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Original Article
January 2006

Socioeconomic Effects of and Risk Factors for Disability in Long-term Survivors of Head and Neck Cancer

Author Affiliations

Author Affiliations: From the Head and Neck Surgery and Otorhinolaryngology Department, Hospital do Câncer A. C. Camargo, São Paulo, Brazil.

Arch Otolaryngol Head Neck Surg. 2006;132(1):32-35. doi:10.1001/archotol.132.1.32

Objective  To evaluate the socioeconomic effect of and risk factors for work-related disability due to head and neck cancer and its treatment.

Design  Cross-sectional analysis of a consecutive series of patients.

Setting  Tertiary cancer center hospital.

Patients  Eligible patients had squamous cell carcinoma of the upper aerodigestive tract, were employed or had an active professional career at the time of initial diagnosis, and were disease free for at least 2 years at the time of interview. The survey instruments were a specific questionnaire to evaluate patient socioeconomic status and a Portuguese version of the University of Washington Quality of Life questionnaire.

Main Outcome Measures  Descriptive analysis of the results and associations between clinical, social, and quality of life variables with work disability.

Results  A total of 301 patients were studied. There were 236 (78.4%) men (median age, 52 years). The tumor sites were the oral cavity in 158 (52.5%), oropharynx in 55 (18.3%), larynx in 78 (25.9%), and hypopharynx in 10 (3.3%). Most patients presented with advanced clinical disease and underwent surgical treatment initially. There were 36 (12.0%) illiterate patients, and only 23 (7.6%) patients had completed college. Ninety-nine patients (32.9%) became unable to work, and 126 (41.9%) reported a significant decrease in household income. Multivariate analysis showed that advanced clinical stage (P = .02), alcohol consumption (P = .02), and low educational level (P = .007) were associated independently with work disability.

Conclusions  We observed a high rate of work-related disability that led to significant decrease in household income. Several clinical, social, and quality of life variables were associated with this degree of disability. These results could be used to better define who should undergo more intensive rehabilitation aiming to reduce work disability. If intensive rehabilitation is unsuccessful, these patients should receive more comprehensive social support.