Socioeconomic Factors Affecting Health-Related Quality-of-Life in Head/Neck Cancer Survivors

Head and neck cancer patients often undergo surgical treatments that can cause disfiguration and compromised functional abilities, such as chewing, swallowing and communicating. The self-perceived importance of such conditions combined with socioeconomic indicators may modify the impact in health-related quality of life (HRQL). Objective: To evaluate the effect of socioeconomic factors on HRQL, taking into consideration the self-perceived importance of different conditions caused by cancer treatment. Methods: Data were obtained from a previous cross-sectional study conducted in survivors of head and neck cancer being evaluated in a tertiary cancer hospital in a major Brazilian city. Patients that had been treated for squamous cell carcinoma of the upper aerodigestive tract and were disease-free for at least 2 years were included in the study. All participants (N= 477) responded to the validated Portuguese version of the FACT and to the University of Washington Quality of Life questionnaires. The outcome variables were self-reported quality of life and self-reported general health which were dichotomized into low (very bad to reasonable) or high (good to excellent). Indicators of socioeconomic position (SEP) included employment status, education level, income stability and owning a property. Logistic regression assessed the odds ratio (OR) and 95% confidence interval (95%CI) for SEP, in relation to self reported health and self reported quality of life, adjusting for potential confounders. Results: Subjects whose total income had decreased were more likely to report having low quality of life (OR 1.7, 95%CI 1.1-2.5), although this was not found for self reported health. Employment status and educational level were associated with the outcome variables in univariate analysis but did not showed to be significant in the logistic regression model. Conclusion: In this population, maintenance of overall income after the treatment had an effect on self-perceived quality of life.