The personality and quality of life in HNSCC patients following treatment H.J. Aarstad a, *, A.K.H. Aarstad b , E.J. Birkhaug a ,E.Bru c , J. Olofsson a a Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, 5021 Bergen, Norway b Bergen University College, 5008 Bergen, Norway c Stavanger University College, 4091 Stavanger, Norway Received 26 September 2002; accepted 19 December 2002 Abstract The aim of the present study was to investigate the association between self-reported quality of life (QoL) and personality in successfully treated primary head and neck squamous cell carcinoma (HNSCC) patients. We determined QoL using the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ) C30/H&N35, and personality by the Eysenck Personality Inventory (EPI). All patients younger than 80 years who had been diagnosed with HNSCC in Western Norway in the period from 1992 to 1997, and who had survived until 1999, were sampled. 96 patients (a 90% response rate) were included. Questionnaires were also mailed to all Norwegian laryngectomised patients; 104 patients returned the questionnaires (a 50% response rate). The neuroticism scores were test re-test reliable as determined by the neuroticism scores measured at the pri- mary HNSCC diagnosis for a sub-sample (N=22) of the included patients. High neuroticism was associated with a low QoL in both patient samples. The neuroticism score was associated with the QLQ-C30 scales (common variance: 17–25%) and all QoL scores in the laryngectomised group (common variance: 11–25%), and the H&N35 symptom scores in the laryngectomised sample. The associations could still be shown when adjustments were made for gender, age, marital status, educational level, number of children and level of treatment. Extraversion was associated with general QoL, physical and emotional scores in the HNSCC patient sample. Radiation therapy in the HNSCC sample was associated with the H&N35 symptom scores, but different ones to those associated with neuroticism. In conclusion, high neuroticism, but not extraversion, is associated with a lowered QoL. # 2003 Elsevier Ltd. All rights reserved. Keywords: Neoplasms; Squamous carcinoma; Quality of life; Neuroticism; Extraversion; Radiation 1. Introduction There has been a growing interest over the last few decades in the Quality of Life (QoL) of Head and Neck Squamous Cell Carcinoma (HNSCC) patients following therapy [1]. New protocols have been implemented in HNSCC treatment, but these have not resulted in sub- stantially better survival [2]. Determination of QoL fol- lowing HNSCC therapy is therefore of interest in order to document that an improved outcome during the last 40 years at least applies to QoL [3]. Several definitions of QoL have been proposed. Gen- erally, the definitions have changed from being obser- ver-based to being based on the perspective of the patients [4,5]. The multiple dimensions of QoL and the importance of symptom-specific, as well as general aspects, of QoL have also been emphasised [4,5]. The European Organisation for Research and Treatment of Cancer (EORTC) has developed QoL questionnaires aimed at cancer patients [5]. These QoL questionnaires have a non-specific part that is common to all cancer diseases [6], together with disease-specific parts and one of these is aimed at HN cancer [7]. These QoL ques- tionnaires fulfill the requirements of a contemporary QoL questionnaire [8–11], and have therefore been used in this study. The more extensive treatment that HNSCC patients receive, the more reduced QoL becomes. However, this is not well established when referring to general QoL scales one year after successfully completed treatment 0959-8049/03/$ - see front matter # 2003 Elsevier Ltd. All rights reserved. doi:10.1016/S0959-8049(03)00308-3 European Journal of Cancer 39 (2003) 1852–1860 www.ejconline.com * Corresponding author. Tel.: 47-55-97-26-64; fax: +47-55-97-49- 56. E-mail address: hans.aarstad@gades.uib.no (H.J. Aarstad).