Prospective study of the quality of life of cancer patients after intraoral tumor surgery

Purpose: The aim of this prospective study was to determine the quality of life of patients with oral cancer after intraoral ablative surgery. Patients and Methods: Eighty-five consecutive patients with squamous cell carcinoma of the floor of the mouth were enrolled in the study. Reconstruction of intraoral soft tissues was accomplished by local tissue (67.8%), jejunal grafts (16.9%), and cutaneous and myocutaneous flaps (15.3%), Soft tissue resections were combined with resections of the alveolar process of the mandible in 35.0% and mandibular discontinuity resections in 31.7% of the cases. A self-administered, standard questionnaire consisting of 22 visual analog scale items with a maximum index value of 154 was used to determine the physical functional status, the psychological status, and social functioning of cancer patients (Functional Living Index-Cancer). The questionnaire was administered preoperatively and 3, 6, and 12 months postoperatively. Results: The Functional Living Index score increased significantly toward the end of the first postoperative year because of an increase in all three factors of the scale. All modes of soft tissue reconstruction achieved nearly equal levels of life quality in patients with median or lateral defects at the end of the observation period. Only patients with large bilateral defects exhibited lower preoperative and postoperative values because of extensive loss of functionally important soft tissue. Patients with discontinuity resections of the mandible took longer to regain the same level of life quality as patients without bone resections. Persistence of dysphagia, reflux of fluids, limitations to liquid food, and sleep disorders had a significant negative effect on the score. Conclusions: It is concluded that rehabilitation of oral cancer patients is particularly difficult in the case of large soft tissue defects and is not always accomplished completely even with primary microsurgical tissue repair.