Pretreatment Health-Related Quality of Life and Survival in Head and Neck Cancer: A Meta-Analysis.

Objective

To quantify associations between pretreatment patient-reported health-related quality of life (HRQoL) domains and overall survival in head and neck cancer. DATA SOURCES PubMed, Embase, and Web of Science were searched from inception through July 27, 2026. REVIEW

Methods

Longitudinal studies evaluating validated patient-reported HRQoL as a prognostic exposure were included. Adjusted hazard ratios (HRs) for overall survival were harmonized to a 10-point worsening and pooled by domain using restricted maximum-likelihood random-effects models. Risk of bias, multiplicity, leave-one-out stability, cohort overlap, residual-confounding sensitivity, and reporting completeness were evaluated.

Results

Thirty-two independent studies in 40 publications were included; 43 estimates contributed to meta-analyses of 10 domains. Worse Global QoL (HR, 1.11; 95% CI, 1.08-1.14), physical functioning (1.16; 1.13-1.20), role functioning (1.09; 1.07-1.11), and social functioning (1.09; 1.06-1.12) were consistently associated with higher mortality and remained leave-one-out stable. Swallowing was associated with mortality (1.15; 1.02-1.29) but was sensitive to one study. Dyspnea was associated with higher mortality in the primary analysis (4 studies; HR, 1.16; 95% CI, 1.01-1.33), but the estimate was heterogeneous and unstable.

Conclusion

Pretreatment HRQoL provides multidimensional prognostic information, with Global QoL and physical, role, emotional, and social functioning showing the most consistent evidence. These domains may help prioritize pretreatment supportive-care assessment, whereas sensitivity-limited or very-low-certainty findings require further confirmation and should not be interpreted as actionable treatment targets. LEVEL OF EVIDENCE N/A. TRIAL REGISTRATION PROSPERO number: CRD420261461389.