The demographics of head and neck cancer (HNC) are evolving. The current human papillomavirus (HPV) epidemic has led to an increasing incidence of HNC among patients under the age of 45, particularly those without a history of smoking or heavy alcohol consumption. Despite advances in treatment, HNC survivors often experience treatment-induced toxicities that impair their long-term quality of life (QoL), such as dysphagia, xerostomia, and dysphonia. HPV-related HNC occurs mainly in the oropharynx. The optimal treatment modality for oropharyngeal cancer (OPC) remains unresolved. While surgical and nonsurgical treatments seem to offer comparable overall survival rates, neither has demonstrated clear superiority in terms of functional outcomes or QoL.
The aim of this thesis was to analyse treatment- and patient-related factors associated with QoL outcomes in patients with OPC. We assessed the long-term QoL of a nationwide, population-based cohort of OPC survivors diagnosed between 2000 and 2009. Additionally, we conducted a prospective multicentre study involving patients with OPC diagnosed between 2019 and 2023. Furthermore, we examined the prevalence of and risk factors for long-term side effects of radiation therapy (RT) in patients with HNC through a single-centre study. We also validated the MD Anderson Dysphagia Inventory (MDADI), a swallowing-related QoL questionnaire, in Finnish HNC patients.
We found that single-modality treatment was associated with better long-term swallowing-related QoL outcomes compared to combined treatment. Among patients with early-stage OPC, surgery alone offered superior QoL outcomes compared to chemoradiotherapy (CRT). Poor QoL was associated with smoking, heavy alcohol use, and feeding tube dependence. Age, gender, tumour subsite, and neck RT influenced susceptibility to late RT-induced toxicities in HNC patients. The Finnish MDADI proved to be a valid, reliable dysphagia questionnaire.
This thesis suggests that single-modality treatment for OPC should be pursued whenever it is oncologically safe. In early-stage OPC, surgical treatment appears to offer better QoL outcomes than CRT; however, it should only be offered to patients whose imaging findings indicate a high likelihood of cure with surgery alone