Estudio de calidad de vida en pacientes diagnosticados de carcinoma epidermoide de mucosa oral, estadios I-IV, intervenidos en el Servicio de Cirugía Oral y Maxilofacial del Hospital Universitario y Politécnico La Fe de Valencia

Tumors of the oral cavity correspond to 3% of all tumors worldwide. Currently, the adequacy of treatments applied to patients with cancer is measured in terms of overall survival, disease free survival and quality of life. Therefore, we should try to approximate as far as possible, the quality of life of these patients to the expected in a state of health. We hypothesize a profound compromise of these patient's quality of life from the diagnosis. We understand that circumstances such as tumor stage, treatments received, comorbidities and socioeconomic variables, affect significantly. The purpose of our work is the understanding of how different variables affect quality of life in squamous cell carcinoma of the oral mucosa patients. Through this, we hope to provide very valid knowledge for the different professionals of the multidisciplinary team involved in the treatment of these patients. Our general objective is to evaluate the quality of life post-surgery in patients diagnosed with squamous cell carcinoma of the oral mucosa, from the moment they are diagnosed, and throughout the first year of follow-up. As well as identifying those factors associated with modifications in quality of life: tumor characteristics, treatments and related sequelae. To reach this purpose, we set 7 specific objectives: 1º To determine the evolution of the quality of life in the patients diagnosed of squamous cell carcinoma in the oral mucosa, from the diagnosis and during the 1st year after the surgery. 2º Assess whether TNM influences quality of life. 3º Analyze if the location of the squamous cell carcinoma in the oral mucosa affects the quality of life. 4º Assess whether the surgical treatment used for the treatment conditions the quality of life. 5º To study if the reception of adjuvant treatment with radiotherapy and / or chemotherapy affects the quality of life. 6º Determine if alterations in speech, swallowing, or body image modify, and how, the quality of life. 7th To evaluate which socioeconomic variables of the studied ones, can influence these patient's quality of life. The initial sample was composed by a series of 28 consecutive patients with squamous cell carcinoma of the oral mucosa, stages I-IV, operated at the Oral and Maxillofacial Surgery Service of the Universitary and Polytechnic Hospital La Fe of Valencia. During the follow-up year there were 4 deaths (2 due to cardiac events, 1 due to advanced tumor disease of another primary esophageal tumor and 1 due to advanced tumor disease of oral cavity), there were no dropouts due to other causes. Therefore, the effective sample of analysis for the investigation consisted of 24 patients for whom 1 year of follow-up had been completed. Completion of the Test: - Quality of life questionnaire EORTC QLQ-H & N35 - Questionnaires with filiation data: sociodemographic data and clinical data of the patient. - Graphic documents (photographs and other tests performed on patients). Methods: - Study design: No Post-authorization prospective observational study, descriptive, uni-center, on quality of life in patients diagnosed with squamous cell carcinoma of the oral mucosa, stages I-IV, operated at the Department of Oral and Maxillofacial Surgery of the Universitary and Polytechnic Hospital La Fe of Valencia.. The methodology used in this study was the face-to-face personal interview. Initially, the patient was informed of the study topic and its purpose. This was only carried out after acceptance by the patient. - Data collection protocol. - Statistical data analysis. Results: - Sample: there were 17 men (70.8%) and 7 women (29.2%), which make up the effective sample of 24 patients. The average age was 61.3 ± 11.6 years, with a range between 36 and 82 years. They were treated surgically between the years 2009 and 2012. - Many factors that significantly determine the evolution of quality of life have not been identified. Strictly speaking, there is not enough statistical evidence that these factors are influencing. However, three of them imply a statistically significant interaction: associated pathologies, neck dissection and late social alteration. - Finally, some other factors exhibit a certain non-significant trend: .- Moderate-intense smokers see their quality of life more affected. .- Radical neck dissection implies a greater loss of quality of life. .- Impairment of masticatory function, this time persistent, also influences the possibility of worsening. - The alteration of the delayed image are also negative prognostic factors. Discussion: - Discussion on feasibility. - Discussion about the methodology and sample size. - Discussion about the time of follow-up and the time to pass the different questionnaires. - Discussion about the evolution of quality of life during the first year after surgery. - Discussion about the variables studied and the influence of these variables on the assessment of quality of life. Conclusions: 1. 91.7% of patients have a good quality of life before surgery. The intervention implies a progressive deterioration of the quality of life throughout the year of follow-up. 2. A high TNM stage increases the probability of a negative evolution, inducing a worse evolution and a greater loss in quality of life. 3. We have not found a statistically significant association between the location of the tumor and a greater loss of quality of life. 4. The realization of surgery implies a loss of quality of life, which only manifests itself from the semi-annual review. Complex surgeries that require reconstruction with radial microvascular flap, neck dissection and / or tracheostomy, imply a greater loss of quality of life. Large reconstructions that require complex flaps affect speech and body image, associated with a poorer quality of life. 5. The use of adjuvant therapy (radiotherapy) is associated with a greater loss of quality of life. 6. Impairment of masticatory function implies a decrease in quality of life. 7. Younger patients manifest a greater perception in the loss of quality of life. It has also been found that patients with a higher education level also perceive this decrease. 8. A prolonged hospitalization, comorbidities and the presence of post-surgical complications are associated with a poorer quality of life. Finally, those subjects with a less satisfactory post-surgery psychological evaluation tend to eventually manage their pain, in parallel with the improvement in their mood.