Assessment of Life Quality of Nasopharyngeal Carcinoma Patients with EORTC QLQ
C30 and H&N 35: Turkish Oncology Group, Head and Neck Working Party Study
Mustafa Cengiz, Enis Özyar, Mustafa Esassolak, Musa Altun, Müge Akmansu , Mehmet Şen,
Ömer Uzel, Aydın Yavuz, Gamze Dalmaz, Cem Uzal, Ayşe Hiçsönmez, Süreyya Sarıhan,
Bünyamin Kaplan, Beste Melek Atasoy, Cüneyt Ulutin, Ufuk Abacıoğlu, Ayşe Nur
Demiral, Mutlu Hayran.
TOG-Head and Neck Cancer Group and Hacettepe University, Department of Preventive
Oncology.
Introduction: Nasopharyngeal carcinoma ranks among the most common tumors in Southern
Asia, however it constitutes only 0.3-0.4 % of all malignant tumors in Western world.
Nasopharyngeal Carcinoma has unique features. Unlike other head and neck carcinomas, it is seen in young age group and is not associated with smoking or alcohol abuse. The primary treatment of nasopharyngeal carcinoma is radiotherapy or chemo-radiotherapy, surgery is not an option. Data concerning quality of life (QoL) in patients with nasopharyngeal carcinomas are rarely reported in the literature. However this critical tool should take place in assessment of current treatment modalities for improvement and comparison. The current study reports on long-term quality of life status following conventional radiotherapy in 187 nasopharyngeal carcinoma patients from 14 centers in Turkey.
Patients and Methods: Patients with the diagnosis of nasopharyngeal carcinoma treated in
14 centers in Turkey with minimum 6 months of follow-up in complete remission were asked to complete Turkish version of EORTC QLQ C30 and HN 35 questionnaires. Inclusion criteria were history of nasopharyngeal carcinoma treated by radiotherapy or chemoradiotherapy without any second primary tumor and without any evident tumor, freedom from psychiatric conditions that might confound QoL evaluation. Each center participated with the required information of clinical data including age at diagnosis, gender, symptoms on admission, follow-up period, treatment modalities, radiotherapy dose and AJCC 1997 tumor stage.
Questionnaires;
A core QoL questionnaire- EORTC QLQ C30 version 3- is used together with diagnosisspecific modules to increase the coverage, sensitivity, and specificity of the assessments in various patient and treatment groups. It is a cancer-specific self report questionnaire. It includes 30 questions and validated in several studies.
EORTC QLQ-H&N 35 is designed to be used together with core QLQ-C30. The time frame of the module is “during past week”, and the format is similar to core questionnaire. Thirtyfive questions regarding the functions and symptoms of the patients were included in this questionnaire.
Each patient’s 33 QoL scores including function, global health status and symptoms were calculated as instructed in EORTC C30 QLQ scoring manual. All of the scales and singleitem measures range in score from 0 to 100. A high scale score represents a higher response level. Thus a high score for a functional scale represents a high / healthy level of functioning, a high score for the global health status / QoL represents a high QoL, but a high score for a symptom scale / item represents a high level of symptomatology / problems.
Kruskal-Wallis and Mann-Whitney U non-parametric tests were used for comparisons.

Results: One hundred eighty-seven patients with median age of 46 years (range; 16-79 years) participated to complete the questionnaires. Characteristics of the patients are summarized in table I. Median follow-up time is 3.4 years (range 6 months-24 years). All patients have received external beam radiotherapy. Beside external radiotherapy, 59 patients underwent brachytherapy boost, 70 patients received concomittant and 85 patients received adjuvant/neoadjuvant chemotherapy. Most of the patients in the analysis (75%) were in advanced stage [(Stage III, n=85 (45.4%); stage IV, n=55(29%)].
Calculated scores for both QLQ-C30 and H&N 35 questionnaires were reported in tables II and III. Mean global health status was calculated as 73. Parameters that increase global health status were male gender, early stage disease and patients with less than 4 year follow up
(p<0.05). Functional parameters were better in male and early stage disease. Factors yielding better symptom scores were short interval after treatment (10 scores), male gender (7 scores) and lower radiation dose (6 scores). Neoadjuvant or adjuvant chemotherapy did not have any effect on quality of life whereas concomitant chemotherapy adversely affected 4 symptom scores; trouble with social eating, ill feeling, weight gain, the need of nutritional supplement.
Conclusion: It is evident from our study that quality of life is adversely affected in our nasopharyngeal carcinoma patients treated with combined treatments. The factors that adversely affect quality of life are advanced tumor stage, female gender and long term follow up. Further controlled studies evaluating both pre and post-radiotherapy status are necessary to clarify the contribution of each treatment modality to quality of life.
Table I. Patient Characteristics
Characteristics
Age
#
46 years (Range 16-79)
Sex
Male
Female
Stage
I
121
66
9
(64.7%)
(35.3%)
(4.8 %)
IIa
IIb
III
IVA
IVB
Surgery
Chemotherapy
None
Neoadjuvant
Concomittant
Adjuvant
Radiotherapy dose
Radiotherapy fraction size
Brachytherapy
Folow-up
<4 years
>4years
13
24
(7 %)
(12.8 %)
86 (46%)
37 (19.8 %)
18 (9.6%)
3
49 (26.2 %)
70
70
25
(37.4 %)
(37.4 %)
(13.4 %)
67.8 Gy (range 50-74 Gy)
2 Gy (range 1.8-2 Gy)
59 (31.6%)
111
76
(59.4%)
(40.6%)

Table II. Calculated Scores for QLQ-C30 version 3.0.
Scale Name
Global health status / QoL
Global health status/QoL
Functional scales
Physical functioning
Mean score
73
Minimum score Maximum score
8,3 100
Role functioning
Emotional functioning
Cognitive functioning
Social functioning
Symptom scales / items
84,8
91,3
76,7
81,2
83
13,3
0
0
0
16,7
100
100
100
100
100
Fatigue
Nausea and vomiting
Pain
Dyspnoea
Insomnia
Appetite loss
Constipation
25,2
5,4
13,8
4,5
13,8
10,5
19,1
0
0
0
0
0
0
0
88,9
100
100
66,7
100
100
100
Diarrhea
Financial difficulties
4,2
27,5
0
0
100
100

Table III. Calculated Scores for QLQ-H&N 35.
Scale Name
Symptom scales / items
Mean score Minimum score Maximum score
Pain 14,8 0 91,7
Swallowing
Senses problems
Speech problems
Trouble with social eating
Trouble with social contact
Less sexuality
Teeth
24,2
17,4
11,9
13,2
9,5
19,3
44,9
0
0
0
0
0
0
0
83,3
100
77,8
75
86,7
100
100
Opening mouth
Dry mouth
Sticky saliva
Coughing
Felt ill
Pain killers
Nutritional supplements
Feeding tube
Weight loss
Weight gain
36
66,4
57,3
17,5
16,9
42,7
15,3
0
16,2
45
0
0
0
0
0
0
0
0
0
0
100
100
100
100
100
100
100
0
100
100