Quality of life and its correlates in pretreatment patients with locally advanced head and neck cancer: A cross-sectional study in Thailand


locally advanced head and neck cancer
quality of life
body mass index
head and neck neoplasm

How to Cite

Pimvichai, S., Matchim, Y., Sinthusake, T., & Wongkalasin, K. (2023). Quality of life and its correlates in pretreatment patients with locally advanced head and neck cancer: A cross-sectional study in Thailand. Belitung Nursing Journal, 9(3), 244–252. https://doi.org/10.33546/bnj.2621
Google Scholar

Link to Google Scholar

Funder - Crossref Registry

Accepted for publication: 2023-06-06
Peer reviewed: Yes

Related articles in

Search Relations - Article by Author(s)

Share this article on:


Background: Locally advanced head and neck cancer (LAHNC) can significantly impact the quality of life of patients in various ways. However, several factors can contribute to the decrease in quality of life. In Thailand, there is limited knowledge about the factors that affect the quality of life of patients with LAHNC before they receive treatment.

Objective: This study aimed to examine the correlations between Palliative Performance Scale (PPS), family income, body mass index (BMI), age, comorbidity index, and the quality of life of patients with LAHNC before they undergo treatment.

Methods: A correlational cross-sectional study was conducted, and data were collected from 94 pretreatment patients with LAHNC who were admitted to a cancer center in central Thailand using purposive sampling. The data collection instruments included a demographic data form, a medical record form, the Charlson Comorbidity Index (CCI), the Palliative Performance Scale (PPS), and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) version 4. Descriptive statistics, Pearson’s correlation, and Spearman’s rank correlation were used to analyze the data.

Results: All study participants completed the questionnaire. The results showed that the overall quality of life of the patients was moderate. PPS, family income, and body mass index were moderately positively correlated with quality of life (r = 0.494, p <0.01; r = 0.420, p <0.01; r = 0.339, p<0.01, respectively). Age had a moderate negative correlation with quality of life (r = -0.596, p <0.01), while comorbidity was not significantly associated with quality of life.

Conclusion: The quality of life of patients with LAHNC before treatment was associated with various factors, including PPS, family income, body mass index, and age. These findings highlight the importance of nutritional support before treatment and the need for social support, especially for older adult patients, to improve their quality of life. The results of this study can be valuable for nurses in developing care programs that enhance the quality of life for patients with LAHNC during the pretreatment phase.


Supporting Agencies

The study was supported by Thammasat University Research Unit in Palliative Care for Adults and Older Adults


Copyright (c) 2023 Sirinya Pimvichai, Yaowarat Matchim, Tanadej Sinthusake, Kiratiya Wongkalasin

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Article Metrics

Total views 359 [Abstract: 173 | PDF: 180 | XML: 6 ]


Download data is not yet available.

PlumX Metrics

Declaration of Conflicting Interest

The authors declared no conflict of interest in this study.


The authors would like to express their gratitude to all the patients who participated in this study. They would also like to extend special thanks to the Faculty of Nursing, Thammasat University, and Maha Vajiralongkorn Thanyaburi Hospital for their generous support. The authors are sincerely grateful to Prof. Dr. Thierry Backeljau from the Royal Belgian Institute of Natural Sciences, Belgium, as well as the reviewers for their valuable feedback and insightful comments, which greatly contributed to the improvement of the manuscript.

Authors’ Contributions

SP was responsible for the research conception and design, data collection, analysis, interpretation of results, and drafting of the manuscript. YM reviewed the results and provided revisions to the draft. TS and KW made significant contributions to the conception and design of the study. All authors have reviewed and approved the final version of the manuscript.

Data Availability

The corresponding author can provide the datasets used for analysis upon reasonable request.

Declaration of Use of AI in Scientific Writing

Nothing to declare.


Ackerman, D., Laszlo, M., Provisor, A., & Yu, A. (2018). Nutrition management for the head and neck cancer patient. In E. Maghami & A. S. Ho (Eds.), Multidisciplinary care of the head and neck cancer patient (pp. 187-208). Springer International Publishing. https://doi.org/10.1007/978-3-319-65421-8_11

Ahlam, A., Hind, M., Haddou Rahou, B., Rachid, R., & Hassan, E. (2019). Quality of life of Moroccan patients on the palliative phase of advanced cancer. BMC Research Notes, 12, 351. https://doi.org/10.1186/s13104-019-4390-1

Amin, M. B., Greene, F. L., Edge, S. B., Compton, C. C., Gershenwald, J. E., Brookland, R. K., Meyer, L., Gress, D. M., Byrd, D. R., & Winchester, D. P. (2017). The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA: A Cancer Journal for Clinicians, 67(2), 93-99. https://doi.org/10.3322/caac.21388

Aparajita, S., Saptarshi, B., Sharmista, D., Srikrishna, M., & Anjan, B. (2022). Quality of life of Indian head and neck cancer patients before and after treatment: A prospective study from a tertiary cancer center. Asian Journal of Medical Sciences, 13(11), 207-213. https://doi.org/10.3126/ajms.v13i11.46860

Arribas, L., Hurtós, L., Milà, R., Fort, E., & Peiró, I. (2013). Predict factors associated with malnutrition from patient generated subjective global assessment (PG-SGA) in head and neck cancer patients. Nutricion Hospitalaria, 28(1), 155-163. https://doi.org/10.3305/nh.2013.28.1.6168

Astrup, G. L., Rustøen, T., Hofsø, K., Gran, J. M., & Bjordal, K. (2017). Symptom burden and patient characteristics: Association with quality of life in patients with head and neck cancer undergoing radiotherapy. Head & Neck, 39(10), 2114-2126. https://doi.org/10.1002/hed.24875

Bonzanini, L. I. L., Soldera, E. B., Ortigara, G. B., Schulz, R. E., Antoniazzi, R. P., Ardenghi, T. M., & Ferrazzo, K. L. (2020). Clinical and sociodemographic factors that affect the quality of life of survivors of head and neck cancer. Supportive Care in Cancer, 28, 1941-1950. https://doi.org/10.1007/s00520-019-05008-4

Bunkong, S., Arpanantikul, M., Sirapo-ngam, Y., Monkong, S., Viwatwongkasem, C., & Olson, K. (2023). A model of factors influencing health-related quality of life among thais with colorectal cancer and a permanent colostomy. Pacific Rim International Journal of Nursing Research, 27(1), 185-199.

Cella, D. F. (1994). Quality of life: Concepts and definition. Journal of Pain and Symptom Management, 9(3), 186-192. https://doi.org/10.1016/0885-3924(94)90129-5

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373-383. https://doi.org/10.1016/0021-9681(87)90171-8

Chen, J. E., Lou, V. W., Jian, H., Zhou, Z., Yan, M., Zhu, J., Li, G., & He, Y. (2018). Objective and subjective financial burden and its associations with health-related quality of life among lung cancer patients. Supportive Care in Cancer, 26, 1265-1272. https://doi.org/10.1007/s00520-017-3949-4

Chewaskulyong, B., Sapinun, L., Downing, G. M., Intaratat, P., Lesperance, M., Leautrakul, S., Somwangprasert, A., & Leerapun, T. (2012). Reliability and validity of the Thai translation (Thai PPS Adult Suandok) of the Palliative Performance Scale (PPSv2). Palliative Medicine, 26(8), 1034-1041. https://doi.org/10.1177/0269216311424633

Chobtamsakul, S. (2018). Taking care and promoting elderly health to have good quality of life. Ph.D. in Social Sciences Journal, 8(3), 15-25.

Chow, L. Q. M. (2020). Head and neck cancer. New England Journal of Medicine, 382(1), 60-72. https://doi.org/10.1056/NEJMra1715715

Chumachote, A. (2016). Quality of life in head and neck cancer patients receivied radiotherapy. Journal of Thai Association of Radiation Oncology, 22(1), 24-33.

Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159. https://doi.org/10.1037/0033-2909.112.1.155

D'Antonio, L. L., Zimmerman, G. J., Cella, D. F., & Long, S. A. (1996). Quality of life and functional status measures in patients with head and neck cancer. Archives of Otolaryngology–Head & Neck Surgery, 122(5), 482-487. https://doi.org/10.1001/archotol.1996.01890170018005

de Araújo Gomes, E. P. A., Aranha, A. M. F., Borges, A. H., & Volpato, L. E. R. (2020). Head and neck cancer patients’ quality of life: Analysis of three instruments. Journal of Dentistry, 21(1), 31-41. https://doi.org/10.30476%2FDENTJODS.2019.77677.0

Fattouh, M., Chang, G. Y., Ow, T. J., Shifteh, K., Rosenblatt, G., Patel, V. M., Smith, R. V., Prystowsky, M. B., & Schlecht, N. F. (2019). Association between pretreatment obesity, sarcopenia, and survival in patients with head and neck cancer. Head & Neck, 41(3), 707-714. https://doi.org/10.1002/hed.25420

Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149-1160. https://doi.org/10.3758/BRM.41.4.1149

Ferlay, J., Ervik, M., Lam, F., Colombet, M., Mery, L., Piñeros, M., Znaor, A., Soerjomataram, I., & Bray, F. (2020). Global cancer observatory: cancer today. International Agency for Research on Cancer. Retrieved from https://gco.iarc.fr/today

Garfield, L. (2020). Head and neck cancers: Update 2020. RGA. https://www.rgare.com/knowledge-center/article/head-and-neck-cancers-update-2020

Hortense, F. T. P., Bergerot, C. D., & Domenico, E. B. L. D. (2020). Quality of life, anxiety and depression in head and neck cancer patients: A randomized clinical trial. Revista da Escola de Enfermagem da USP, 54. https://doi.org/10.1590/S1980-220X2018040103546

Johnson, D. E., Burtness, B., Leemans, C. R., Lui, V. W. Y., Bauman, J. E., & Grandis, J. R. (2020). Head and neck squamous cell carcinoma. Nature Reviews Disease Primers, 6(1), 92. https://doi.org/10.1038/s41572-020-00224-3

Karimi, A. M., Gairola, M., Ahlawat, P., Tandon, S., Pal, M., Sachdeva, N., Sharief, M. I., & Dobriyal, K. (2019). Health-related quality of life assessment for head-and-neck cancer patients during and at 3 months after radiotherapy–A prospective, analytical questionnaire-based study. National Journal of Maxillofacial Surgery, 10(2), 134-140. https://doi.org/10.4103%2Fnjms.NJMS_92_18

Kim, S. A., Roh, J. L., Lee, S. A., Lee, S. w., Kim, S. B., Choi, S. H., Nam, S. Y., & Kim, S. Y. (2016). Pretreatment depression as a prognostic indicator of survival and nutritional status in patients with head and neck cancer. Cancer, 122(1), 131-140. https://doi.org/10.1002/cncr.29693

Kumar, A., Chandrasekaran, A., & Kumar, T. (2019). Assessment of nutritional status of locally advanced head and neck carcinoma patients treated with concomitant chemo-radiation, using Body Mass Index (BMI). Journal of Medical Science and Clinical Research, 7(8), 715-722. https://dx.doi.org/10.18535/jmscr/v7i8.121

Kumar, N. B. (2012). Assessment of malnutrition and nutritional therapy approaches in cancer patients. In N. B. Kumar (Ed.), Nutritional management of cancer treatment effects (pp. 7-41). Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-642-27233-2_2

Lee, Y.-G., Kang, E. J., Keam, B., Choi, J.-H., Kim, J.-S., Park, K. U., Lee, K. E., Kwon, J. H., Lee, K.-W., & Kim, M. K. (2020). Treatment strategy and outcomes in locally advanced head and neck squamous cell carcinoma: A nationwide retrospective cohort study (KCSG HN13–01). BMC Cancer, 20, 813. https://doi.org/10.1186/s12885-020-07297-z

Liao, L.-J., Hsu, W.-L., Lo, W.-C., Cheng, P.-W., Shueng, P.-W., & Hsieh, C.-H. (2019). Health-related quality of life and utility in head and neck cancer survivors. BMC Cancer, 19, 425. https://doi.org/10.1186/s12885-019-5614-4

Lo Nigro, C., Denaro, N., Merlotti, A., & Merlano, M. (2017). Head and neck cancer: Improving outcomes with a multidisciplinary approach. Cancer Management and Research, 363-371. https://doi.org/10.2147/CMAR.S115761

Lu, L., O’Sullivan, E., & Sharp, L. (2019). Cancer‐related financial hardship among head and neck cancer survivors: Risk factors and associations with health‐related quality of life. Psycho‐Oncology, 28(4), 863-871. https://doi.org/10.1002/pon.5034

Maggiore, R., Zumsteg, Z. S., BrintzenhofeSzoc, K., Trevino, K. M., Gajra, A., Korc-Grodzicki, B., Epstein, J. B., Bond, S. M., Parker, I., & Kish, J. A. (2017). The older adult with locoregionally advanced head and neck squamous cell carcinoma: Knowledge gaps and future direction in assessment and treatment. International Journal of Radiation Oncology* Biology* Physics, 98(4), 868-883. https://doi.org/10.1016/j.ijrobp.2017.02.022

Mañós, M., Giralt, J., Rueda, A., Cabrera, J., Martinez-Trufero, J., Marruecos, J., Lopez-Pousa, A., Rodrigo, J. P., Castelo, B., Martínez-Galán, J., Arias, F., Chaves, M., Herranz, J. J., Arrazubi, V., Baste, N., Castro, A., & Mesía, R. (2017). Multidisciplinary management of head and neck cancer: First expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 1). Oral Oncology, 70, 58-64. https://doi.org/10.1016/j.oraloncology.2017.04.004

Naing, L., Winn, T., & Rusli, B. N. (2006). Practical issues in calculating the sample size for prevalence studies. Archives of Orofacial Sciences, 1, 9-14.

Nayak, S. G., Pai, M. S., & George, L. S. (2019). Quality of life of patients with head and neck cancer: A mixed method study. Journal of Cancer Research and Therapeutics, 15(3), 638-644. https://doi.org/10.4103/jcrt.JCRT_1123_16

Pequeno, N. P. F., Cabral, N. L. d. A., Marchioni, D. M., Lima, S. C. V. C., & Lyra, C. d. O. (2020). Quality of life assessment instruments for adults: A systematic review of population-based studies. Health and Quality of Life Outcomes, 18(1), 1-13. https://doi.org/10.1186/s12955-020-01347-7

Puengsook, W., Kanthawee, P., & Markmee, P. (2019). Factors associated with quality of life among cancer patients with palliative care at the end of life residing in Chiang Rai Province. Nursing Journal of The Ministry of Public Health, 29(2), 116-128.

Rettig, E. M., D’Souza, G., Thompson, C. B., Koch, W. M., Eisele, D. W., & Fakhry, C. (2016). Health‐related quality of life before and after head and neck squamous cell carcinoma: Analysis of the Surveillance, Epidemiology, and End Results–Medicare Health Outcomes Survey linkage. Cancer, 122(12), 1861-1870. https://doi.org/10.1002/cncr.30005

Rojanamatin J, Ukranun W, Supaattagorn P, Chiawiriyabunya I, Wongsena M, Chaiwerawattana A, Laowahutanont P, Chitapanarux I, Vatanasapt P, Greater S.L, Sangrajrang S, & Buasom R. (2021). Cancer in Thailand Vol.X, 2016-2018 (Vol. X). Bangkok, Thailand: National Cancer Institute.

Schrijvers, D., & Charlton, R. (2022). Palliative care and end-of-life issues in elderly cancer patients with head and neck cancer. Frontiers in Oncology, 12. https://doi.org/10.3389/fonc.2022.769003

Shah, J. P., & Montero, P. H. (2018). New AJCC/UICC staging system for head and neck, and thyroid cancer. Revista Médica Clínica Las Condes, 29(4), 397-404. https://doi.org/10.1016/j.rmclc.2018.07.002

Sharma, Y., Mishra, G., & Parikh, V. (2019). Quality of life in head and neck cancer patients. Indian Journal of Otolaryngology and Head & Neck Surgery, 71(Suppl 1), 927-932. https://doi.org/10.1007/s12070-019-01620-2

Silva, J. C., Silveira, A., Sacau, A., Monteiro, E., & Sequeira, T. (2019). Head and neck cancer early identification of malnutrition high risk patients and quality of life optimization. International Journal of Otolaryngology and Head & Neck Surgery, 8(6), 96194. https://doi.org/10.4236/ijohns.2019.86023

Silveira, A. P., Gonçalves, J., Sequeira, T., Ribeiro, C., Lopes, C., Monteiro, E., & Pimentel, F. L. (2010). Patient reported outcomes in head and neck cancer: Selecting instruments for quality of life integration in clinical protocols. Head & Neck Oncology, 2(1), 32. https://doi.org/10.1186/1758-3284-2-32

Sittitrai, P. (2019). Head and neck cancer. Chiang Mai: Tric Ink.

Suraseraneewong, & Sreeprasarn. (2017). The roles of home health care nurse in head and neck cancer patients at home. Journal of Public Health Nursing, 31(1), 175-188.

Terrell, J. E., Ronis, D. L., Fowler, K. E., Bradford, C. R., Chepeha, D. B., Prince, M. E., Teknos, T. N., Wolf, G. T., & Duffy, S. A. (2004). Clinical predictors of quality of life in patients with head and neck cancer. Archives of Otolaryngology–Head & Neck Surgery, 130(4), 401-408. https://doi.org/10.1001/archotol.130.4.401

Utriyaprasit, K. (2001). The relationship between recovery symptoms and functional outcomes in Thai CABG patients [Doctoral Dissertation, Case Western Reserve University (Health Sciences)]. Cleveland, Ohio.

Viani, G., Faustion, A., Danelichen, A. F. B., Maatsura, F. K., Neves, L. V. F., Fernandes, M. H., & Pavoni Fernandes, J. (2021). Radiotherapy for locally advanced head and neck cancer in elderly patients: Results and prognostic factors a single cohort. Reports of Practical Oncology and Radiotherapy, 26(1), 12-19. https://doi.org/10.5603/RPOR.a2021.0002

Von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. The Lancet, 370(9596), 1453-1457. https://doi.org/10.1016/S0140-6736(07)61602-X

Zanoni, D. K., Patel, S. G., & Shah, J. P. (2019). Changes in the 8th Edition of the American Joint Committee on Cancer (AJCC) staging of head and neck cancer: Rationale and implications. Current Oncology Reports, 21(6), 52. https://doi.org/10.1007/s11912-019-0799-x

Readers are able to give us their valuable feedbacks here. The comments will be reviewed by the editors and then published here. Important Note: The "Comments" related to the Galley Proof PDF must NOT be submitted via this form. Authors should submit their comments on their galley proofs only via system