Int. J. Oral Maxillofac. Surg.

2009; 38: 250–255

doi:10.1016/j.ijom.2008.12.001, available online at http://www.sciencedirect.com

Clinical Paper
Head and Neck Oncology

Quality of life in patients with P. Infante-Cossio1,

E. Torres-Carranza1, A. Cayuela2,
J. L. Gutierrez-Perez1,

oral and oropharyngeal cancer§

M. Gili-Miner3
1
Department of Oral and Maxillofacial
Surgery, Virgen del Rocio University Hospital,
Seville, Spain; 2Department of Medical
Record, Virgen del Rocio University Hospital,
Seville, Spain; 3Department of Preventive
P. Infante-Cossio, E. Torres-Carranza, A. Cayuela, J. L. Gutierrez-Perez, M. Gili- Medicine, Virgen Macarena University
Miner: Quality of life in patients with oral and oropharyngeal cancer. Int. J. Oral Hospital, Seville, Spain
Maxillofac. Surg. 2009; 38: 250–255. # 2008 International Association of Oral and
Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Abstract. Quality of life (QoL) is an important aspect in the clinical assessment and
management of patients with cancer. The aim of the present study was to evaluate
QoL at the time of diagnosis in patients with oral and oropharyngeal cancer and to
establish the influence of variables such as gender, age, tumor location and tumor
staging. The authors studied 149 patients with oral and oropharyngeal cancer for 2
years. QoL was measured using the EORTC QLQ-C30 and its specific modules for
head and neck cancer QLQ-H&N 35. Variable deterioration of QoL was observed
before therapy. The emotional domain showed the greatest alterations, while pain
was the most remarkable symptom variable. QoL seems to be associated with
gender (female patients obtained worse scores in most of the functional scales), age
(patients < 65 years scored better), tumor location (orpharyngeal tumors showed
worse prognosis) and tumor staging (early stages obtained better scores than
advances ones). Many patients with oral and oropharyngeal cancer show poor QoL
Keywords: EORTC; oral cancer; oropharyn-
before initiating treatment. The present study of a homogeneous group of patients is geal cancer; quality of life.
the first carried out in Spain following the EORTC QLQ-C30 questionnaire and its
results may serve for future reference. These results are similar to those obtained in Accepted for publication 1 December 2008
populations from the north and centre of Europe. Available online 9 January 2009

In Spain, head and neck cancer accounts
for 20% of every new instance of cancer
diagnosed at oncology clinics17. Among
head and neck cancers, oral and orophar-
yngeal tumors represent approximately
40% and their incidence shows a steady
tendency to increase annually17,18. The
treatment of resectable tumors involves
§ clinical characteristics of the patients and
The present study has been given finan-
cial support by the Andalusian Regional Min-
istry of Health (File number: 0142/2000 and
0023/2005).
surgical resection of important areas of
tissue followed by adjuvant radiotherapy,
if required. Considering the functional and
aesthetic impact of this treatment and the
survival rate achieved, the absence of
recurrence or the period free of disease
should not be the only aspects that deter-
mine the success of the therapy. Manage-
ment of cancer patients must assess the
their quality of life (QoL) before therapy,
immediately after therapy and in the long
term.
QoL measures an individual’s sense of
his place within the cultural and intellec-
tual conditions in which he lives, and takes
into account his expectations and worries;
it defines what is most important for each
individual. Health-related QoL studies are
becoming widely used in clinical practice.
QoL studies provide physicians with
information about the impact of the dis-
ease, the treatment of symptoms and the
side effects. These studies also allow
patients to define the aspects of the disease
they consider most distressing and to take

0901-5027/030250 + 06 $30.00/0 # 2008 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

part in therapeutic decisions. QoL studies
are becoming part of oncological research
standards in developed countries8,9.
QoL is not a tangible concept and can
only be measured indirectly. Different
methods are available. The European
Organization for Research and Treatment
(EORT) has devised a combined evalua-
tion instrument comprising a general ques-
tionnaire (Quality of Life Questionnaire
30-QLQ-C30) that measures aspects
shared by a variety of tumors and treat-
ments; it has become the most widely used
reference method to measure QoL world-
wide. It has been validated for patients
with head and neck cancer in different
countries and in a variety of languages1,5,6.
The established scores are useful to com-
pare data. This questionnaire has a specific
module for head and neck cancer patients:
the Quality of Life Questionnaire 35-
QLQ-H&N35.
During the last decade, the number of
publications dealing with QoL in
patients with head and neck cancer has
increased. Head and neck cancer
includes a large group of tumors (oral
cavity, oropharynx, larynx, hypophar-
ynx, nasopharynx, paranasal sinuses
and salivary glands cancer) and affects
different functions depending on the
location of the tumor and the therapy.
Few studies have been published on QoL
in patients with oral and oropharyngeal
cancer. These studies include small sam-
ples and mix information from oral and
oropharyngeal cancer with data corre-
sponding to other head and neck cancers.
It is only recently that studies have been
published focussing precisely on QoL in
patients with oral and oropharyngeal
cancer4. The authors have found only
three studies dealing with QoL in Span-
ish patients with head and neck cancer.
ARRARAS et al2,3 published two studies of
a sample of 201 patients with head and
neck cancer and carried out three mea-
surements to validate the Spanish ver-
sion of the EORTC QLQ C-30 and the
QLQ-H&N35. HERCE et al14 used the
Short Form 36-item Health Survey
(SF-36) to compare QoL of 23 patients
undergoing surgery for oral cancer with
a survival rate >5 years with the refer-
ence values of the Spanish population.
The authors have not found any Spanish
reports using the generic QoL question-
naire devised by the EORTC and its
specific module for head and neck can-
cer to assess QoL at diagnosis in the
subgroup of patients with oral and oro-
pharyngeal cancer. 149 patients with
oral and oropharyngeal cancer were
enrolled in the present study so that
Quality of life in patients with oral and oropharyngeal cancer
the results obtained may serve as com-
parison reference values for future
research in Spain.
In the present study, the EORTC QLQ-
C30 and its specific module for H&N
cancer, QLQ-H&N35 were used to mea-
sure QoL at diagnosis in a group of
patients with oral and oropharyngeal can-
cer and to establish the impact of sex, age,
tumor location and tumor staging.
Material and method
From January 2000 through December
2001 the authors carried out a transversal
study of 149 patients recently diagnosed
with oral and oropharyngeal squamous
cell carcinoma admitted to the Department
of Oral and Maxillofacial Surgery of the
Virgen del Rocio University Hospital in
Seville, Spain. Oral cavity tumors
included tumors affecting the mobile ton-
gue, gums, floor of the mouth, buccal
mucosa, hard palate and the buccal area
of the soft palate. Oropharyngeal tumors
were located behind the anterior pillar of
the pharynx, retromolar trigone, tonsils,
tonsillar region of the soft palate and the
base of tongue. Excluded from the study
were patients presenting: in poor general
condition; with serious concomitant dis-
ease; with mental or psychomotor disor-
ders that prevented the interview with the
physician; with a previous history of can-
cer and local or distant recurrences; also
excluded were cases that had not been
confirmed by biopsy. Of the 149 patients
who met the inclusion criteria, 21 were
excluded (3 died before the onset of the
study, 5 refused to participate, 4 filled in
the questionnaire in the wrong way, 5
showed changes in their disease or treat-
ment, and 1 patient suffered an intercur-
rent disease). The study was approved by
the Ethical Committee of the Hospital and
all patients gave informed consent.
Patient information was collected at
diagnosis and before onset of therapy
and it included sociodemographic data
(age, gender, schooling, employment sta-
tus and marital status), comorbidity, diag-
noses (tumor location, size and staging),
performance status (Karnofsky scale) and
QoL. Comorbidity was assessed by study-
ing the patient’s clinical history, cardio-
vascular, respiratory, gastrointestinal,
renal, endocrine, neurological, rheumato-
logical and immunological data, previous
tumors and tobacco/alcohol consumption.
Performance status was measured using
the Karnofsky scale15.
QoL was measured using EORTC
QLQ-C30 version 3.0 and its module
H&N35, validated and adapted for the
251
Spanish population by ARRARAS et al2,3.
Before onset of therapy, the patients com-
pleted the questionnaire in the presence of
an interviewer who only helped them if
they had difficulty in understanding the
questions, but who did not indicate or
explain the answers. The EORTC QLQ-
C30 provided information about cancer in
general and its treatment. It comprised 5
functioning scales (physical, role, cogni-
tive, emotional and social), 3 symptom
scales (fatigue, pain and emesis), 6 single
items assessing dyspnea, appetite loss,
insomnia, constipation, diarrhea and
financial impact and 1 global health and
QoL scale. Scores were transformed onto
a 0–100 scale. For the functioning scales, a
high score corresponded with a healthy
function level. For the symptom scales and
the single items, a high score meant a high
level of symptoms or problems. The
EORTC QLQ-H&N35, a specific QoL
questionnaire for head and neck cancer
designed to be used together with the
EORTC QLQ-C30, was made up of 7
scales (pain, swallowing, sense, speech,
social eating, social contact and sexuality)
and 11 single items that considered aspects
associated with the location, symptoms of
the disease and treatment (teeth problems,
opening mouth, dry mouth, sticky saliva,
coughing, feeling ill, intake of painkillers,
nutritional supplements, feeding tube,
weight loss and weight gain). Data were
interpreted as in the case of the EORTC
QLQ-C30. The highest scores represented
the highest level of symptoms. The scores
of both questionnaires were interpreted in
accordance with the scoring guidelines
established by the EORTC.
Statistical analysis of data was per-
formed using the SPSS1 version 11.0
(SPSS Inc.). A p value < 0.05 was con-
sidered statistically significant. The authors
carried out the descriptive analysis of the
different variables studying the absolute
and relative frequency (percentages) of
qualitative variables. Quantitative vari-
ables, depending on their distribution (nor-
mal or abnormal as confirmed by means of
the Kolmogorov–Smirnov test) were
expressed as mean +/- SD or median (inter-
quartile range). The Mann–Whitney U-test
or the Kruskall–Wallis test were used to
compare the different grouped quantitative
variables because these variables showed
abnormal distribution. Qualitative vari-
ables were measured using the x2 test or
Fisher’s exact test, if necessary.
Results
Table 1 shows the characteristics of the
128 patients enrolled in the study. 74%
252 Infante-Cossio et al.

Table 1. Characteristics of the 128 patients included in the study. tically significant (p < 0.08). In male
All n (%) Male n (%) Female n (%) patients, the tumor was diagnosed at an
advanced stage, in female patients, tumors
Age (years) 63.3 (11) 61.1 (10) 67.3 (14)
were diagnosed at an early stage; the
Gender 128 (100) 95 (74) 33 (26) difference was statistically significant
(p < 0.012).
Educational level Tables 2–5 show the distribution of the
University 13 (10) 9 (7) 4 (3) medians and interquartile ranges of the 5
Secondary 19 (15) 17 (13) 2 (2) functioning scales, the 3 symptoms scales
Compulsory studies 18 (14) 15 (12) 3 (2) and the global health and QoL scale mak-
Less than compulsory 34 (27) 22 (17) 12 (9) ing up the EORTC QLQ-C30 question-
No studies 44 (34) 32 (25) 12 (9) naire, as well as the statistically significant
results (p < 0.05) obtained from the com-
Employment status parison of groups of patients as regards
Employed 54 (42) 31 (24) 23 (18) gender, age (<65 years and >65 years),
Retired 65 (51) 59 (46) 6 (5) tumor location (oral cavity and orophar-
Unemployed 9 (7) 5 (4) 4 (3) ynx) and tumor staging (stages I, II and III,
IV). The rest of the information about
Marital status scales and single items in the QLQ-C30
Married/co-habiting 104 (81) 86 (67) 18 (14) and the results obtained in the QLQ-
Family/friend 14 (11) 4 (3) 10 (8) H&N35 questionnaire do not appear in
Single 10 (8) 5 (4) 5 (4) the tables.
QoL varied with gender (Table 2). In
Comorbility the male patients, statistically significant
Yes 55 (43) 32 (25) 23 (18) differences were observed in the physical,
No 73 (57) 41 (32) 32 (25) nausea and emesis, and pain scales of the
QLQ-C30 and in the dry mouth and sticky
Karnofsky saliva scales of the QLQ-H&N35 ques-
60–80 35 (27) 24 (19) 11 (9) tionnaire. Patients < 65 years showed
90–100 93 (73) 57 (45) 36 (28) more clinical symptoms (Table 3) and
statistically significant differences in the
Location QLQ-C30 questionnaire (physical and
Oral cavity 71 (55) 46 (36) 25 (20) cognitive scales) and in the QLQ-
Oropharynx 57 (45) 49 (38) 8 (6) H&N35 questionnaire (pain, swallowing,
cough and sexuality scales). In patients
T >65 years, fatigue and constipation
<4 cm (T 1–2) 85 (66) 61 (48) 24 (19) (QLQ-C30) and dry mouth and sticky
>4 cm (T 3–4) 43 (34) 34 (27) 9 (7) saliva (QLQ-H&N35) obtained the high-
est scores.
N (clinical) Oral tumors (Table 4) showed a statis-
0 74 (58) 50 (39) 24 (19) tically significant differences in relation to
1 37 (29) 31 (24) 6 (5) global QoL and role, cognitive and social
2 16 (13) 13 (10) 3 (2) functioning scales (QLQ-C30). When
3 1 (1) 1 (1) 0 compared with oral tumors, oropharyngeal
tumors showed statistically significant dif-
Stage AJCC ferences in relation to the scales of fatigue,
I/II 57 (45) 36 (28) 21 (16) nausea and emesis, pain, dyspnea and loss
III/IV 71 (56) 59 (46) 12 (9) of appetite (QLQ-C30) and the scales of
The number together with per cent is given, except for age which is given as mean (standard pain, swallowing, restricted mouth open-
deviation). ing, cough, feeling ill and pain killers
(QLQ-H&N35).
Patients with early stage tumors (I and
were male (2.8:1, females:males). The The following primary locations showed II) showed statistically significant differ-
mean age was 63.3 years with a range the highest incidence: tip or lateral edge of ences regarding global QoL and the
of 27–83 years. 26% of patients had com- the tongue (32%); anterior region of floor functional scales of role and social
pleted compulsory studies and 34% had no of mouth (14%); retromolar trigone (Table 5). Tumors in stages III and IV
studies. 104 patients (81%) lived with a (10%); and buccal mucosa (9%). 66% of revealed statistically significant differ-
partner. 43% presented with associated tumors were <4 cm in size; 55% of ences in the scales of fatigue, nausea
comorbidity; osteoarticular disease, arter- patients did not show cervical nodes at and emesis, pain and loss of appetite
ial hypertension and diabetes being the diagnosis and 55% of tumors were (QLQ-C30) and in the scales of pain,
most common. 50% of patients had a advanced (stages III and IV). Oropharyn- swallowing, sense, speech, social eating,
history of alcohol consumption and 69% geal tumors were more common in male social contact, sexuality, restricted
were smokers. Oral tumors represented patients and oral tumors were more com- mouth opening, cough, painkillers and
55% and oropharyngeal tumors 45%. mon in females; the difference was statis- weight loss (QLQ-H&N35).
 Quality of life in patients with oral and oropharyngeal cancer 253

Table 2. Results of EORTC QLQ-C30 for gender in functioning and symptom scales.
Male P50 [P25-P75] (n = 95) Female P50 [P25-P75] (n = 33) p
EORTC QLQ-C30
Global quality of life 83,3 [66,6-91,6] 91,6 [66,6-100] NS
Physical functioning 100 [93,3-100] 93,3 [80-100] p < 0.01
Role functioning 100 [83,3-100] 100 [83,3-100] NS
Emotional functioning 66,6 [58,3-83,3] 66,6 [33,3-83,3] NS
Cognitive functioning 100 [83,3-100] 100 [83,3-100] NS
Social functioning 100 [83,3-100] 100 [83,3-100] NS
Symptom scales
Fatigue 0 [0-22,2] 0 [0-22,2] NS
Nausea/emesis 0 [0-0] 0 [0-0] p < 0.05
Pain 33,3 [16,6-50] 33,3 [0-41,6] p < 0.05
[] = interquartile range; NS: no significant.

Table 3. Results of EORTC QLQ-C30 for age in functioning and symptom scales.
<65 years P50 [P25-P75] (n = 72) >65 years P50 [P25-P75] (n = 56) p

EORTC QLQ-C30
Global quality of life 83,3 [68,7-97,6] 83,3 [58,3-91,6] NS
Physical functioning 100 [100-100] 93,3 [73,3-100] p < 0.01
Role functioning 100 [83,3-100] 100 [83,3-100] NS
Emotional functioning 66,6 [50-83,3] 70,8 [58,3-83,3] NS
Cognitive functioning 100 [100-100] 100 [83,3-100] p < 0.01
Social functioning 100 [83,3-100] 100 [83,3-100] NS
Symptom scales
Fatigue 0 [0-11,1] 11,1 [0-22,2] p < 0.05
Nausea/emesis 0 [0-0] 0 [0-0] NS
Pain 33,3 [16,6-66,6] 33,3 [4,1-50] p < 0.05
[] = interquartile range; NS: no significant.

Table 4. Results of EORTC QLQ-C30 for location tumor in functioning and symptom scales.
Oral cavity P50 [P25-P75] (n = 72) Oropharynx P50 [P25-P75] (n = 56) p
EORTC QLQ-C30
Global quality of life 83,3 [68,7-100] 83,3 [66,6-91,6] p < 0.05
Physical functioning 100 [86,6-100] 100 [86,6-100] NS
Role functioning 100 [87,5-100] 100 [66,6-100] p < 0.05
Emotional functioning 66,6 [58,3-83,3] 66,6 [50-75] NS
Cognitive functioning 100 [83,3-100] 100 [83,3-100] p < 0.05
Social functioning 100 [87,5-100] 100 [66,6-100] p < 0.05
Symptom scales
Fatigue 0 [0-11,1] 11,1 [0-22,2] p < 0.05
Nausea/emesis 0 [0-0] 0 [0-16,6] p < 0.01
Pain 33,3 [41,1-50] 50 [33,3-66,6] p < 0.01
[] = interquartile range; NS: no significant.

Discussion published assessing QoL at diagnosis by in a study of QoL at diagnosis in 357

means of the EORTC QLQ-C30 and patients with head and neck cancer in 5
This is the first study in Spain assessing
QLQ-H&N35. In Holland, BORGGREVEN hospitals in Sweden and Norway, found
QoL at diagnosis in patients with oral and
et al.7 have recently demonstrated, in a differences among different tumor loca-
oropharyngeal cancer by means of the
study on 80 patients, that QoL before tions (for example, patients with oral
EORTC QLQ-C30 and its specific module
therapy in patients with oral and orophar- tumors reported higher pain levels),
for head and neck cancer (QLQ-H&N35).
yngeal cancer was associated with tumor advanced tumor stages, gender (females
Most reports published on QoL include all
location, staging and comorbidity. scored worse in the emotional scale) and
groups of head and neck cancer. Some
Patients with oral tumors reported more age (patients >65 years obtained better
authors11 complain about the heterogene-
pain than patients with oropharyngeal scores in emotional and social scales).
ity of these reports, because great differ-
tumors; patients with stage III and IV The present transversal study, carried
ences among subgroups can be observed
tumors showed more restricted mouth out in southern Spain, reveals that the
in the scores obtained by the QoL items;
opening and felt more ill than patients emotional scale shows the greatest altera-
other authors16 do not find significant
with stage II tumors. Also, comorbidity tions followed by the physical scale with
differences. Only two studies have been
seemed to affect QoL. HAMMERLID et al.12 slightly better scores. As regards symp-
254 Infante-Cossio et al.
Table 5. Results of EORTC QLQ-C30 for tumor stage in functioning and symptom scales.
I + II P50 [P25-P75] (n = 57)
EORTC QLQ-C30
Global quality of life
Physical functioning
Role functioning
Emotional functioning
Cognitive functioning
Social functioning
Symptom scales
Fatigue
Nausea/emesis
Pain
[] = interquartile range; NS: no significant.
toms scales, pain obtained worse scores
than teeth problems, sexuality, swallow-
ing, speech, social eating and dry mouth.
The results obtained in relation to gender,
age, tumor location and tumor staging are
helpful in establishing the therapy and
care these patients require.
Regarding gender, some studies do not
reveal significant differences19. In the
present study, females had statistically
significantly worse scores in most func-
tional scales, particularly in the emo-
tional one. They also scored worse in
relation to insomnia, loss of appetite,
pain in head and neck, social eating,
social contact and use of painkillers,
which results in a greater level of psy-
chological stress than that reported by
males12. These findings could be related
also to age because the female patients
were diagnosed at a later age than the
males but at an earlier stage of the dis-
ease. For BJORDAL et al.5 QoL pretreat-
ment in women presented worse results
than in men, although after a year these
differences disappeared, when more
mental alterations, alcohol problems
and bad nutrition were found in men.
Significant correlations between age
and some of the QoL scales such as phy-
sical, dry mouth and teeth problems are the
natural consequence of the passage of
time. Social and emotional scales are
two exceptions, since younger patients
usually obtain worse scores in them10.
Global assessment of QoL before onset
of therapy is better in younger patients
because they show less comorbidity, but
financial difficulties are more relevant in
this group.
In general, tumors located in more pos-
terior areas of the oropharynx have a
worse prognosis as they may go unnoticed
at primary care clinics and, when symp-
toms occur (commonly as cervical nodes),
the tumor is already at an advanced stage.
At diagnosis, the most common symptoms
of oropharyngeal cancer are fatigue, nau-
III + IV P50 [P25-P75] (n = 70)
91,6 [75-100] 83,3
100 [86,6-100] 100
100 [100-100] 100
75 [58,3-83,3] 66,6
100 [91,6-100] 100
100 [100-100] 100
0 [0-11,1] 11,1 [0-22,2]
0 [0-0] 0 [0-16,6]
16,6 [0-41,6] 41,6 [29,16-66,6]
sea and emesis and appetite loss. Fatigue
and appetite loss are explained by the
advanced stage of the lesion with a higher
probability of systemic affectation. As
oropharyngeal lesions stimulate the nau-
sea reflex and become a mechanical obsta-
cle for the food bolus, they usually
provoke nausea and vomiting. Patients
with oropharyngeal cancer usually have
a history of pharyngitis or dysphagia trea-
ted with painkillers which initially dis-
guise the tumor. When a diagnosis is
established, the tumors have evolved
and have become resistant to painkillers,
so that patients visit the physician com-
plaining of a severe sore throat that pre-
vents them from eating. The specific
QLQ-H&N35 has a higher sensitivity to
detect a greater number of statistically
significant items. Pain is one of the most
important scales in the case of orophar-
yngeal cancer as are swallowing, speech,
social eating, restricted mouth opening,
dry mouth and sticky saliva, cough, feel-
ing ill and painkillers. All these symptoms
are provoked by the location of the tumor,
which may affect masticatory and speech
muscles.
Tumor staging is considered more
important than gender or age when mea-
suring QoL at diagnosis, as has been
proved by the values assigned to QoL in
the general EORTC QLQ-C30 and in the
specific module H&N3512. Patients with
early stage tumors show better global QoL
than patients with advanced tumors. QLQ-
C30 does not reveal significant differences
between these two groups as regards
symptoms. The QLQ-H&N35 has more
sensitivity to detect changes in both
groups but always at the expense of
patients with advanced tumors.
Initially, 149 patients, who met the
inclusion criteria, were invited to take
part in the study, but 13% did not start
the study. Patients who refused to parti-
cipate were not different from the rest of
the sample regarding sociodemographic
p
[58,3-91,6] p < 0.01
[86,6-100] NS
[83,3-100] p < 0.01
[50-77,08] NS
[83,3-100] NS
[83,3-100] p < 0.01
p < 0.01
p < 0.01
p < 0.01
or clinical characteristics; unlike other
studies in which patients with more
advanced stages refused to take part in
the study13. Questionnaires and inter-
views are usually a source of bias. In order
to minimize this disadvantage, the authors
used a questionnaire previously validated
in Spain and paid special attention to the
qualifications of the interviewers. The
inclusion of newly diagnosed patients
reduces the risk of survival and memory
bias. The longer the time elapsing from
diagnosis to questionnaire completion,
the greater the chance for patients to
develop mechanisms to tolerate and
become adapted to the disease, which
may improve their scores20. In the present
study, the patients were asked to complete
the questionnaire 1 week after they were
informed of the diagnosis and the thera-
peutic options. This allows changes in
the emotional functioning of patients
and the psychological impact to be deter-
mined, feelings that are usually neglected
at diagnosis.
In conclusion, this study on QoL in a
subgroup of patients with oral and oro-
pharyngeal cancer is the first carried out
in a Mediterranean population using
the EORTC QLQ-C30 and its specific
module QLQ-H&N35. The results
obtained are similar to those obtained
in populations from the north and centre
of Europe.
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Address: Pedro Infante-Cossio
Department Oral and
Maxillofacial Surgery
‘‘Virgen del Rocio’’ University Hospital
Av. Manuel Siurot s/n
41013 Seville
Spain
Fax: +34 954 481 129.
E-mail: pinfante@us.es