HEALTH UTILITY, FUNCTION, AND WORK PRODUCTIVITY AFTER FREE FLAP RECONSTRUCTION FOR HEAD AND NECK CANCER: IMPLICATIONS FOR MEASURING VALUE
Author(s)
Hansoo Kim, BSc, MSc, PhD1, Leonard Lee2, Jonathan Clark, MBBS (Hons Class 1), BSc(Med), MBiostat, FRACS AM3, Arun Jones, MS4, Masako Dunn, PhD3, Timothy Manzie, BOH (DSc.), Grad. Dip. Dent, MBBS, FRACDS (OMFS)3, Emma Charters, PhD3, Catriona Froggatt, BN3, Reena Wen, BMedSc4, Rebecca Venchiarutti, PhD3.
1Bond University, Robina, Australia, 2University of Sydney, Camperdown, Australia, 3Chris O'Brien Lifehouse, Sydney, Australia, 4Griffith University, Gold Coast, Australia.
1Bond University, Robina, Australia, 2University of Sydney, Camperdown, Australia, 3Chris O'Brien Lifehouse, Sydney, Australia, 4Griffith University, Gold Coast, Australia.
OBJECTIVES: Free flap reconstruction is central to restoring form and function after advanced head and neck cancer (HNC) resection, yet its long‑term value is often judged using generic health utility measures that may not reflect disease‑specific burden. This study quantified multi-domain patient-reported outcomes and health utilities among Australian HNC survivors to inform value assessment and economic evaluation.
METHODS: An Australian national cross-sectional survey was administered to adults who had undergone free flap reconstruction for HNC, recruited via advocacy organisations, treating surgeons, and social media. Participants completed EQ-5D-5L, UW-QoL, FACE-Q Head and Neck smile scales, Insomnia Severity Index, and Work Productivity and Activity Impairment (WPAI) questionnaires; analyses were descriptive.
RESULTS: Of 186 respondents, 141 with free flap reconstruction were analysed (median 44.0 months since reconstruction). Mean EQ-5D-5L utility was 0.90 (SD 0.11), similar to or higher than Australian population norms and many chronic diseases, suggesting preserved global health-related quality of life. Nonetheless, disease-specific measures showed substantial residual burden: 52.5% could not swallow certain solids, 61.0% could eat only soft solids, and 54.9% screened positive for trismus. Fear of cancer recurrence was important for 62.7% of participants, and 55.8% felt self-conscious about their smile, with 31.0% reporting a crooked or asymmetric smile all the time. Sleep disturbance was common (mean Insomnia Severity Index 11.9, mild-moderate), while among the 38.1% employed, mean overall WPAI was 21%, indicating modest work impairment.
CONCLUSIONS: Survivors of HNC with free flap reconstruction report high global utility despite persistent, reconstruction-specific functional, psychosocial, sleep, and smile-related burdens. Reliance on generic utility alone risks underestimating the true burden of this disease and undervaluing interventions that target domains such as functional outcomes, aesthetics and trismus. Incorporating reconstruction-specific patient-reported outcomes into health technology assessment and reimbursement decisions is critical to align future innovations in HNC reconstruction with affordability, access, and outcomes that matter to patients.
METHODS: An Australian national cross-sectional survey was administered to adults who had undergone free flap reconstruction for HNC, recruited via advocacy organisations, treating surgeons, and social media. Participants completed EQ-5D-5L, UW-QoL, FACE-Q Head and Neck smile scales, Insomnia Severity Index, and Work Productivity and Activity Impairment (WPAI) questionnaires; analyses were descriptive.
RESULTS: Of 186 respondents, 141 with free flap reconstruction were analysed (median 44.0 months since reconstruction). Mean EQ-5D-5L utility was 0.90 (SD 0.11), similar to or higher than Australian population norms and many chronic diseases, suggesting preserved global health-related quality of life. Nonetheless, disease-specific measures showed substantial residual burden: 52.5% could not swallow certain solids, 61.0% could eat only soft solids, and 54.9% screened positive for trismus. Fear of cancer recurrence was important for 62.7% of participants, and 55.8% felt self-conscious about their smile, with 31.0% reporting a crooked or asymmetric smile all the time. Sleep disturbance was common (mean Insomnia Severity Index 11.9, mild-moderate), while among the 38.1% employed, mean overall WPAI was 21%, indicating modest work impairment.
CONCLUSIONS: Survivors of HNC with free flap reconstruction report high global utility despite persistent, reconstruction-specific functional, psychosocial, sleep, and smile-related burdens. Reliance on generic utility alone risks underestimating the true burden of this disease and undervaluing interventions that target domains such as functional outcomes, aesthetics and trismus. Incorporating reconstruction-specific patient-reported outcomes into health technology assessment and reimbursement decisions is critical to align future innovations in HNC reconstruction with affordability, access, and outcomes that matter to patients.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
CO3
Topic
Clinical Outcomes
Disease
SDC: Oncology, STA: Surgery