Living longer or living better - priorities among head and neck cancer survivors

Abstract Background Head and neck cancer and its treatment can profoundly affect physical function, psychosocial well-being, and overall quality of life (QoL). As survival rates improve, integrating patient-reported outcomes and individual treatment preferences into clinical decision-making has become increasingly important. This study aimed to assess the preferences of head and neck cancer (HNC) survivors regarding QoL versus life prolongation in order to better inform patient-centered treatment decisions. Methods Adult head and neck cancer survivors completed validated questionnaires assessing health-related QoL (EORTC QLQ-C30), distress (Distress Thermometer), and preferences for QoL versus life prolongation (QQ questionnaire). Multivariable regression analyses were used to identify predictors of QoL and distress, while associations between patient characteristics and treatment preference were examined using group comparisons. Results The study included 207 patients (70.5% male; mean age 66.2 years). The median global health status (QLQ-C30) was 66.6, and the median distress score was 3, indicating a relatively good overall QoL and a comparatively low level of psychological distress. In multivariable analysis, lower distress and employment (both p < 0.001) as well as surgical treatment and lower comorbidity (both p < 0.05) were independently associated with better QoL. Independent predictors of distress included sex, global health status, tumor stage, educational level, and treatment modality (all p < 0.05). Regarding preferences ( n = 202), 53.0% of patients prioritized QoL, 21.8% favored life prolongation, and 25.2% reported no clear preference. Preference was significantly associated with age ( p = 0.035), with older patients favoring QoL, and with tumor stage ( p = 0.032), with the differences between options diminishing in advanced stages. Conclusion QoL in head and neck cancer survivors is shaped by both clinical and psychosocial factors. Lower distress, employment, surgical treatment, and lower comorbidity were associated with better QoL, while most patients prioritized QoL over life prolongation, particularly at older age. These findings emphasize the need to align treatment strategies with patient values, placing QoL at the center of clinical decision-making.