The Quality-of-Life Impact of Head and Neck Cancer: Preference Values from the Canadian General Public

Objectives To elicit preferences for standardized head and neck cancer (HNC) health states describing the health-related quality of life (HRQoL) impact of cancer type or stage, progression, or treatment-related toxicities; and to measure the association between an individual’s locus of control (LOC) and mean preference values for HNC health states. Study Design We elicited preferences from a sample of 106 members of the Canadian general public, using the standard gamble method. Eight health states representing HNC characteristics, and 10 describing treatment-related toxicities, were developed based on literature review, data analysis, and clinician interview. All participants valuated these, anchored against full health and dead, and completed the Multidimensional Health LOC scale. A mixed-regression model was used to calculate adjusted preference decrements for all states compared with a reference state (locoregional preprogression nonlaryngeal HNC). Results Mean participant age was 47 years, and 48% were male. All health states were associated with substantially decreased preferences compared with full health. Mean preferences ranged from 0.62 (locoregional laryngeal HNC) to 0.33 (hospitalization for severe toxicity). After adjusting for age and sex, mean preference decrements were: −0.28 (postprogression), −0.11 (metastases), and −0.05 (recurrent disease). There was suggestive evidence that LOC was associated with preferences overall (P =.079); those with stronger beliefs in Chance rated health states lower (P =.012). Conclusions Health state preferences elicited here demonstrate that members of the Canadian general public rate HNC to have a large negative impact on HRQoL. The greatest impact was for postprogression and metastatic health states. These values are useful for quantifying the devastating impact of HNC on HRQoL, and for economic modeling.