continuity resection, 5 underwent mandibula resection with continuity resection (out of these 3 received a mandibular reconstruction with a free fibula transplant, one with a free scapula transplant, and one received stabilization with a reconstruction plate without a free flap); (b) pre-existing conditions: number of patients with comorbidities and risk factors. Among the 10 metabolic disorders, 8 were hypothyreoidisms. Important subgroups are highlighted in color.

Figure 2

EORTC QLQ 30 and QLQ H&N 35 scores over functional and symptom scales pre-and post-surgery of ORNJ patients. p-values with Spearman’s correlation analysis, indicating statistical significance and suggesting a rejection of the hypothesis of identical distributions between pre- and post-surgery scores, are marked for scores with p < 0.05 with an asterisk (*). (A) pre- and postoperative scores from the EORTC QLQ 30 functional scales and GHS/QoL; (B) pre- and postoperative scores from the EORTC QLQ 30 symptom scales; (C) pre- and postoperative scores from the EORTC H&N35 symptom scales.

Figure 3

Pre- and post-operative comparison of subgroups regarding the overall GHS/QoL Score (A), the OHIP G-14 Score (B) and the EORTC-QLQ HN35 scores for swallowing (C) and speech problems (D). Significant p-values are marked with asterisks. Improvements are labelled in green and deteriorations in red.

Figure 4

Comparison of GHS improvement of different subgroups using Kruskal Wallis test: Difference of post- and preoperative GHS/QoL scores are shown for various subgroups with corresponding p-value marked. The numbers of individuals in each group are added in brackets. p-values < 0.05 are marked with an asterisk (*).