# Quality of Life Among Head and Neck Cancer Patients at a Tertiary Care Hospital in Assam, India: A Mixed-Methods Study

## TL;DR

This study evaluates the quality of life of head and neck cancer patients in Assam, India, using both quantitative and qualitative methods to understand their physical, emotional, and social challenges.

## Contribution

The study provides a mixed-methods assessment of HNC patients' quality of life in a specific Indian context, highlighting unique regional challenges.

## Key findings

- Emotional and role functioning were significantly compromised in HNC patients.
- Symptoms like fatigue, dry mouth, and financial difficulties had a high impact on quality of life.
- Qualitative interviews revealed issues like social disengagement and emotional distress affecting patients' lives.

## Abstract

Introduction: The physical, psychological, and social functioning of patients with head and neck cancer (HNC) is profoundly affected, resulting in considerable challenges to their quality of life (QoL). This mixed-method study used both quantitative and qualitative methods to evaluate the QoL of HNC patients who were attending a tertiary cancer centre in Assam.

Materials and methods: Eighty adult HNC patients who were seen in the State Cancer Institute's outpatient department in Guwahati participated in a cross-sectional mixed-method study. Quantitative data were collected using the Assamese versions of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ-C30) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Head and Neck 43 (EORTC QLQ-H&N43) questionnaires. Relationships between the functional and symptom domains and overall QoL were investigated using correlation analysis. To explore patients’ experiences related to physical, emotional, social, and role functioning, semi-structured interviews were conducted. Integration of quantitative and qualitative findings ensured methodological rigour.

Results: While emotional and role functioning were significantly compromised, cognitive functioning displayed the highest mean functional score. Emotional (45.3%) and role functioning (54.1%) showed lower scores, while physical (64.4%) and social functioning (52.6%) demonstrated moderate limitation. Cognitive functioning was the highest-scoring domain (75.3%). The most affected symptom domains included fatigue (56.2%), financial difficulty (55.2%), dry mouth (55.9%), sticky saliva (53.2%), social contact problems (53.7%), appetite loss (44.8%), and pain (41.3%). The H&N43's recently measured domains of sexual desire, neck/skin symptoms, and fear of recurrence also demonstrated a moderate impact. Persistent pain, difficulty swallowing, reliance on food, speech impairment, social disengagement due to disfigurement, and severe emotional distress were all highlighted in the qualitative findings. Many patients suffered from financial toxicity, strained family ties, and diminished work capacity.

Conclusion: In the social, emotional, physical, and financial spheres, HNC substantially lowers QoL. When paired with psychological distress and financial stress, symptom burden, particularly xerostomia, swallowing issues, and exhaustion, strongly predicts lower overall QoL. Improving survivorship outcomes requires comprehensive multidisciplinary care that addresses financial counselling, psychological support, and symptom management.