A prospective investigation of swallowing, nutrition, and patient-rated functional impact following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer

Dysphagia

Volumn 27, Issue 1, 2012, Pages 32-45

  Cartmill, Bena ^a,b   Cornwell, Petrea ^c,d   Ward, Elizabeth ^b,c   Davidson, Wendy ^a   Porceddu, Sandro ^a,b  

^a PRINCESS ALEXANDRA HOSPITAL   (Australia)

^b UNIVERSITY OF QUEENSLAND   (Australia)

^c QUEENSLAND HEALTH   (Australia)

^d GRIFFITH UNIVERSITY   (Australia)

Author keywords

Altered fractionation radiotherapy; Deglutition; Deglutition disorders; Nutrition; Oropharynx; Patient rated function; Squamous cell carcinoma

Indexed keywords

ADULT; AGED; ALTERED FRACTIONATION RADIOTHERAPY; ARTICLE; AUSTRALIA; CANCER RADIOTHERAPY; CANCER STAGING; CLINICAL ARTICLE; COHORT ANALYSIS; CONTROLLED STUDY; CONVALESCENCE; DYSPHAGIA; FEMALE; FUNCTIONAL ASSESSMENT; HUMAN; MALE; NUTRITIONAL STATUS; OROPHARYNX CANCER; OUTCOME ASSESSMENT; PATIENT ATTITUDE; PRIORITY JOURNAL; PROSPECTIVE STUDY; RADIATION DOSE FRACTIONATION; RADIATION RESPONSE; SQUAMOUS CELL CARCINOMA; SWALLOWING;

AGED; AGED, 80 AND OVER; CARCINOMA, SQUAMOUS CELL; DEGLUTITION; DEGLUTITION DISORDERS; DOSE FRACTIONATION; FEMALE; FLUOROSCOPY; HUMANS; MALE; MIDDLE AGED; NUTRITIONAL STATUS; OROPHARYNGEAL NEOPLASMS; PROSPECTIVE STUDIES; QUESTIONNAIRES; RADIATION INJURIES; RADIOTHERAPY; RECOVERY OF FUNCTION; TREATMENT OUTCOME;

EID: 84858079791     PISSN: 0179051X     EISSN: 14320460     Source Type: Journal    
DOI: 10.1007/s00455-011-9333-5     Document Type: Article

References (86)

1. Fu KK, Pajak TF, Trotti A, Jones CU, Spencer SA, Phillips TL, Garden AS, Ridge JA, Cooper JS, Ang KK. A radiation therapy oncology group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys. 2000;48:7-16. (Pubitemid 30488207)
2. Horiot JC, Le Fur R, N'Guyen T, Chenal C, Schraub S, Alfonsi S, Gardani G, Van Den Bogaert W, Danczak S, Bolla M, Van Glabbeke M, De Pauw M. Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy. Radiother Oncol. 1992;25:231-41. (Pubitemid 23000765)
3. Saunders MI, Dische S, Barrett A, Parmar MKB, Harvey A, Gibson D. Randomised multicentre trials of CHART vs conventional radiotherapy in head and neck and non-small-cell lung cancer: an interim report. Br J Cancer. 1996;73:1455-62. (Pubitemid 26235366)
4. Ang KK, Peters LJ, Weber RS, Maor MH, Morrison WH, Wendt CD, Brown BW. Concomitant boost radiotherapy schedules in the treatment of carcinoma of the oropharynx and nasopharynx. Int J Radiat Oncol Biol Phys. 1990;19:1339-45.
5. Johnson CR, Schmidt-Ullrich RK, Wazer DE. Concomitant boost technique using accelerated superfractionated radiation therapy for advanced squamous cell carcinoma of the head and neck. Cancer. 1992;69:2749-54.
6. Knee R, Fields RS, Peters LJ. Concomitant boost radiotherapy for advanced squamous cell carcinoma of the head and neck. Radiother Oncol. 1985;4:1-7. (Pubitemid 15019024)
7. Mak AC, Morrison WH, Garden AS, Ang KK, Goepfert H, Peters LJ. Base-of-tongue carcinoma: treatment results using concomitant boost radiotherapy. Int J Radiat Oncol Biol Phys. 1995;33:289-96.
8. Yu K, Chua M, Vlantis A, Kam MKM, Lee WY, Tsang RKY, Yuen HY, Hui EP, Chan ATC. Swallowing function after altered fractionation radiotherapy for head and neck carcinoma. J Hong Kong Coll Radiol. 2005;8:207-13. (Pubitemid 351596456)
9. Zouhair A, Azria D, Pasche P, Stupp R, Chevalier J, Betz M, Mirimanoff RO, Ozsahin M. Accelerated postoperative radiotherapy with weekly concomitant boost in patients with locally advanced head and neck cancer. Radiother Oncol. 2004; 70:183-8. (Pubitemid 38353018)
10. Grobbelaar EJ, Owen S, Torrance AD, Wilson JA. Nutritional challenges in head and neck cancer. Clin Otolaryngol. 2004;29:307-13. (Pubitemid 38981316)
11. Caudell JJ, Schaner PE, Meredith RF, Locher JL, Nabell LM, Carroll WR, Magnuson JS, Spencer SA, Bonner JA. Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2009;73:410-5.
12. Kotz T, Abraham S, Beitler JJ, Wadler S, Smith RV. Pharyngeal transport dysfunction consequent to an organ-sparing protocol. Arch Otolaryngol Head Neck Surg. 1999;125:410-3. (Pubitemid 29169767)
13. Kumar S, Pandey M, Lal P, Rastogi N, Maria Das KJ, Dimri K. Concomitant boost radiotherapy with concurrent weekly cisplatin in advanced head and neck cancers: a phase II trial. Radiother Oncol. 2005;75:186-92. (Pubitemid 40805248)
14. Smith R, Goldman S, Beitler J, Wadler S. Decreased short- and long-term swallowing problems with altered radiotherapy dosing used in an organ-sparing protocol for advanced pharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2004;130:831-6. (Pubitemid 38915969)
15. Smith R, Kotz T, Beitler J, Wadler S. Long-term swallowing problems after organ preservation therapy with concomitant radiation therapy and intravenous hydroxyurea: initial results. Arch Otolaryngol Head Neck Surg. 2000;126:384-9. (Pubitemid 30140395)
16. Vokes E, Kies M, Haraf D, Stenson K, List M, Humerickhouse R, Dolan ME, Pelzer H, Sulzen L, Witt ME. Concomitant chemoradiotherapy as primary therapy for locoregionally advanced head and neck cancer. J Clin Oncol. 2000;18:1652-61. (Pubitemid 30220543)
17. Medina JA, Rueda A, de Pasos AS, Contreras J, Cobo M, Moreno P, Benavides M, Villanueva A, Alba E. A phase II study of concomitant boost radiation plus concurrent weekly cisplatin for locally advanced unresectable head and neck carcinomas. Radiother Oncol. 2006;79:34-8.
18. Bentzen SM, Trotti A. Evaluation of early and late toxicities in chemoradiation trials. J Clin Oncol. 2007;25:4096-103. (Pubitemid 47492954)
19. Machtay M, Moughan J, Trotti A, Garden AS, Weber RS, Cooper JS, Forastiere A, Ang KK. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26:3582-9.
20. van den Berg M, Rasmussen-Conrad E, Gwasara G, Krabbe P, Naber A, Merkx M. A prospective study on weight loss and energy intake in patients with head and neck cancer, during diagnosis, treatment and revalidation. Clin Nutr. 2006;25: 765-72. (Pubitemid 44426426)
21. Pauloski BR, Rademaker AW, Logemann JA, Stein D, Beery Q, Newman L, Hanchett C, Tusant S, MacCracken E. Pretreatment swallowing function in patients with head and neck cancer. Head Neck. 2000;22:474-82. (Pubitemid 30483056)
22. Stenson KM, MacCracken E, List M, Haraf DJ, Brockstein B, Weichselbaum R, Vokes EE. Swallowing function in patients with head and neck cancer prior to treatment. Arch Otolaryngol Head Neck Surg. 2000;126:371-7. (Pubitemid 30140393)
23. Frowen JJ, Perry AR. Swallowing outcomes after radiotherapy for head and neck cancer: a systematic review. Head Neck. 2006;28:932-44. (Pubitemid 44497870)
24. Kendall KA, Leonard RJ, McKenzie SW, Jones CU. Timing of swallowing events after single-modality treatment of head and neck carcinomas with radiotherapy. Ann Otol Rhinol Laryngol. 2000;109:767-75. (Pubitemid 30637033)
25. Lazarus C, Logemann JA, Pauloski BR, Rademaker AW, Helenowski IB, Vonesh EF, MacCracken E, Mittal BB, Vokes EE, Haraf DJ. Effects of radiotherapy with or without chemotherapy on tongue strength and swallowing in patients with oral cancer. Head Neck. 2007;29:632-7. (Pubitemid 47168233)
26. Argiris A. Update of chemoradiotherapy for head and neck cancer. Curr Opin Oncol. 2002;14:323-9. (Pubitemid 34492866)
27. Logemann JA. Evaluation of swallowing disorders. In: Logemann JA, editor. Evaluation and treatment of swallowing disorders. 2nd ed. Austin, TX: Pro-Ed; 1998. p. 89-100.
28. Dietitians Association of Australia and Speech Pathology Association of Australia Limited. Texture-modified foods and thickened fluids as used for individuals with dysphagia: Australian standardised labels and definitions. Nutr Diet. 2007;64:S53-63.
29. Ward EC, Conroy AL. Validity, reliability, and responsivity of the Royal Brisbane Hospital outcome measure for Swallowing. Asia Pac J Speech Lang Hear. 1999;4:109-29.
30. Lazarus CL. Effects of radiation therapy and voluntary maneuvers on swallow functioning in head and neck cancer patients. Clin Commun Disord. 1993;3:11-20.
31. Huckabee ML. New Zealand index for multidisciplinary evaluation of swallowing. http://www.cmds.canterbury.ac.nz/documetns/nzimesa4.pdf. Accessed 20 Feb 2009.
32. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93-8. (Pubitemid 26107509)
33. van der Molen L, van Rossum M, Ackerstaff A, Smeele LE, Rasch C, Hilgers FJ. Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients' views. BMC Ear Nose Throat Disord. 2009;9:10.
34. Hughes P, Scott P, Kew J, Cheung DM, Leung SF, Ahuja AT, van Hasselt CA. Dysphagia in treated nasopharyngeal cancer. Head Neck. 2000;22:393-7. (Pubitemid 30413306)
35. Kendall K, Leonard R. Bolus transit and airway protection coordination in older dysphagic patients. Laryngoscope. 2001; 111:2017-21. (Pubitemid 33042120)
36. Ku P, Yuen E, Cheung D, Chan BY, Ahuja A, Leung SF, Tong MC, van Hasselt A. Early swallowing problems in a cohort of patients with nasopharyngeal carcinoma: symptomatology and videofluoroscopic findings. Laryngoscope. 2007;117:142-6. (Pubitemid 46066077)
37. Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Gaziano J, Stachowiak L, Newman L, MacCracken E, Santa D, Mittal B. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck. 2008;30:148-58. (Pubitemid 351251697)
38. Nguyen N, Moltz C, Frank C, Vos P, Smith HJ, Karlsson U, Nguyen LM, Rose S, Dutta S, Sallah S. Evolution of chronic dysphagia following treatment for head and neck cancer. Oral Oncol. 2006;42:374-80.
39. Ottery F. Patient-generated subjective global assessment. In: McCallum P, Polisena C, editors. The clinical guide to oncology nutrition. Chicago: The American Dietetic Association; 2000. p. 11-23.
40. Bannerman E, Miller MD, Daniels LA, Cobiac L, Giles LC, Whitehead C, Andrews GR, Crotty M. Anthropometric indices predict physical function and mobility in older Australians: the Australian Longitudinal Study of Ageing. Public Health Nutr. 2002;5:655-62.
41. National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults. Commonwealth of Australia, 2003. http://www.health.gov.au/internet/main/Publishing.nsf/ Content/7AF116AFD4E2EE3DCA256F190003B91D/$File/adults.pdf. Accessed 15 Sept 2010.
42. Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002;56:779-85.
43. Isenring E, Bauer J, Capra S. The scored patient-generated subjective global assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr. 2003;57:305-9. (Pubitemid 36240484)
44. Chen AY, Frankowshi R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, Goepfert H. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson Dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001;127:870-6. (Pubitemid 32619370)
45. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J, Eckberg K, Lloyd S, Purl S, Blendowski C, Goodman M, Barnicle M, Stewart I, McHale M, Bonomi P. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11:570-9. (Pubitemid 23071057)
46. List MA, D'Antonio LL, Cella DF, Siston A, Mumby P, Haraf D, Vokes E. The performance status scale for head and neck cancer patients and the functional assessment of cancer therapy-head and neck scale: a study of utility and validity. Cancer. 1996;77: 2294-301. (Pubitemid 26162422)
47. D'Antonio LL, Zimmerman GJ, Cella DF, Long SA. Quality of life and functional status measures in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 1996;122:482-7. (Pubitemid 26153857)
48. Colangelo LA, Logemann JA, Rademaker AW. Tumor size and pretreatment speech and swallowing in patients with resectable tumors. Otolaryngol Head Neck Surg. 2000;122:653-61. (Pubitemid 30333840)
49. Pauloski BR, Rademaker AW, Logemann JA, Lazarus CL, Newman L, Hamner A, MacCracken E, Gaziano J, Stachowiak L. Swallow function and perception of dysphagia in patients with head and neck cancer. Head Neck. 2002;24:555-65. (Pubitemid 34568557)
50. Cheng SS, Terrell JE, Bradford CR, Ronis DL, Fowler KE, Prince ME, Teknos TN, Wolf GT, Duffy SA. Variables associated with feeding tube placement in head and neck cancer. Arch Otolaryngol Head Neck Surg. 2006;132:655-61. (Pubitemid 43927044)
51. Kaanders JH, Van Daal WA, Hoogenraad WJ, Van der Kogel AJ. Accelerated fractionation radiotherapy for laryngeal cancer, acute, and late toxicity. Int J Radiat Oncol Biol Phys. 1992;24: 497-503.
52. Ang KK, Peters LJ. Concomitant boost radiotherapy in the treatment of head and neck cancers. Semin Radiat Oncol. 1992; 2:31-3.
53. Delaney GP, Fisher RJ, Smee RI, Hook C, Barton MB. Split-course accelerated therapy in head and neck cancer: an analysis of toxicity. Int J Radiat Oncol Biol Phys. 1995;32:763-8.
54. Fu KK, Clery M, Ang KK, Byhardt RW, Maor MH, Beitler JJ. Randomized phase I/II trial of two variants of accelerated fractionated radiotherapy regimens for advanced head and neck cancer: results of RTOG 88-09. Int J Radiat Oncol Biol Phys. 1995;32:589-97.
55. Olmi P, Cellai E, Chiavacci A, Faliai C. Accelerated fractionation in advanced head and neck cancer: results and analysis of late sequelae. Radiother Oncol. 1990;17:199-207. (Pubitemid 20110267)
56. Pauloski BR, Rademaker AW, Logemann JA, Colangelo LA. Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients. Otolaryngol Head Neck Surg. 1998;118: 616-24. (Pubitemid 28222203)
57. Trotti A, Bellm LA, Epstein JB, Frame D, Fuchs HJ, Gwede CK, Komaroff E, Nalysnyk L, Zilberberg MD. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol. 2003;66:253-62. (Pubitemid 36556043)
58. Dworkin JP, Hill SL, Stachler RJ, Meleca RJ, Kewson D. Swallowing function outcomes following nonsurgical therapy for advanced-stage laryngeal carcinoma. Dysphagia. 2006;21:66-74. (Pubitemid 43926938)
59. Logemann JA, Rademaker AW, Pauloski BR, Lazarus CL, Mittal BB, Brockstein B, MacCracken E, Haraf DJ, Vokes EE, Newman LA, Liu D. Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation. Head Neck. 2006;28:64-73. (Pubitemid 43099637)
60. Chang YC, Chen SY, Lui LT, Wang TG, Wang TC, Hsiao TY, Li YW, Lien IN. Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Dysphagia. 2003;18:135-43. (Pubitemid 36918090)
61. Shapiro J. Evaluation and treatment of swallowing disorders. Compr Ther. 2000;26:203-9.
62. Beaver ME, Matheny KE, Roberts DB, Myers JN. Predictors of weight loss during radiotherapy. Otolaryngol Head Neck Surg. 2001;125:645-8.
63. Öhrn KE, Sjoden PO, Wahlin YB, Elf M. Oral health and quality of life among patients with head and neck cancer or haematological malignancies. Support Care Cancer. 2001;9:528-38.
64. Denham JW, Peters LJ, Johansen J, Poulsen M, Lamb DS, Hindley A, O'Brien PC, Spry NA, Penniment M, Krawitz H, Williamson S, Bear J, Tripcony L. Do acute mucosal reactions lead to consequential late reactions in patients with head and neck cancer? Radiother Oncol. 1999;52:157-64. (Pubitemid 29461083)
65. Dörr W, Hendry JH. Consequential late effects in normal tissues. Radiother Oncol. 2001;61:223-31. (Pubitemid 33127227)
66. Bleier B, Levine M, Mick R, Rubesin SE, Sack SZ, McKinney K, Mirza N. Dysphagia after chemoradiation: analysis by modified barium swallow. Ann Otol Rhinol Laryngol. 2007;116:837-41. (Pubitemid 350174843)
67. Eisbruch A, Lyden T, Bradford CR, Dawson LA, Haxer MJ, Miller AE, Teknos TN, Chepeha DB, Hogikyan ND, Terrell JE, Wolf GT. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2002;53:23-8. (Pubitemid 34465803)
68. Eisele DW, Koch DG, Tarazi AE, Jones B. Aspiration from delayed radiation fibrosis of the neck. Dysphagia. 1991;6:120-2.
69. Ekberg O, Nylander G. Pharyngeal dysfunction after treatment for pharyngeal cancer with surgery and radiotherapy. Gastrointest Radiol. 1983;8:97-104. (Pubitemid 13114763)
70. Logemann JA, Smith CH, Pauloski BR, Rademaker AW, Lazarus CL, Colangelo LA, Mittal B, MacCracken E, Gaziano J, Stachowiak L, Newman LA. Effects of xerostomia on perception and performance of swallow function. Head Neck. 2001;23:317-21. (Pubitemid 32234110)
71. Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Mittal B, Gaziano J, Stachowiak L, MacCracken E, Newman LA. Xerostomia: 12-Month changes in saliva production and its relationship to perception and performance of swallow function, oral intake, and diet after chemoradiation. Head Neck. 2003;25: 432-7. (Pubitemid 36577026)
72. Wu C, Hsiao T, Ko J, Hsu M. Dysphagia after radiotherapy: endoscopic examination of swallowing in patients with nasopharyngeal carcinoma. Ann Otol Rhinol Laryngol. 2000;109:320-5. (Pubitemid 30149149)
73. Ng K, Leung SF, Johnson PJ, Woo J. Nutritional consequences of radiotherapy in nasopharynx cancer patients. Nutr Cancer. 2004;49:156-61. (Pubitemid 39487874)
74. Bosaeus I, Daneryd P, Svanberg E, Lundholm K. Dietary intake and resting energy expenditure in relation to weight loss in unselected cancer patients. Int J Cancer. 2001;93:380-3. (Pubitemid 32592057)
75. Lee H, Havrila C, Bravo V, Shantz K, Diaz K, Larner J, Read P. Effect of oral nutritional supplementation on weight loss and percutaneous endoscopic gastrostomy tube rates in patients treated with radiotherapy for oropharyngeal carcinoma. Support Care Cancer. 2008;16:285-9. (Pubitemid 351422801)
76. Lees J. Incidence of weight loss in head and neck cancer patients on commencing radiotherapy treatment at a regional oncology centre. Eur J Cancer Care. 1999;8:133-6.
77. Epstein JB, Emerton S, Kolbinson DA, Le ND, Phillips N, Stevenson-Moore P, Osoba D. Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck. 1992;21:1-11.
78. Campbell BH, Spinelli K, Marbella AM, Myers KB, Kuhn JC, Layde PM. Aspiration, weight loss, and quality of life in head and neck cancer survivors. Arch Otolaryngol Head Neck Surg. 2004;130:1100-3. (Pubitemid 39195394)
79. Tschudi D, Stoeckli S, Schmid S. Quality of life after different treatment modalities for carcinoma of the oropharynx. Laryngoscope. 2003;113:1949-54. (Pubitemid 37409683)
80. Barbosa-Silva MC, Barros AJ. Bioelectric impedance and individual characteristics as prognostic factors for post-operative complications. Clin Nutr. 2005;24:830-8. (Pubitemid 41403640)
81. Seltzer MH, Slocum BA, Cataldi-Betcher EL, Fileti C, Gerson N. Instant nutritional assessment: absolute weight loss and surgical mortality. JPEN J Parenter Enteral Nutr. 1982;6:218-21.
82. Van Bokhorst-De Van der Schueren M, Langendoen S, Vondeling H, Kuik D, Quak J, Van Leeuwen P. Perioperative enteral nutrition and quality of life of severely malnourished head and neck cancer patients: a randomized clinical trial. Clin Nutr. 2000;19:437-44.
83. van der Schueren M, van Leeuwen P, Sauerwein H. Assessment of malnutrition parameters in head and neck cancer and their relation to postoperative complications. Head Neck. 1997;19: 419-25. (Pubitemid 27293225)
84. de Graeff A, de Leeuw JRJ, Ros WJG, Hordijk GJ, Blijham GH, Winnubst JA. Long-term quality of life of patients with head and neck cancer. Laryngoscope. 2000;110:98-106. (Pubitemid 30046653)
85. Terrell J, Ronis D, Fowler K, Bradford CR, Chepeha DB, Prince ME, Teknos TN, Wolf GT, Duffy SA. Clinical predictors of quality of life in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2004;130:401-8. (Pubitemid 38456313)
86. Weymuller E Jr, Alsarraf R, Yueh B, Deleyiannis F, Coltrera M. Analysis of the performance characteristics of the University of Washington Quality of Life instrument and its modification (UWQOL-R). Arch Otolaryngol Head Neck Surg. 2001;127:489-93. (Pubitemid 32434043)