Early Changes in Quality of Life and Symptom Burden Following Cancer-Directed Treatment Among Head and Neck Cancer Patients in Bangladesh: Findings From a Prospective Pilot Study.

BACKGROUND AND AIMS: Evidence on early quality of life (QoL) outcomes among patients with head and neck cancer (HNC) remains limited in low-resource settings like Bangladesh. This prospective pilot study assessed changes in QoL, functioning, and symptom burden following initiation of cancer-directed treatment (CDT) among patients with HNC in Bangladesh. METHODS: A prospective observational pilot study was conducted among 102 consecutively recruited patients with HNC from three public cancer care hospitals located in Dhaka City, Bangladesh. Ninety-one patients were reached at follow-up, of whom 57 completed QoL assessment following a mean of 7.4 ± 2.2 weeks of treatment initiation. QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30). Linear mixed-model analyses were employed to evaluate longitudinal changes and identify factors associated with QoL outcomes. RESULTS: Of 91 followed-up patients, 16.5% of patients died, and 27.5% did not start CDT, including 25% of survivors. Global quality of life (GQL) among 57 finally assessed patients remained impaired and unchanged over time (β = -0.15, p = 0.95). Overall functioning declined markedly (β = -5.87, p = 0.03), primarily mediated by deteriorated physical and role functions, along with significantly increased fatigue, nausea/vomiting, and insomnia. Younger than 50 years older and better social functioning were positively associated with QoL, whereas clinical conditions such as laryngeal or pharyngeal cancers, fatigue, pain, and financial difficulties were independently associated with poorer QoL. CONCLUSION: Patients with HNC in Bangladesh experienced an extensive burden of deteriorated QoL, functioning, and increased symptom severity during the early treatment period, besides considerable treatment gaps and mortality. Our findings underscore the necessity of addressing treatment gaps, symptom management, and supportive care. More studies are recommended to support policy implications and implementation regarding early identification, diagnosis, and treatment of HNC in resource-limited settings.