Problems with the Existing QOL Literature

1. Potential for bias:

How the questions are phrased

Who administers the questionnaire (biased when data are interpreted by interested parties with an agenda favoring a particular treatment)

Reporting long-term results including only survivors or cancer-free patients (eliminating patients with recurrent/persistent cancer or unfavorable outcomes)

2. Lack of prospective, long-term data reporting that includes all relevant inputs

3. Failure to report oncologic, functional, and QOL outcomes in the same publication, which would highlight the overall value of a given treatment strategy

4. Lack of assessing impact of differences related to ethnicity and culture

5. QOL studies include too few patients who have undergone comparable therapies for HNC arising in similar anatomic locations

6. Significance of anti-intuitive and conflicting literature results

7. Using group-mean QOL data to predict an individual patient's QOL status/concerns; studies emphasizing the results of groups of patients, rather than individuals, may obscure important individual differences

QOL, quality of life, HNC, head and neck cancer.

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