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335

ICAR SINONASAL TUMORS

Assessment of QOL in sinonasal tumors

items on a 1–5 Likert scale across four domains (physi cal function, psychological function, social function, and side effects). 2077 In a sample of 487 patients, it was deter mined to have good internal consistency (Cronbach’s alpha 0.72–0.84), reliability (ICC > 0.8), and validity as evidenced by correlation with QOL-NP, FACT-G, and FACT-H&N, as well as by confirmatory factor analysis. 2077,2082 The Chinese QOL Instruments for Cancer Patients (QLICP v 2.0) was developed to assess QOL specifically in Chinese patients. It contains a general module for most patients (32 items) as well as short modules for specific diseases, including NPC, consisting of 11 items. 2083 The structure is hierarchical and broken into items, facets, domains, and overall. The four domains include physi cal, psychosocial, and social QOL, as well as common symptoms/side effects. It generally demonstrated accept able overall validity and reliability; however, a large ceiling effect was noted in some facets and low responsiveness was identified in some domains, leading the authors to suggest improvements prior to widespread use. Additional QOL instruments have been developed specifically for other cultures. The CV-IOR-CyC-01 is a 65 item questionnaire of three domains and two ungrouped questions on perceived health and health-related QOL used to assess QOL of head and neck cancer patients. The instrument explores health-related QOL in detail and is adapted to Cuban society and culture. It demonstrated acceptable internal consistency (Cronbach’s alpha 0.79– 0.90) and validity in a large sample of patients, of which a small number had NPC. 2084 Given the variety of QOL instruments available, it can be challenging to determine which are most appropriate (Table XXX.1). Deckard examined three validated QOL instruments (ASBQ, SNOT-20, and European Quality of-Life-5 Dimension [EQ-5D]) and one endoscopy scale (Lund–Kennedy Endoscopic [LKE]) in a cohort of 71 patients following both benign and malignant sinus and skull base tumor resection. 2085 The most common pathol ogy included IP, JNA, and SCC. Most surgical approaches were endoscopic (78.8%), followed by combined endo scopic and open (21.1%). Forty-nine percent of patients received a form of postoperative adjuvant therapy. A strong correlation was found between the ASBS-Q and SNOT-20 instruments and between ASBS-Q and the EQ-5D; how ever, the EQ-5D did not differentiate between any of the assessed variables in the study and may be too general for use in this setting. The LKE correlated moderately with SNOT-20 and weakly with the other instruments. This highlights that there is not one ideal instrument to mea sure QOL in patients undergoing treatment for sinonasal and skull neoplasms. Use of multiple instruments may pro vide more useful complementary information depending on the goals of the assessment.

Aggregate level of evidence

B (Level 1: one study; Level 2: eight studies; Level 3: nine studies; Level 4: one study) QOL outcomes for patients with sinonasal tumors have been studied with reliable instruments that have been validated for sinonasal disorders or head and neck malignancies. No consensus has been made for the best instrument for assessing QOL in sinonasal tumors. Time (interviewer, patient, data entry, and data analysis); survey fatigue especially with multiple instruments Preponderance of benefits over harms. Since there is no well-defined superior metric, multiple metrices may be needed for full evaluation of QOL outcomes. More studies directly comparing QOL metrics should be performed specific to sinonasal tumor outcomes. management of patients with sinonasal tumors to monitor patient outcomes, as they have the potential to provide valid and reliable information on outcomes for patients with sinonasal tumors.

Benefit

Harm

Cost

Benefits–harm assessment

Value

judgments

Policy level Recommendation. Intervention QOL surveys should be utilized during the

XXXI

QUALITY OF LIFE FOR

SINONASAL NEOPLASMS A Quality of life for benign neoplasms 1 Baseline and postoperative QOL differences Historically, open resection of sinonasal tumors resulted in high morbidity with lasting impact on patients’ QOL. 2088 The advent of endoscopic surgery avoids the morbidity associated with external incisions required for open resec tion, but the impact on sinonasal and overall QOL was not significantly investigated until the early 2010s. Several recent studies have investigated the impact of minimally invasive endoscopic resection of both benign and malig nant sinonasal tumors. 2085,2089–2094 Early studies focused on QOL outcomes following endoscopic skull base surgery, and Harrow and Batra in 2013 reported on sinonasal QOL after endoscopic resection of sinonasal tumors. In this series, patients with benign tumors, predominantly IP (46%), recorded mean preoperative SNOT-20 scores of