Evaluation of Quality of Life and Organ Function in Head and Neck Squamous Cell Carcinoma Rosemary Martino, MA, MSc, PhD a,b, *, Jolie Ringash, BSc, MD, MSc c,d Despite contributing only 3% of incident cancer cases and cancer deaths, affecting approximately 4,000 Canadians each year, head and neck squamous cell cancer (HNC) has a significant impact on function and quality of life (QOL). 1 Treatment is becoming increasingly complex, long, and toxic; 2 currently, as an extreme example, a selected patient may undergo 6 months of therapy, including 3 months of induction chemotherapy, followed by 7 weeks of concurrent chemoradiotherapy (CRT), a 4-week break, and a surgical neck dissection. Other strategies combine accelerated fractionation radiotherapy (RT) with chemotherapy, again followed by neck surgery in selected patients. 3 How biologic agents will be optimally integrated with other thera- pies is an open question, but some current clinical trials are using such agents as the anti-epidermal growth-factor receptor (EGFR) antibody cetuximab as a further addi- tion to standard therapies, such as CRT (eg, Radiation Therapy Oncology Group 0522). 4 Each intensification has shown small benefits in survival or local control: for example, 6% to 8% improvement in 5-year overall survival with CRT versus standard RT; 3% with altered fractionation versus standard RT; 5 10% improvement in 3-year overall survival with RT-cetuximab versus standard RT. 6 However, the cost in terms a Department of Speech Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, Ontario, Canada M5G 1V7 b Health Care and Outcomes Research, Toronto Western Research Institute, 399 Bathurst Street, MP 11-331, Toronto, Ontario, Canada M5T 2S8 c Department of Radiation Oncology, The Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9 d The University of Toronto, 27 King’s College Circle, Toronto, Ontario, Canada M5S 1A1 * Corresponding author. Department of Speech Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, Ontario, Canada M5G 1V7. E-mail address: rosemary.martino@utoronto.ca (R. Martino). KEYWORDS  Speech  Swallowing  Quality of life  Measurement outcomes  Xerostomia  Head and neck cancer Hematol Oncol Clin N Am 22 (2008) 1239–1256 doi:10.1016/j.hoc.2008.08.011 hemonc.theclinics.com 0889-8588/08/$ – see front matter. Crown Copyright ª 2008 Elsevier Inc. All rights reserved.