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Purpose: To explore the impact of head and neck radiation therapy on the quality of life of patients in Kumas, Ghana and Ann Arbor, MI.

Methods: Prospective series including three groups of patients: treatment group of Ghanaian patients at KATH, control group of Ghanaians in Kumasi, and treatment group of patients at the University of Michigan Health Systems. Participants completed the FACT-H+N Quality of Life questionnaire. Responses were analyzed comparing the QOL for patients in Kumasi and Michigan for all domains of the questionnaire.

Results: Ghanaian patients undergoing treatment demonstrated a trend toward better mean scores for overall quality of life and head and neck cancer specific symptoms.

Conclusion: Emotional well-being is significantly better for the Ghanaian treatment cohort when compared with the University of Michigan patients. This has an effect on the patients reported QOL scores. The reasons for this finding are not entirely clear but may be related to attitudes towards death.

Quality of Life and Head and Neck RadiationIn Kumasi, Ghana and Ann Arbor, MI

Susannah E. Hills, MD; Ernest Osei-Bonsu, MD; Tony Asante, MD; Nick Douville, BA, MSE; Scott McLean, MD; Mark Prince, MDDepartment of Otolaryngology-Head and Neck Surgery

University of Michigan Health System, Komfo Anokye Teaching Hospital, Kumasi, Ghana

Results demonstrate a trend toward higher mean FACT H+N scores for overall quality of life among Ghanaian patients undergoing head and neck cancer treatment compared patients undergoing treatment at the University of Michigan (95.9 vs. 87.7, p = 0.41). Ghanaian patients also had statistically significantly higher scores for emotional well-being (19.6 vs. 15.9, p = 0.04) and showed a trend toward better scores for head and neck specific symptoms than the Michigan patients (25.0 vs. 19.6, p=0.16). Michigan patients had higher scores for Social/Family well-being compared with Ghanaian patients (20.4 vs. 17.0, p = 0.13).

Comparison of the Ghanaian and American treatment groups revealed similar scores for physical well-being and functional well-being.

Our initial results suggest that Ghanaian head and neck radiation patients have a higher self-perception of quality of life than patients undergoing treatment at the University of Michigan, though our results do not show statistical significance. The Ghanaian patients in our cohort also reported fewer head and neck specific symptoms compared with Americans, despite their tendency to present with later stages of disease in a setting with fewer economic and medical resources. Michigan patients had higher scores for social and family well-being

It is particularly notable that the scores for emotional well-being were significantly higher in the Ghanian treatment group (p = 0.04). One possible explanation is that, within this section of the questionnaire, American patients frequently expressed a fear of dying, where almost none of the Ghanaian patients expressed this fear. Further exploration of the factors contributing to higher emotional well-being scores among Ghanaians may lend insight into ways emotional well-being and quality of life could be improved for patients at the University of Michigan.

The study includes patients undergoing radiation treatment for head and neck cancer, with or without chemotherapy, as well as healthy individuals as a control group.

Patients undergoing treatment were approached during the last week of their radiation therapy and invited to participate. They were asked to complete the internationally validated FACT–H+N Quality of Life Questionnaire. The healthy controls were family or friends accompanying patients being seen in the outpatient Otolaryngology clinic for concerns other than cancer.

Patient scores were summarized for descriptive data including means, medians and standard deviations. The statistical significance was assessed by calculating p-values.

Emotional well-being is significantly better for the Ghanaian treatment cohort when compared with the University of Michigan patients. This has an effect on the patients reported QOL scores. The reasons for this finding are not entirely clear but may be related to attitudes towards death. Future studies should explore the basis for this improved emotional well-being as this may lend insight into ways quality of life could be improved for our patients at the University of Michigan.

Each year, over 400 new patients seek treatment for oral cavity and pharynx cancers in Ghana, and 220 head and neck cancer patients are documented to die of their disease. Given the limited resources, particularly for ancillary services such as feeding tube placement, nutritionists, and speech and language pathologists, the effects of head and neck cancer on communication and swallowing are particularly severe. In the unique cultural and socioeconomic context of Ghana, it is unclear how head and neck cancer and its treatment affects quality of life.

Purpose: To investigate the quality of life of patients undergoing radiation therapy for head and neck cancer at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, and at the University of Michigan. Quality of life scores were compared to see if there was a significant difference within these two distinct cultural and socioeconomic contexts.

INTRODUCTION

METHODS

1. Clegg-Lamptey J et al. Why do breast cancer patients report late or abscond during treatment in Ghana? A pilot study. Ghana Med J. 2009 Sep;43(3):127-31.

2. Murphy JP. Two years of otolaryngology in Ghana, West Africa. Arch Otolaryngol. 1981 Jul;107(7):422-4.

3. Kitcher et al. Laryngeal cancer at the Korle Bu Teaching Hospital Accra, Ghana. Ghana Med J. 2006 Jun;40(2):45-9.

4. O’Brien KS et al. Traditional Herbalists and Cancer Management in Kumasi, Ghana. J Cancer Educ. May, 2012.

5. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Human Papil- lomavirus and Related Cancers in Ghana. Summary Report 2010.

6. Wiredu EK et al. Cancer mortality patterns in Ghana: a 10-year review of autopsies and hospital mortality. BMC Public Health. 2006 Jun 20;6:159.

CONCLUSIONS

DISCUSSIONRESULTS

REFERENCES

Figure 2. KATH inpatient building.

Figure 1. KATH hospital, Kumasi, Ghana.

Figure 3. Radiation Oncology waiting room at KATH hospital,

Kumasi, Ghana

ABSTRACT

Susannah E. Hills, MDDepartment of OtolaryngologyUniversity of Michigan Health SystemsEmail: shills@med.umich.eduPhone: 410-905-4455Website: www.mottchildren.org

CONTACT

Figure 4. KATH XRT treatment room with cobalt radiation machine.

Figure . Low-risk features of HPV, including enlarged, irregular nuclei

surrounded by a “halo.”

FACT HN Domain Ghana Patientsn=9 Mean (std), median, range

Michigan Patients n=7 Mean (std), median, range

p‐value

Physical 17.4 (5.9), 19, 9‐26 16.3 (6.2), 16, 8‐25 0.71Social‐Family 17.0 (4.1), 18, 9‐22 20.4 (4.5), 24, 15‐24 0.13Emotional 19.6 (2.2), 19, 17‐24 15.9 (4.4), 17, 10‐20 0.04Functional 16.9 (4.3), 17, 11‐23 15.6 (4.7), 13, 11‐24 0.57Additional H+NSpecific Concerns

25.0 (5.9), 26, 14, 34 19.6 (8.8), 18, 11‐36 0.16

Total Score 95.9 (13.1), 92, 84‐122 87.7 (25.2), 81, 61‐128 0.41