Clinical and psychosocial factors associated with quality of life in patients with head and neck cancer: an analytical cross-sectional study from a lower-middle-income country

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Surgery; Medical College Pakistan; School of Nursing and Midwifery, Pakistan; Psychiatry; Community Health Sciences


Introduction: The disease course of head and neck (H&N) cancers can severely impair patients’ quality of life (QoL). In Pakistan, a South Asian lower-middle-income country (LMIC), psychosocial factors may be associated with QoL. Thus, we aimed to assess QoL and associated factors amongst patients with H&N cancers in Pakistan.
Methods: An analytical cross-sectional study was conducted amongst adult (≥ 18 years) patients with H&N cancer who were ≥ 4 weeks post-initiation of treatment. The survey assessed QoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaires), mental health outcomes (Hospital Anxiety and Depression Scale), and social support (Enriched Social Support Instrument). Multivariable linear regression was used for analysis.
Results: A total of 250 patients (mean age: 51.6 years) were included. The majority of patients were married (87%) and living with multigenerational/extended family households (53%). On multivariable linear regression, ongoing cancer treatment (beta coefficient: -13.93), having a tracheostomy (-10.02), and receiving adjuvant chemoradiotherapy (-8.17) were significantly associated with poorer global QoL. Additionally, poorer QoL was associated with depression (-24.37) and anxiety (-13.34). However, having more household family member was associated with better global QoL (0.34).
Conclusion: The QoL of patients with H&N cancer in Pakistan is affected by both the nature of cancer treatment as well as sociocultural factors such as household size. Given that poorer QoL is associated with poorer mental health outcomes, there is a need to develop and implement psychosocial interventions to improve QoL of patients with H&N cancer in Pakistan, particularly during active treatment.


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Research Square