Screening for Dysfunction to Promote Multidisciplinary Intervention by Using the University of Washington Quality of Life Questionnaire

Objective: To investigate the potential of the University of Washington Quality of Life Questionnaire (UW-QOL) in routine clinics as a quick screening tool for possible dysfunction in patients after treatment of head and neck cancer. Design: Retrospective analysis. Setting: Regional Maxillofacial Unit, Aintree University Hospitals National Health Service Foundation Trust Liverpool, a National Health Service teaching hospital. Patients: Consecutive disease-free patients with oral or oropharyngeal squamous cell carcinoma, who had undergone primary surgery with or without adjuvant radiotherapy, for whom UW-QOL version 4 data from 2000 to May 2006 were available in our research database; and consecutive patients from previous studies (4 postal surveys of disease-free patients with oral or oropharyngeal squamous cell carcinoma, 1 clinic-based study that targeted speech and swallowing in patients with oropharyngeal disease, 1 that evaluated shoulder function in patients with various diagnoses, and 1 that recruited patients without cancer attending a general dental practice). Main Outcome Measures: Cutoff strategies for further evaluation/intervention derived from studies using the UW-QOL in parallel with 13 other established questionnaires. Effects of preferred cutoffs on trigger variation were assessed with the use of all available UW-QOL version 4 data (615 patients). Results: Trigger rates for further intervention fell between 9% (recreation and speech) and 16% (swallowing). Eighty-one percent of patients with free-flap surgery and adjuvant therapy for T3 or T4 tumors met the trigger criteria at around 2 years, with 42% meeting the trigger on 3 or more domains. Conclusion: The fourth version of the UW-QOL is suitable for routine screening in clinical practice.