Xerostomia and effects on quality of life in long-term head and neck cancer survivors

Abstract Problem: Few studies have evaluated the degree of xerostomia in long-term cancer survivors or its impact on quality of life (QOL). The purpose of this study was to objectively measure the degree of xerostomia and to determine the effect of xerostomia on the subjective quality of life of long-term survivors of head and neck cancer treated with external beam irradiation. Methods: A convenience sample of 5-year head and neck cancer survivors underwent the following battery of tests: (1) targeted head and neck exam, (2) OPSE (swallow evaluation), (3) measurements of stimulated and unstimulated saliva, and (4) standardized QOL questionnaires. Results: Eighty-six survivors were included in the study. The following associations were identified: (1) unstimulated weights were influenced by site ( P = 0.0096) and stage of cancer (and P = 0.047); (2) stimulated saliva weights were influenced by stage ( P = 0.0018); site ( P = 0.0002), particularly the larynx ( P = 0.0001); and treatment ( P = 0.0071); (3) unstimulated weight only correlated with one QOL measure (mouth is dry); (4) decreased stimulated saliva weight correlated with impaired swallowing ( P = 0.0043) and negatively impacted all but three QOL measures; and (5) subjective xerostomia correlated with impaired swallowing ( P = 0.046) as well as worse scores on about half of the QOL measures. Conclusion: This study shows that objective (stimulated saliva weight) and subjective (standardized QOL questionnaires) xerostomia persists in long-term head and neck cancer survivors. The xerostomia impairs swallowing and has a negative influence on many QOL measures. Laryngeal irradiation has little or no impact on subsequent xerostomia. Significance: Though many of the effects of radiation therapy resolve in the first 3 years, xerostomia may persist. This study demonstrates that subjective and objective indicators of xerostomia are present 5 years after treatment. The presence of chronic xerostomia continues to affect many areas of QOL in long-term head and neck cancer survivors, including though not limited to those related to the oral cavity. Support: None reported.