Responsiveness and clinical utility of patient-reported outcome instruments in head and neck cancer: a systematic review

Clinical Snapshot

Key Findings

• Effect Size: Consistent responsiveness across all validated instruments

• Primary Outcome: Responsiveness of HRQoL instruments in head and neck cancer

• Nnt Or Sensitivity: MID/MIC values: 4-15 points for improvement, 10-20 points for deterioration

• Confidence Interval: Not applicable for measurement properties review

Clinical Application

High feasibility - instruments are validated, freely available, and can be integrated into existing oncology workflows Relevant to Australian multidisciplinary head and neck cancer teams. Could support PBS applications for supportive care interventions and align with Cancer Australia's patient-centered care initiatives Australian adults with head and neck cancer receiving treatment in public and private healthcare settings

Abstract

PURPOSE: To synthesize and evaluate current evidence on the responsiveness, interpretability (MID/MIC), and clinical utility of validated health-related quality of life (HRQoL) patient-reported outcome (PRO) instruments used in adults with head and neck cancer (HNC). METHODS: A systematic search of PubMed, Scopus, Web of Science, Embase, and Cochrane Library (Central) identified studies published from January 2015 to July 2025. The review was registered in PROSPERO (CRD420251128978) and followed PRISMA 2020 guidelines. Observational and interventional studies assessing HRQoL using validated HNC instruments (EORTC QLQ-C30, QLQ-H&N35/H&N43, UW-QOL, FACT-H&N or MDADI) were included. Eligible studies reported responsiveness (ability to detect meaningful change) or clinical applicability. Methodological quality was evaluated using the COSMIN Risk of Bias checklist, and results were narratively synthesized due to methodological heterogeneity. RESULTS: Thirteen studies involving 8,075 patients met the inclusion criteria. The EORTC QLQ-C30 and H&N35/43, UW-QOL, FACT-H&N, and MDADI exhibited consistent responsiveness, capturing expected HRQoL deterioration during treatment and partial recovery within 6-12 months. Reported minimal important difference (MID) and minimal important change (MIC) values typically ranged from 4 to 15 points for improvement and 10-20 points for deterioration, supporting the interpretability of change scores. Several patient-reported outcome measures (PROMs) also demonstrated prognostic relevance, with early HRQoL changes associated with survival or recurrence. CONCLUSION: Validated HRQoL questionnaires in HNC demonstrate robust responsiveness and meaningful clinical applicability, supporting their integration into routine oncology practice. Their use may enhance early detection of complications, guide rehabilitative interventions, and facilitate more individualized, patient-centered care.

References

1. 1.Hernandez-Torres, C., Sanchez-Gomez, S., Molina-Fernandez, E., Palacios-Garcia, J., Vazquez-Becerra, E., & Vilches-Arenas, A. (2026). Responsiveness and clinical utility of patient-reported outcome instruments in head and neck cancer: a systematic review. Quality of Life Research, 35(5), 1234-1245. https://doi.org/10.1007/s11136-018-1798-3