Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Burden of reconstructive surgery for head and neck cancer: impact on health utility, quality of life, function, and work productivity (145375)

Hansoo Kim 1 2 , Leonard Lee 1 3 4 , Jonathan R Clark 3 4 5 6 , Arun Jones 1 , Masako Dunn 3 4 , Timothy Manzie 3 4 , Emma Charters 3 4 , Catriona Froggatt 3 , Reena Wen 1 , Rebecca L Venchiarutti 3 4
  1. School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
  2. Faculty of Health Science and Medicine, Bond University, Robina, QLD, Australia
  3. Chris O'Brien Lifehouse, Missenden Road, NSW, Australia
  4. The University of Sydney, Camperdown, NSW, Australia
  5. Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW, Australia
  6. NHMRC Centre of Research Excellence for Applied Innovations in Oral Cancer, Sydney, NSW, Australia

Aims: Free flap reconstruction is critical to restore form and function after surgery for advanced head and neck cancer (HNC). However, its long‑term value is often judged using generic health utility measures that may not reflect disease‑specific burden. This study quantified multi-domain patient-reported outcomes (PROs) and health utilities among Australian HNC survivors to inform value assessment and economic evaluation.

 

Methods: An Australian national cross-sectional survey was administered to adults who had undergone free flap reconstruction for HNC, recruited via advocacy organisations, treating surgeons, and social media. Participants completed EQ-5D-5L, UW-QoL, FACE-Q Head and Neck smile scales, Insomnia Severity Index, and Work Productivity and Activity Impairment (WPAI) questionnaires. All analyses were descriptive.

 

Results: One-hundred and forty-one responses were analysed (median 44.0 months since reconstruction). Mean EQ-5D-5L utility was 0.90 (SD 0.11), similar to or higher than Australian population norms and many chronic diseases, suggesting preserved global health-related quality of life. Disease-specific measures showed substantial burden: 52.5% could not swallow certain solids, 61.0% could eat only soft solids, and 54.9% screened positive for trismus. Fear of cancer recurrence was reported in 62.7% of participants, and 55.8% felt self-conscious about their smile. Sleep disturbance was common (mean Insomnia Severity Index 11.9, suggesting mild to moderate impact) and among the 38.1% participants who were employed, the mean overall WPAI was 21%, indicating modest work impairment.

 

Conclusions: Survivors of HNC with free flap reconstruction report high global utility despite persistent, reconstruction-specific functional, psychosocial, sleep, and smile-related burdens. Reliance on generic utility alone risks underestimating the true burden of this disease and undervaluing interventions that target domains such as function, aesthetics, and trismus. Incorporating reconstruction-specific PROs into health technology assessment and reimbursement decisions will align future innovations in HNC reconstruction with affordability, access, and outcomes that matter to patients.