Page 101 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

Long-term function after CRT and preventive rehabilitation
Quality of life related outcomes
See Table 5 for all quality of life related outcomes. Scores increased moderately on all of the Dutch SWAL-QOL subscales, except for ‘food selection’ and ‘fear of eating’, indicating a deteriorated swallowing-related quality of life. Also, the median total SWAL-QOL score deteriorated from 12 (range 0–58) to 22 (range 0–41), which is above the cut-off value of 14, indicating swallowing problems in daily life. At six-year follow-up, 5 of the 13 patients (39%) who filled in the SWAL-QOL had a score above the cut-off value. At-ten-year plus follow-up, this was the case for 8 of the 14 patients (57%).
Overall, the results suggest that at ten-year plus follow-up, patients have only minor problems in voice/speech-related quality of life. Median VHI scores slightly worsened from 2 to 5, indicating a little more voice related problems in daily life, while maximum scores improved from 91 to 47, indicating voice related quality of life of patients with the worst VHI scores improved. Also, at both six-year and ten-year plus follow-up four patients had a VHI score above the cut-off value (of whom three were the same patients). The patients with a VHI score above the cut-off had tumors of mixed localizations (hypopharynx (n = 2), oropharynx (n = 1), and nasopharynx (n = 1)). Subjective speech (based on the median SHI) remained stable, while maximum SHI scores also improved from 92 to 47. Of the six patients that currently had an SHI above the cut-off value indicating speech problems in daily life, only four had an SHI above cut-off value at last follow-up. Of the six patients with SHI scores above the cut-off value, three had an hypopharyngeal tumor, two an oropharyngeal tumor, and one had a nasopharyngeal tumor. EQ-5D-5L scores slightly increased from six- to ten-year plus follow-up, indicating a lower quality of life, although the median EQ-VAS scores were more or less equal (85 (range 60–100) and 88 (range 50–100), respectively). At six-year follow-up 2 (14%), 0 (0%), 2 (14%), 5 (36%) and 4 (29%) patients reported problems with mobility, self-care, usual activities, pain/discomfort and anxiety/depression respectively. At ten-year plus follow-up this was the case in 4 (29%), 1 (7%), 6 (43%), 4 (29%) and 4 (29%) patients, respectively.
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