Researchers looked at 384 people with head and neck cancer who were employed when they were diagnosed and found 52 percent reported work-related disability after cancer treatment. Results of the study were published this week in the Archives of Otolaryngology – Head and Neck Surgery.
Patients who had undergone chemotherapy were 3.5 times more likely to report disability, and patients who had had a neck dissection, surgery to remove lymph nodes in the neck, were twice as likely to be disabled. Worse pain scores also were linked to disability, with each 10-point decline on a standard pain scale leading to a 20 percent increase in the odds of disability. Patients were on average more than four years out from their initial diagnosis.
"Although chemotherapy and neck dissection appear to be associated with disability, patients should not opt out of these important treatments because of that. Decisions about treatment should be primarily concerned with ensuring survival and preventing recurrence. Still, disability and quality of life issues are secondary concerns and need to be addressed," says study author Jeffrey Terrell, M.D., associate professor of otolaryngology at the U-M Medical School and a member of the U-M Comprehensive Cancer Center.
"As we develop new therapies, doctors need to consider ways to minimize patient discomfort. Pain needs to be prevented or treated appropriately and the negative effects of chemotherapy and neck dissection should be addressed in an effort to reduce patient disability," says Joseph Taylor, M.D., study co-author and an otolaryngology resident at UMHS. UMHS is among a handful of centers using surgical techniques that seek to minimize the impact of treatment.
More than 40,000 Americans are diagnosed with head and neck cancer and 12,000 die from it each year. Previous studies have shown cancer is more likely than other chronic medical conditions to cause work-related problems and missed days on the job. Head and neck cancer includes conditions affecting the mouth, tongue, nose, throat, larynx and ears, but excludes brain and spine tumors.
This study, the first to look at specific factors associated with disability in head and neck cancer patients, is part of a larger study evaluating quality of life of patients with head and neck cancer. Patients were from UMHS and the Veterans Affairs medical centers in Ann Arbor, Mich.; Gainesville, Fla.; and Dallas, Texas. Only patients who were working at the time of their diagnosis were considered for this smaller study.
Researchers obtained information from patient charts and asked study participants to complete surveys related to pain, nicotine usage, alcohol use and depression. Participants were also asked if they were working before their diagnosis and if their doctors had told them they were unable to work because of their cancer or treatment. Patients were considered disabled by their cancer if they were working before they were diagnosed and were unable to work after treatment.
Head and neck cancer often causes debilitating speech, eating and respiratory problems. Chemotherapy and neck dissection can compound those problems. Chemotherapy, which can take up to four months to complete, may lead to severe fatigue as well as other side effects that may make returning to work difficult. Neck dissection can cause pain, weakness and overall loss of function.
"Each type of treatment – whether it's surgery, chemotherapy or radiation therapy – takes its toll on a patient's functional abilities, well being and health status. Patients need to know what to expect from their treatment and develop a support network to get through it," Terrell says. "In the future, basic research of the molecular biology of cancer may also allow us to predict which patients may respond best to surgery, chemotherapy or radiation therapy, rather than combination treatment. This may allow us to eventually tailor therapy to only one type of treatment and reduce disability in our patients as well."
In addition to Terrell and Taylor, study authors were David Ronis, Ph.D., Ann Arbor VA Healthcare System and U-M School of Nursing; Karen Fowler, VA Ann Arbor Healthcare System; Carol Bishop, Veterans Affairs Hospital, Gainesville, Fla.; Michael Lambert, M.D., University of Texas Southwestern Medical School and VA North Texas Health Care System; Larry Myers, M.D., University of Texas Southwestern Medical School and Dallas Veterans Affairs Medical Center; Sonia Duffy, Ph.D., U-M Department of Otolaryngology and Ann Arbor VA Healthcare System.
Funding for the study was from the National Institutes of Health SPORE grant, GlaxoSmithKline's Managed Care Forum and a U.S. Department of Veterans Affairs grant.
For more information on the U-M head and neck oncology program, visit www.cancer.med.umich.edu/clinic/headneckclinic.htm. For information on cancer treatment and research at U-M, call the Cancer AnswerLine at 800-865-1125.
Archives of Otolaryngology – Head and Neck Surgery, volume 130, No. 6, pages 764-769
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Archives of Otolaryngology - Head and Neck Surgery