Evaluation of Quality of Life and Psychiatric Morbidity in Patients with Malignant Tumors of the Skull Base

Aim: To evaluate the effectiveness of treatment, in terms of physical and mental quality of life, in patients with a skull base malignancy.

Patients and Method: This is a retrospective study of patients treated for malignant tumors of the skull base over a 10-year period. All patients completed a University of Washington Quality of Life Questionnaire (UW-QOL), Version 4, and a Hospital Anxiety and Depression scale. Eighteen patients took part in the study. Outcome measures were: age, sex, diagnosis, treatment modality, follow-up, complications, recurrence, disease-free interval, Quality of Life Questionnaire score, and Anxiety and Depression score.

Results: The male-to-female ratio of the 18 patients was 1:1, and mean age was 60.4 years (range, 34–75 years). The mean follow-up period was 2 years and 10 months (range, 6–70 months). A total of 5 complications were reported (28%). Four patients had recurrence of their original disease (22%), and the disease-free interval was found to be 2 years and 4 months. The UW-QOL score was 978.05 (range, 480–1125), with the worst domains being related to mood, activity, and taste. The complications score (total) was 998 (range, 895–1115), with the worst domains being related to anxiety, appearance, and taste. The recurrence score (total) was 781.25 (range, 480–1095). Worst domains were taste, mood, activity, and recreation. The Anxiety and Depression score (HAD) results were: anxiety >7 (possible) in 4 patients (22%), anxiety >10 (probable) in 3 patients (16.6%), depression >7 in 2 patients (11%), depression >10 in 1 patient (5.6%). Number of patients >7 on a scale was 6 (33%).

Conclusions: The conclusions from this scoring system were: (1) The quality of life in patients treated for a skull base malignancy is equal to or better than patients with other head and neck cancers. (2) Mood, activity, and taste are the main complaints in these patients. (3) One third of patients suffer from mental distress and psychiatric morbidity. (The HAD scale is a useful instrument to evaluate psychiatric morbidity.)(4) Specific issues such as hearing, vision, and olfaction should be included in QOL questionnaires.