Aims
Generic utility measures and disease-specific patient-reported outcome measures capture different aspects of survivorship, and neither is perfectly tailored to the complex functional sequelae of head and neck free-flap reconstruction. We examined whether functional and sleep-related patient-reported problems identify free-flap survivors with reduced EQ-5D-5L health utility.
Methods
Cross-sectional responses from 113 complete-case head and neck free-flap survivors were analysed. Exploratory factor analysis was performed across 25 items from the University of Washington Quality of Life, Work Productivity and Activity Impairment, and Insomnia Severity Index questionnaires. EQ-5D-5L utility was compared across lower quartile, middle 25-75% and upper quartile groups and linear regression assessed associations adjusted for age, gender, months since diagnosis and since surgery.
Results
Two patient-reported burden factors were identified, explaining 47.3% of item variance. Factor 1 accounted for 27.4% and reflected functional/global burden, including swallowing, speech, activity, recreation and general health-related quality of life. Factor 2 accounted for 19.9% and reflected sleep/insomnia burden. Factor 1 showed a clear gradient in EQ-5D-5L utility; 0.971 (SD=0.030) in the lower quartile, 0.919 (SD=0.064) in the middle 25-75% group, and 0.789 (SD=0.141) in the upper quartile (linear trend p=1.83x10-12). Factor 2 demonstrated a threshold-like pattern, with similar utility in the lower quartile and middle group, both 0.924 (SD=0.078 and 0.090, respectively), falling to 0.827 (SD=0.136) in the upper quartile (p<0.001). In adjusted modelling, Factor 1 had a larger association with utility than Factor 2 (-0.073 vs -0.020). The interaction was significant (p<0.001).
Conclusions
Although many survivors reported utilities above 0.9, broadly consistent with return toward population-level health, high functional burden identified a subgroup with substantially lower utility. Functional patient-reported burden may help clinicians identify survivors requiring additional support.