Oral health-related quality of life among long-term head and neck cancer survivors: a multinational study

Purpose: Our aim was to investigate oral health-related quality of life (OHRQoL) and toxicities in long-term head and neck cancer (HNC) survivors diagnosed ≥five years earlier. Methods: HNC survivors treated between 2007 and 2013 participated in an international cross-sectional study. They completed the European Organization for Research and Treatment of Cancer (EORTC) core quality of life questionnaire (EORTC QLQ-C30) and the oral health module (EORTC QLQ-OH15) and attended a hospital examination. Clinicians scored toxicities using the Common Terminology Criteria for Adverse Events version 5.0. OHRQoL was analyzed based on four types of treatment: surgery, radiotherapy, chemoradiotherapy without surgery and surgery with postoperative (chemo) radiotherapy. Survivors were divided into three groups according to the EORTC QLQ-OH15 oral health-QoL scale score; the lowest (defined as poor OHRQoL), middle and highest tertile. Results: Eleven sites in six countries enrolled 404 HNC survivors. The median time since diagnosis was 8.4 years, the mean age was 66 years and 67% were male. A total of 116 (29%) of the survivors reported poor OHRQoL. They were more often females and survivors with advanced disease. The survivors with poor OHRQoL also had more toxicity: dysphagia, trismus, osteonecrosis of the jaw, oral pain and dry mouth. There were no clinically significant differences in OHRQoL between the four treatment groups. Conclusion: Our study showed that the survivors who reported poor OHRQoL also had a high level of late toxicity. This highlight the need for improved follow-up of the oral health of HNC survivors many years after initial treatment, especially for women and those who were treated for advanced disease.