General and Specific Quality of life in long-term oral cancer survivors reconstructed with free forearm flap.

doi:10.21203/rs.3.rs-1756929/v1

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General and Specific Quality of life in long-term oral cancer survivors reconstructed with free forearm flap.

https://doi.org/10.21203/rs.3.rs-1756929/v1

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Background: This study evaluates the general and specific quality of life (QoL) in oral cancer patients with more than 5 years of survival after initial surgery and reconstructed with Radial Forearm Free Flap (RFFF), comparing these results with a general population group, used as a reference.

Methods: We used in our study the SF36 (Short Form 36), the UW (University of Washington) and the EORTC-H&N35 (European Organisation for Research and Treatment of Cancer, Head and Neck 35) QoL questionnaires, self-administered to 30 oral cancer patients reconstructed with RFFF, and at least 5 years of cancer-free survival after surgery. Paired Student t test and Student t test to compare a sample with a theoretical value or Wilconxon test to compare a sample with a theoretical value, when indicated, were used to analyze the statistical significance, which was considered at a value of p<0.05.

We applied the Minimum Important Difference (MID) to the difference of means between our patients and the general population. The difference of means was considered clinically relevant if it overcame the MID.

Results: The SF-36 questionnaire in our patients yielded a better HRQL (Health Related Quality of Life), both statistically significant and clinically relevant in physical limitation and pain dimension, and statistically significant in emotional limitation dimension when compared to general population. At EORTC-H&N35 questionnaire, our patients presented clinically relevant negative differences and statistically significant scores in specific dimensions of the oral cavity. With UW questionnaire, anxiety dimension scored the best, with clinically and statistically significant differences versus general population. The other dimensions showed clinically and statistically significant worst results than general population.

Conclusions: Our patient´s General QoL is similar or even better in some dimension than general population. However, most specific dimensions presented clinically and statistically worst results than general population.

Quality of life

Oral oncology

Free flap

Oral surgery

Reconstruction

survival

Oral cavity

Cancer

Surgery, with or without adjuvant radiation therapy and/or chemotherapy, remains the first line treatment in oral cancer. Recent advances in different reconstruction techniques have not overcome important sequelae that surgery produces in oral cancer patients. In this sense, speech, chewing, swallowing and cosmetic sequelae are still major issues to oral and maxillofacial surgeons1. One of the most used reconstructive techniques aimed for this purpose is the radial forearm free flap (RFFF), which is associated with an overall survival rate close to 95% of cases2.

Although overall survival of patients with oral cancer still remains the main goal of any therapeutic intervention, a Health-Related Quality of Life (HRQL) outcome has been incorporated as an assessment tool for the evaluation of our treatments in recent years, and is becoming an increasingly important parameter for decision making3. HRQL measurement is performed using designed and validated questionnaires that can be general or specific. Specific questionnaires measure the effect that a disease has on HRQL, while general questionnaires measure HRQL in people or patients without focusing on the specific disease or pathology, which allows comparing patients with different pathological processes or with more than one disease4,5.

There is huge evidence regarding the value of HRQL in patients treated for oral cancer in the medical literature. However, there are few studies including patients with long-term follow-up and even fewer including free flap reconstructed patients after primary surgery6. Furthermore, published studies comparing HRQL results in patients with those in the general population7,8,9 are still scarce. The reasons for this include the natural loss of patients over time (overall mortality) and the specific oncological disease mortality itself which is aggravated by the fact that these patients present with more advanced tumors. An additional reason is related to administrative challenges in locating such patients9,10. The HRQL assessment at least after 5 years of follow up would provide an accurate measure of this outcome in patients who survive to the disease.

Our objective in this study is to evaluate the general and specific HRQL in oral cancer patients that underwent RFFF reconstruction who survived 5 or more years after initial surgery and compare this data with that of the general population.

We conducted a retrospective study of oral cancer patients who were treated in Virgen Macarena University Hospital (VMUH), Seville, Spain, between 2000 and 2014. Patient selection was obtained from the Oral and Maxillofacial Unit registry. Inclusion criteria were: patients diagnosed of oral cavity squamous cell carcinoma who were surgically treated, with or without adjuvant radiotherapy, using a RFFF reconstruction and with at least 5 years of survival. Tumors were staged according to the American Joint Committee on Cancer (AJCC) guidelines using the TNM staging system11.

The Hospital Ethics Committee approved this study and all patients signed an informed consent form to take part in the study.

All patients were contacted by phone and came to the hospital where they completed the “Medical Outcomes Short-Form Health Survey questionnaire 36” (SF-36)12 as a general quality of life questionnaire and the Head and Neck module of the European Organization for Research and Treatment of Cancer (EORTC-HN35)13 and the University of Washington quality of life questionnaire (UW-QOL) as head and neck specific questionnaire. All questionnaires were self-administered.

SF36 is a generic questionnaire composed by 36 items which are grouped in 8 dimensions: physical function, physical role, body pain, general health perception, vitality, social function, emotional role and mental health. SF36 alternates yes or no questions with question that have 3 to 5 possible answers. Every question is scored from 0 to 100, being 0 the worst result and 100 the best one. Dimension value is calculated by mean score of all questions composing every dimension12. The SF36 questionnaire is validated in Spanish and we have the general population reference values stratified by sex and age14.

EORTC-HN35 is the specific module of the European Organization for Research and Treatment of Cancer for head and neck cancer and is composed of 35 items13. Thirty questions are scored from 1 (nothing) to 4 (much), being 4 the worst result, and the last 5 items that refer to analgesia, supplementary feeding and possible weight variations are answered by yes or no. These 35 items are grouped in the following18 dimensions: oral pain, swallowing, sense, speech, social eating, social contact, sexuality, teeth, mouth opening, dry mouth, sticky saliva, cough, feeling ill, pain killers needed, nutrition, feeding tube, weight loss and weight gain. The scored results go from 0 (meaning better quality of life) to 100 (meaning worse quality of life). Arraras et al. published the Spanish validated version in 200115 and reference values were obtained from a Northern Europe general population cohort16.

UW-QOL is a specific questionnaire that collects information on health areas related to head and neck cancer17. UW-QOL v4 is the last version published in 200218 and includes 16 items. 12 items identify 12 domains: pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder disease, taste, salivation, mood and anxiety that are scored from 0 (worst result) to 100 (best result). The remaining 4 questions aim to assess the general health perception. This questionnaire was translated to Spanish and validated by Nazar and cols. in 2010 for Chilean population19. The general population values were obtained from people attending dental clinics in Liverpool with an age and sex similar to oncologic patients20.

We compared our patients group QOL levels with general population values for every QOL questionnaire following the same methodology as made by Høxbroe Michaelsen et al. in their review5.

The dimensions scores and the quantitative variables were presented through the mean (M), median (Md), standard deviation (SD) and quartiles, and qualitative variables were presented as a percentage of the total sample. For non-answered questions, the other items’ mean score, within the same dimension, was imputed.

Data were analyzed using the statistical package SPSS V.22 (Statistical Package for the Social Sciences, Inc., Chicago, IL, USA).

Normal distribution of variables was verified by Kolmogorov test. Paired Student t test and Student t test or Wilconxon test were used when indicated to compare a sample with a theoretical value and to analyze the statistical significance, which was considered at a value of p<0.05.

The Minimum Important Difference (MID) was defined as “smallest difference on a scale or outcome of interest that the patient perceives as beneficial and will lead to changes in treatment in the absence of side effects and high costs”21 or more simply “the smallest change that is important to the patient”22. The MID of each questionnaire was obtained from the literature. It was consider a 5 points difference for the SF36 12 and a difference of 7 points for the UW23. We adopted for EORTC the same rule of thumb used in other studies, and consequently, a 10% change of the maximal questionnaire score corresponds to the MID5,24.

We compared the MID to the difference of means between our patients and the general population reference values. Whenever this difference exceeded the MID, it was considered to be clinically relevant5.

Between January 2017 and December 2018, we reviewed 110 patients with oral cancer treated between 2001 to 2014 with surgery and primary reconstruction with RFFF by the Oral and Maxillofacial Surgery Unit of the VMUH.

We excluded 61 patients for relapse of their disease before 5 years follow up. Of the 49 patients with a survival greater than 5 years, 19 patients could not be contacted because 9 had died from other causes, 8 could not be located, and 2 refused to participate in the study due to transportation difficulties. The mean age of these patients was 68,3 years (SD, 7,5), 15 were male, 4 females, 11 were in a stage II, 8 in a stage III, and they had a mean survival time of 83,30 months (SD, 17,34).

Of the remaining 30 patients who were included and interviewed, 24 were male (86,7%) and 4 were female (13,3%) with a mean age of 63,96 years (SD, 10,3). The survival time ranged between 80,05 and 136,07 months, with a mean of 80,05 months. All patients included in this study were disease-free at that moment.

Primary tumor location was lateral edge of tongue 7(23,3%), lateral mouth floor 7(23,3%), midline mouth floor 5(16,7%), retromolar trigone 6(20%), buccal mucosa 4 (13,3%) and tongue base 1(3,3%). The distribution by stages was as follows; 7 patients (23,3%) in stage II, 10 patients (33,3%) in stage III and 13 patients (43,4%) in stage IV. In all cases, the anatomopathological diagnosis was squamous cell carcinoma and all of them were treated by tumor removal and functional cervical dissection and reconstruction with RFFF. Adjuvant radiotherapy was administered to 21 patients (70%) (Table 1).

SF36 questionnaire results (Table 2):

Worst scores were presented in general health and vitality dimensions, and the bests ones were obtained in emotional role and physical role. When comparing our patients with the general population as reference, we found our patients to have a statistically significant and clinically relevant better HRQL by overcoming the MDI in physical limitation and pain dimension and a statistically significant better score in the emotional limitation dimension. Social functioning and general health were the only negative dimensions, yet with differences not reaching statistical significance (Table 2).

EORTC-HN35 questionnaire results (Table 3):

Our patients presented positive differences with the general population in feeling ill and cough dimensions, although only the last one was statistically significant. We found clinically relevant negative differences (more than 10 points) and statistically significant worse scores in specific dimensions of the oral cavity, pain, swallowing, social eating, teeth, month opening, dry mouth, saliva dimensions. Opening mouth wide presented only clinically significant difference vs. general population (Table 3).

UW questionnaire results (Table 4):

Our patients obtained the best score in anxiety dimension, which presented clinically (>7 points) and statistically significant differences with the general population. Mood dimension had clinically, but not statistically significant positive differences vs general population. The other dimensions showed clinically and statistically significant worst results when compared to the general population. The worst rated dimensions were chewing, speech, saliva, appearance and swallowing. In the general questions, 55,2% of our patients considered their HRQL equal, better or much better before illness, 75% considered that their HRQL in the last 7 days was good, very good or excellent and 82% rated their general QoL in the last 7 days as good, very good or excellent, either (Table 4) .

The introduction of micro-vascularized free flaps in oral cancer reconstructive surgery has represented a major advance in improving both functionality and patients’ aesthetics. Measurement of the impact of reconstruction techniques in terms of function improvement, aesthetics and patients’ well-being, is carried out by using validated general and specifically designed HRQL questionnaires.

Multivariate analysis studies have proven that male sex, advanced tumor stage, adjuvant treatment with chemotherapy and/or radiotherapy and flap reconstruction surgery are independent factors that negatively impact HRQL of patients treated for head and neck cancer25,26,27,28.

Our study shows that patients with primary oral cancer reconstructed with forearm free flap have a clinically and statistically significant better general HRQL score as compared to general population in physical limitation and pain domains. Additionally, our patients presented a statistically significant, and very close to the clinically significant threshold, positive result in the emotional limitation dimension when compared to the reference general population.

These results are in accordance with those published by Ferri et al. who compared physical and mental domains of the SF12 questionnaire in a population aged over 75 years old, and although this research did not find statistically significant differences, patients who underwent free flap reconstruction surgery presented a numerically better physical domain score9. The statistically significant better results found in our patients using the SF36 questionnaire when compared to the general population can be explained by the younger patients’ age and the longer follow-up, (at least 5 years follow-up versus a minimum of 2 years in the paper by Ferri). During this longer follow-up time, patients may develop adaptation mechanisms for the new situation after overcoming the disease that might predispose then to a higher HRQL score8.

The specific HRQL measured by UW questionnaire showed that our patients presented better HRQL outcomes in humor and anxiety domains as compared to general population, although only the latter reached statistical and clinical significance. All other domains resulted in worst clinically and statistically significant comparisons, except for pain and recreation that were only clinically significant. The greatest differences observed were related to the specific dimensions of the oral cavity: chewing, speech, saliva, appearance, and swallowing. We consider that the discrepancy in pain dimension obtained with SF 36 questionnaire is due to the fact that the UW questionnaire has a less sensitive scale and that its control group was younger.

Specific HRQL measured by the EORTC-HN35 questionnaire indicated that our patients presented minimally positive differences in feeling ill domain and clinically significant differences in cough. The specific dimensions of the oral cavity; oral pain, swallowing, social eating, teeth, dry mouth and sticky saliva scored significantly worse as compared to general population, what is concordant with the UW questionnaire results. The opening mouth domain was clinically but not statistically significant due to the logarithmic distribution of this item. The rest of domains were not compared due to the lack of reference values.

Despite HRQL research in oral cancer patients reconstructed with free flap is abundant, we have only found 6 studies presenting results with at least a minimum follow-up of 2 years29,30,8,31,9,32 and with sample sizes ranging between 2532 and 90 patients31. Questionnaires used in these studies were SF-368,9, UW questionnaire29,31 and EORTC-HN3530,32. The free flap reconstruction technique were RFFF8,31,9, anterolateral thigh flap29,31 and fibular free flap32. Among these studies, only Ferri et al. compared oral cancer patients versus healthy population9 and only Zang et al. applied the MID to their results31.

The HRQL is a multifunctional, dynamic and changing concept. Long-term follow-up studies focused on HRQL in head and neck cancer show a decrease in patients scores10,32. However, other studies have shown improvements in several HRQL domains33. Long-term follow-up studies, with at least 5 years of follow-up are needed, as they allow detecting changes that occur far beyond surgery. In fact, this long-term follow-up can justify the results found in our patients. The only prospective follow-up study whit free flap reconstructed oral cancer patients with at least 2 years of follow-up using the EORTC questionnaire found that between 12 months and the end of follow-up, social function and social contact did worsen significantly, as well as all specific domains related to the oral cavity, except pain, taste, dry mouth, saliva and cough30. Between the preoperative situation and long-term follow-up, oral pain domain improved significantly. Additionally, Warsahsky et al. found significantly improved differences in activity, recreation, taste, physical and social average functioning comparing UW questionnaire in patients with mandibular defects reconstructed with free flap and a long-term follow-up more than 5 years with those with less than 5 years follow-up34. In the same line are the results published by Petrovic et al., who found a significant improvement with a time-dependent correlation of sexual performance using EORTC-HN35 questionnaire32.

In addition to this, long term follow-up avoids the short-term relapse risk factor that negatively impacts HRQL scoring35,36, and allows taking into account the development of adaptation mechanisms against sequelae, like the aesthetic ones which require more time to be detected32.

We consider that pre-post treatment change analysis is important as it provides information regarding the HRQL level reached as compared to the baseline situation before surgical procedure. However this analysis does not provide information regarding comparison with normality and can lead to errors since the pre-treatment HRQL score is reduced by the disease itself37 and the anxiety generated by the information provided, and therefore the baseline HRQL score would be easier to reach or overcome after surgical procedure. Accordingly, and in line with other studies,5,7,8,9 we compared our population HRQL results with that of a matched healthy population control group. In order to facilitate the interpretability of the results, both to clinicians and patients, we applied the concept of MID to the statistical differences obtained5,31. This allowed us to have an objective reference of our survivor patients as well as explain and agree with new patients and their families the different treatment choices and their potential sequelae25.

Long-term survival is generally accepted as a 5 to 10 years of free of disease follow-up and measuring such long-term HRQL results is both important but technically hazardous38. Technical difficulties arise as a consequence of the natural loss of patients with time due to the oncologic disease course itself37,39,31, which in these patients is aggravated by their advanced tumor stages and additionally, administrative hazards may surge when it comes to locating patients10,9.

Positive results with clinically and statistically significant differences were found in our patients when compared to the general population in physical limitation, general pain and emotional limitation domains of the SF36 questionnaire and in anxiety dimension of the UW questionnaire. These differences may represent an adaptation developed throughout time to some sequelae of cancer and its treatment. In the same way, our patients did not show differences in feeling ill dimension and 82% considered that the last 7 days general QOL was good, very good or excellent.

Our study is the only one that combines general and specific HRQL questionnaires, and this allows for a more comprehensive and holistic view of HRQL in a homogeneous oral cancer patients group treated with RFFF, who survived the disease and were compared to the normal population applying MID. However, this research has weaknesses derived from a single-center retrospective study without prospective follow-up or individualized analysis of patients, with a significant rate of patient loss during the follow-up, which reduced the sample size and prevented to analyze other variables, and finally the comparison with a population group different from the Spanish normal population.

Nevertheless, all oral cavity specific domains of UW and EORTC-HN35 questionnaires were both, clinically and statistically, significantly worse than those of the general population, and these should be the future goals for therapeutic improvements.

QoL: quality of life

RFFF: Radial Forearm Free Flap

SF36: Short Form 36

UW: University of Washington

EORTC-H&N35: European Organisation for Research and Treatment of Cancer, Head and Neck 35

MID: Minimum Important Difference

HRQL: Health Related Quality of Life

VMUH: Virgen Macarena University Hospital

AJCC: American Joint Committee on Cancer

M: mean

Md: median

SD: standard deviation

SPSS V.22: Statistical Package for the Social Sciences, Inc., Chicago, IL, USA

Ethics approval and consent to participate: The authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript. The Hospital Ethics Committee ( internal code number 1829) approved this study and all patients signed an informed consent form to take part in the study.

Consent for publication: Not Applicable

Availability of data and materials: The datasets used and analysed during the current study are available from the corresponding author on reasonable request

Competing interests: The authors declare that they have no competing interests

Funding: No funding was obtained for this study

Author´s contributions:

Tofe-Povedano A: wrote the paper, contributed data and analysis tools, Collected data

Herce-Lopez J.: Contributed data and analysis tools, Collected data

Rollon-Ugalde V.: Contributed data and analysis tools, Collected data

Parras-Hernandez J.: Collected data

Tofe-Povedano S.: Contributed data and analysis tools

Rollon-Mayordomo A.: Conceived and designed the analysis, wrote the paper.

Acknowledgements: Not Applicable

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Table 1. Clinical characteristics

	N	%
Sex
Male	26	86,7
Female	4	13,3
Tumor Stage
II	7	23,30
III	10	33,30
IV	13	43,4
Tumor site
Lateral edge of the tongue	7	23,3
Lateral floor of the mouth	7	23,3
Midline mouth floor	5	16,7
Retromolar trigone	6	20
Buccal mucosa	4	13,3
Tongue base	1	3,3
Treatment
Surgery + neck dissection	30	100
Postoperative radiotherapy	21	70

Table 1. Clinical characteristics and treatment of patients reconstructed with RFFF.

Table 2. SF36 descriptive results

	FFG							GPG		Difference	P
DIMENSION	M	ds	MD	P25	P75	Min	Max	M	ds
Physical function	75,83	24,25	83,00	63,75	91,30	15,00	100,00	74,25	11,98	1,57	0,26*
Role physical	87,50	31,31	100,00	100,00	100,00	0,00	100,00	77,46	7,54	10,03	0,01*
Role emotional	92,22	25,79	100,00	100,00	100,00	0,00	100,00	88,12	5,88	4,09	0,002*
Social functioning	83,33	17,78	88,00	75,00	100,00	38,00	100,00	87,13	4,84	-3,80	0,50
Mental health	74,53	18,42	76,00	59,00	89,00	44,00	100,00	73,93	4,21	0,61	0,83
vitality	64,83	24,72	70,00	40,00	85,00	20,00	100,00	63,08	6,02	1,75	0,54
Bodily Pain	82,83	17,42	90,00	69,38	92,50	35,00	100,00	76,02	6,55	6,82	0,017*
General health	59,83	19,76	63,00	40,00	75,00	10,00	95,00	60,17	7,31	-0,34	0,98

Table 2. FFG (Free Flap Group), GPG (General Population Group).
SF36 descriptive results and its comparison with general population. Difference: mean of the differences between the group of free flaps and the population group. Positive score means better QOL in free flap group and negative ones means worse QOL.

*Wilconson test.

Table 3. EORTC-HN35 descriptive results

	FFG								GPG		Difference	P
DIMENSION	M	DS	MD	Min		Max	P 25	P 75		M
ORAL PAIN	14,37	14,17	16,50	0,00		58,50	0,00	18,56	ORAL PAIN	3,00	-11,37	0.000
SWALLOWING	13,53	14,22	8,25	0,00		50,00	0,00	24,81	SWALLOWING	3,00	-10,53	0.000
SENSES PROBLEMS	8,28	13,61	0,00	0,00		50,00	0,00	16,50	SENSES PROBLEMS	3,00	-5,28	0.631*
SPEECH PROBLEMS	18,80	19,84	22,00	0,00		89,00	0,00	22,00	SPEECH PROBLEMS	NA	NA	NA
SOCIAL EATING	25,23	24,15	20,75	0,00		75,25	0,00	43,56	SOCIAL EATING	1,00	-24,23	0.000
SOCIAL CONTACT	11,04	15,59	4,13	0,00		49,75	0,00	16,75	SOCIAL CONTACT	NA	NA	NA
LESS SEXUALITY	25,52	34,69	0,00	0,00		100,00	0,00	37,25	LESS SEXUALITY	NA	NA	NA
TEETH	32,17	39,64	16,50	0,00		100,00	0,00	67,00	TEETH	12,00	-20,17	0.019*
OPENING MOUTH	18,83	27,25	0,00	0,00		100,00	0,00	33,00	OPENING MOUTH	1,00	-17,83	0.193*
DRY MOUTH	34,40	37,68	33,00	0,00		100,00	0,00	67,00	DRY MOUTH	17,00	-17,40	0.017
STICKY SALIVA	29,93	35,42	33,00	0,00		100,00	0,00	41,50	STICKY SALIVA	7,00	-22,93	0.008*
COUGHING	14,40	25,79	0,00	0,00		100,00	0,00	33,00	COUGHING	19,00	4,60	0.007*
FEELS ILL	9,97	19,86	0,00	0,00		67,00	0,00	8,25	FEELS ILL	10,00	0,03	0.343*
PAIN KILLERS	36,67	49,01	0,00	0,00		100,00	0,00	100,00		NA	NA	NA
NUTRITIONAL SUPLEMENTS	13,33	34,57	0,00	0,00		100,00	0,00	0,00		NA	NA	NA
FEEDING TUBE	3,33	18,26	0,00	0,00		100,00	0,00	0,00		NA	NA	NA
WEIGHT LOSS	13,33	6,31	34,57		0,00	0,00	100,00	0,00		NA	NA	NA
WEIGHT GAIN	6,67	4,63	25,37		0,00	0,00	100,00	0,00		NA	NA	NA

Table 3. FFG (Free Flap Group), GPG (General Population Group).

EORTC-HN35 descriptive results and its comparison with general population. Difference: mean of the differences between Free flap group and general population group. Positive score means better QOL in free flap group and negative ones means worse QOL.

*Wilconson test. NA: not available.

Table 4. UW descriptive results

	FFG							GPG	Difference	p
DIMENSION	M	SD	MD	MIN	MAX	p25	p75	M
Pain	76,72	22,68	75,00	50,00	100,00	50,00	100,00	86,00	-9,28	0.184*
Appearance	73,00	18,52	75,00	50,00	100,00	50,00	81,25	93,00	-20,00	0.000
Activity	73,28	23,61	75,00	0,00	100,00	50,00	100,00	86,00	-12,72	0.006
Recreation	78,43	15,71	75,00	50,00	100,00	75,00	100,00	86,00	-7,57	0.268*
Swallowing	80,57	20,52	73,50	33,00	100,00	67,00	100,00	98,00	-17,43	0.007*
Chewing	58,60	32,35	50,00	0,00	100,00	50,00	100,00	94,00	-35,40	0.000*
Speech	71,47	16,88	67,00	33,00	100,00	67,00	68,00	98,00	-26,53	0.000*
Shoulder	78,27	21,92	67,00	33,00	100,00	67,00	100,00	91,00	-12,73	0.003*
Taste	83,90	22,56	100,00	33,00	100,00	67,00	100,00	95,00	-11,10	0.012
Saliva	73,67	25,35	67,00	0,00	100,00	67,00	100,00	97,00	-23,33	0.000*
Mood	87,07	20,36	100,00	25,00	100,00	75,00	100,00	82,00	5,07	0.052*
Anxiety	91,70	14,24	100,00	67,00	100,00	78,25	100,00	83,00	8,70	0.000*
GlobalQOL	50,83	30,43	50,00	0,00	100,00	25,00	75,00	NA	NA	NA
HRQL Last 7 days	63,43	20,39	60,00	20,00	100,00	55,00	80,00	NA	NA	NA
QOL last 7 days	62,07	17,69	60,00	20,00	100,00	60,00	80,00	NA	NA	NA

Table 4. FFG (Free Flap Group), GPG (General Population Group).

UW descriptive results and its comparison with general population. Difference: mean of the differences between Free flap group and general population group. Positive score means better QOL in free flap group and negative ones means worse QOL.

*Wilconson test. NA: not available.

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Editorial decision: Major revision
06 Jun, 2023
Reviewers agreed at journal
20 Oct, 2022
Reviewer #1 agreed at journal
19 Oct, 2022
Reviewers invited by journal
18 Oct, 2022
Submission checks completed at journal
24 Aug, 2022
Editor invited by journal
28 Jul, 2022
Editor assigned by journal
20 Jun, 2022
First submitted to journal
19 Jun, 2022

You are reading this latest preprint version

General and Specific Quality of life in long-term oral cancer survivors reconstructed with free forearm flap.

Status:

Version 1

Abstract

Background

Method

Results

SF36 questionnaire results (Table 2):

EORTC-HN35 questionnaire results (Table 3):

UW questionnaire results (Table 4):

Discussion

Conclusion

Abbreviatons

Declarations

References

Tables

Status:

Version 1