Health scores after 1 year may predict survival in head and neck cancer patients

Changes in patients' physical health status during the year after being diagnosed with head and neck cancer appear to predict survival at five years, according to a report in the September issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.

The TNM staging system for cancer (based on the tumor, involvement of lymph nodes and any distant spread) is effective in predicting whether cancer patients will die of their disease, according to background information in the article. However, it considers only factors directly related to cancer and not information about other medical conditions or the patient's overall health status. "These factors may have a meaningful effect on the management of patients with head and neck cancer from the initial assessment through treatment selection and management of complications," the authors write.

Mark J. Jameson, M.D., Ph.D., then of the University of Iowa College of Medicine, Iowa City, and now of the University of Virginia Health System, Charlottesville, and colleagues studied 403 patients (64 percent men, average age 58.7) who were diagnosed with head and neck cancer between 1995 and 2005. Participants completed general physical health assessments when they were diagnosed and again three, six, nine and 12 months later and then were followed up for five years.

Among all patients, scores on the health assessments decreased between diagnosis and the three-month point. Those who died during the second or third year exhibited no recovery in their scores, while those who died within the fourth or fifth year exhibited some recovery and those who survived five years or longer approached beginning scores again at the 12-month mark.

The findings suggest that a self-reported measure of general health "captures prognostic information related to cancer state," the authors write. "It seems intuitive that a patient's perception of well-being would fluctuate (e.g., during intensive cancer therapy vs. after recovery from successful treatment), and it seems possible that this fluctuation may be predictive of long-term outcome. This study demonstrates that the change in self-reported health status during the first year is predictive of long-term outcome (i.e., five-year survival)."

In light of the findings, a measure of general health and well-being may be a useful addition to the care of patients with head and neck cancer, especially in the first year, they conclude. "It has the benefits of refining prognosis and identifying patient needs that may not be clinically obvious in a brief encounter but may have substantial effect on quality of life," the authors write. "Further study is warranted to determine how to best integrate data from patient-reported health assessment into patient care."

(Arch Otolaryngol Head Neck Surg. 2008;134[9]:958-964. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported in part by a grant from the National Cancer Institute, Office of Cancer Survivorship. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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