Treatment- and Symptom-Related Determinants of Health-Related Quality of Life in Patients with Oropharyngeal Cancer

Treatment- and Symptom-Related Determinants of Health-Related Quality of Life in Patients with Oropharyngeal Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Treatment- and Symptom-Related Determinants of Health-Related Quality of Life in Patients with Oropharyngeal Cancer Ji-Eun An, Bon-Seok Koo, Sei-Young Lee, Su-Yeon Yu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7997928/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Oropharyngeal cancer, an oropharynx malignancy primarily linked to human papillomavirus infection, has seen substantial improvements with advances in treatment. However, many long-term survivors still experience functional impairments such as dysphagia and xerostomia that significantly reduce health-related quality of life (HRQoL). This study aims to identify treatment- and symptom-related factors associated with HRQoL in patients with oropharyngeal cancer. Methods This multicenter cross-sectional study enrolled 327 patients with oropharyngeal cancer from 14 hospitals in Korea. HRQoL was assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) instrument, and independent variables were categorized into sociodemographic, clinical, and symptom-related domains. Descriptive statistics, t-tests, ANOVA, and multivariate linear regression were used to identify factors associated with HRQoL. Results The mean EQ-5D-5L index was 0.851 ± 0.141. Female patients exhibited significantly lower HRQoL than that of males (p = 0.022), while higher educational attainment and employment were associated with better HRQoL (p < 0.05). Robotic surgery correlated positively with HRQoL (β = 0.045, p = 0.025). Dyspnea, insomnia, dysphagia, social eating and contact difficulties, and trismus were independent predictors of poorer HRQoL. The final regression model accounted for 62.2% of the variance (R² = 0.622). Conclusions This study identified key determinants of HRQoL in patients with oropharyngeal cancer, emphasizing the influence of sex, education, robotic surgery, and symptom burden. Early integration of symptom-focused care is recommended, with particular emphasis on managing swallowing difficulties, insomnia, and social functioning. These findings underscore the need to incorporate HRQoL into survivorship programs and optimize treatment strategies that balance oncologic control with long-term quality of life. Oropharyngeal cancer Health-related quality of life Regression analysis Predictive factors EQ-5D-5L Figures Figure 1 Figure 2 1. Background Oropharyngeal cancer, a malignancy of the oropharynx primarily linked to human papillomavirus (HPV) infection, accounted for approximately 98,400 new cases and 48,100 deaths worldwide in 2020, according to the Global Cancer Observatory ( 1 ). Epidemiologic analyses indicate its incidence is steadily increasing across multiple regions over recent decades, with annual increases exceeding 3% in several high-income countries ( 2 ). Consequently, oropharyngeal cancer represents a growing global health burden. Health-related quality of life (HRQoL) is a critical concern for patients with oropharyngeal cancer. Despite substantial improvements in survival due to treatment, many long-term survivors still experience functional impairments such as dysphagia and xerostomia that significantly compromise their HRQoL( 3 ). Additionally, HRQoL varies considerably across sociocultural and healthcare contexts ( 4 ), underscoring the importance of measuring quality of life in various countries. Although several studies have comprehensively examined factors influencing HRQoL in patients with oropharyngeal cancer ( 5 ), data on Asian populations remain limited. Moreover, while randomized trials such as the ORATOR2 phase II study have emphasized the importance of preserving quality of life between de-escalation treatments, including radiotherapy and transoral surgery ( 6 ), evidence directly linking treatment modalities, and with EuroQol 5-Dimension 5-Level (EQ-5D-5L)-based HRQoL in real-world clinical practice remains limited. Both disease-specific instruments, such as the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Head and Neck 35 (EORTC QLQ-H&N35), and generic tools such as the EQ-5D-5L are commonly used to assess HRQoL. A recent multi-institutional Korean study reports that the EQ-5D-5L shows strong explanatory validity compared to those of EORTC measures, highlighting its value for assessing HRQoL in patients with oropharyngeal cancer. Moreover, the EQ-5D-5L provides a standardized, validated single-index measure, offering a convenient means to quantify overall HRQoL ( 7 ). Therefore, this study aims to utilize the EQ-5D-5L to assess HRQoL and identify sociodemographic, clinical, and symptom-related factors associated with HRQoL in patients with oropharyngeal cancer. Given the limited real-world data on HRQoL among Asian patients with oropharyngeal cancer, this study aims to fill this gap and contribute evidence to guide patient-centered clinical care. 2. Methods 2.1. Participants This study included adult patients with oropharyngeal cancer who visited outpatient clinics for treatment or follow-up and provided informed consent. Overall, 327 patients were enrolled, exceeding the minimum sample size of 167 estimated using G*Power software (version 3.1.9.7; Heinrich-Heine-Universität Düsseldorf, Germany). The estimation assumed an effect size of 0.15, a significance level of 0.05, a statistical power of 0.80, and a 10% allowance for potential attrition. 2.2. Survey This study was conducted across 14 hospitals in Korea from August 2023 to March 2024. Data were collected using a structured questionnaire assessing HRQoL and related influencing factors in patients with oropharyngeal cancer. The survey was administered during outpatient visits, completed anonymously, and required approximately 20 min to complete. 2.3. Health-related quality of life HRQoL was assessed using the EQ-5D-5L instrument, which measures five dimensions—mobility, self-care, usual activities, pain/discomfort, and anxiety/depression—each rated on five response levels. Index scores were calculated using the Korean value set established in 2014. The resulting values ranged from 0 to 1, with higher scores indicating better quality of life ( 8 , 9 ). In this study, the EQ-5D-5L index was used as the dependent variable. 2.4. Independent variables Independent variables were selected according to the World Health Organization biopsychosocial framework and categorized into three domains: sociodemographic, clinical, and symptom-related factors ( 10 ). Sociodemographic variables included sex, age, household size, education, marital status, income, employment status, and religion. Clinical variables comprised TNM stage, cancer site (tonsil, base of tongue, soft palate, or posterior pharyngeal wall), HPV status, post-diagnosis duration, recurrence history, post-treatment duration, and treatment modalities (robotic surgery, other surgery, radiotherapy, chemotherapy, immunotherapy, and targeted therapy). Symptom-related factors included dyspnea, nausea/vomiting, insomnia, constipation, diarrhea, swallowing difficulty, sensory changes (taste/smell), speech, social eating, social contact, sexuality, dental problems, mouth opening limitation, xerostomia, sticky saliva, and coughing. Symptom scores were calculated and transformed into a 0–100 scale following the EORTC QLQ-C30 and QLQ-H&N35 scoring manual. And Higher scores indicated greater symptom severity. For analytical purposes, transformed scores were categorized into four severity levels: none (0), mild (1–33), moderate (34–66), and severe (67–100). Symptom variables overlapping with EQ-5D-5L dimensions (pain/discomfort, anxiety, and depression) were excluded to avoid redundancy. Symptom variables were derived from the EORTC QLQ-C30 and QLQ-H&N35 questionnaires. 2.5. Statistical analysis Descriptive statistics (frequencies, percentages, means, and standard deviations) were calculated to summarize the general characteristics of participants. Group differences in HRQoL were analyzed using independent t-tests or one-way ANOVA, depending on the number of comparison groups. For variables with more than two categories, post hoc tests were performed to identify pairwise differences. Two-way ANOVA was performed to examine the effects of sex and symptom severity on HRQoL to account for potential interaction effects, as symptom impact may vary by sex. Multivariable regression was conducted to adjust for confounders and identify independent factors associated with HRQoL. All statistical analyses were performed using Python (version 3.11). 3. Results 3.1. Characteristic of research participants In total, 327 patients with oropharyngeal cancer were included in the analysis. The mean age was 63.96 ± 10.53 years. Among them, 278 (85.0%) were male, while 49 (15.0%) were female. Regarding education, 57 (17.4%) completed middle school or below, 114 (34.9%) were high school graduates, and 156 (47.7%) held a college degree or higher. Most participants were married or in common-law partnerships 245 (74.9%), while 19 (5.8%) had never married and 63 (19.3%) were separated, divorced, or widowed. The average household size was 2.53 ± 1.16. Regarding household income, 118 patients (36.1%) reported < 3,000,000 KRW, 153 (46.8%) reported ≥ 3,000,000 and < 8,000,000 KRW, and 56 (17.1%) reported ≥ 8,000,000 KRW. Overall, 186 participants (56.9%) were employed, whereas 141 (43.1%) were unemployed. Religious affiliation was reported by 128 participants (39.1%) (Table 1 ). Table 1 Sociodemographic variables of patients with oropharyngeal cancer Variable a n (%) mean ± SD EQ-5D-5L index c (Mean ± SD) p-value All participants 0.851 ± 0.141 Sex 0.022* Male 278 (85.0) 0.860 ± 0.137 Female 49 (15.0) 0.800 ± 0.156 Age (years) 63.96 ± 10.53 Household size 2.53 ± 1.16 Education 0.004** Middle school or below 57 (17.4) 0.788 ± 0.159 0.005** High school graduate 114 (34.9) 0.868 ± 0.142 0.007** College graduate or above 156 (47.7) 0.863 ± 0.128 0.960 Marital status 0.317 Never married 19 (5.8) 0.879 ± 0.141 Married (including common-law) 245 (74.9) 0.852 ± 0.141 Other (Separated/divorced/widowed) 63 (19.3) 0.840 ± 0.143 Income (Korean Won b ) 0.160 < 3,000,000 118 (36.1) 0.834 ± 0.153 ≥ 3,000,000 to < 8,000,000 153 (46.8) 0.860 ± 0.131 ≥ 8,000,000 56 (17.1) 0.865 ± 0.140 Employment < 0.001*** Employed 186 (56.9) 0.882 ± 0.107 Unemployed 141 (43.1) 0.811 ± 0.169 Religion 0.556 No 199 (60.9) 0.854 ± 0.136 Yes 128 (39.1) 0.847 ± 0.150 SD, standard deviation; EQ-5D-5L, EuroQol five-dimension five-level a Variables whose percentages do not sum up to 100% indicate missing values. b 1,000 Korean won ( W ) = 0.70 dollar ( $ ) c Higher values indicate the best possible outcome, with values ranging from 0 to 1. *p < 0.05, **p < 0.01, ***p < 0.001 Regarding clinical characteristics, the primary tumor site was the tonsil in 248 patients (75.8%), base of the tongue in 51 (15.6%), soft palate in 16 (4.9%), and posterior pharyngeal wall in 7 (2.1%). At diagnosis, 119 patients (36.4%) had TNM stage I disease, 97 (29.7%) stage II, 68 (20.8%) stage III, and 43 (13.1%) stage IV. The mean post-diagnosis duration was 40.45 ± 28.29 months. HPV infection was confirmed in 216 patients (66.1%) and absent in 71 (21.7%). The mean number of recurrences was 1.13 ± 4.44, and the mean post-treatment duration was 34.35 ± 32.18 months. Seventy-nine (24.2%) patients were still under treatment or within 6 months of completing treatment, while 247 (75.5%) patients were more than 6 months post-treatment. Regarding treatment modalities, 47 patients (14.4%) underwent robotic surgery and showed significantly higher EQ-5D-5L index scores than those who did not (0.887 ± 0.101 vs. 0.846 ± 0.146, p = 0.029). Other treatments included conventional surgery in 163 patients (49.8%), radiotherapy in 267 (81.7%), and chemotherapy in 203 (62.1%). Immunotherapy and targeted therapy were less common, administered to 7 (2.1%) and 1 (0.3%) patients, respectively. These treatments were not significantly associated with differences in EQ-5D-5L scores (Table 2 ). Table 2 Clinical variables of patients with oropharyngeal cancer Variable a n (%) EQ-5D-5L index b (Mean ± SD) p-value mean ± SD Cancer site 0.174 Tonsil No 79 (24.2) 0.833 ± 0.142 Yes 248 (75.8) 0.857 ± 0.141 Base of tongue 0.388 No 276 (84.4) 0.853 ± 0.141 Yes 51 (15.6) 0.842 ± 0.142 Soft palate 0.267 No 311 (95.1) 0.854 ± 0.140 Yes 16 (4.9) 0.805 ± 0.169 Posterior pharyngeal wall 0.799 No 320 (97.9) 0.852 ± 0.142 Yes 7 (2.1) 0.842 ± 0.089 TNM classification 0.391 Stage I 119 (36.4) 0.858 ± 0.118 Stage II 97 (29.7) 0.854 ± 0.147 Stage III 68 (20.8) 0.858 ± 0.145 Stage IV 43 (13.1) 0.816 ± 0.178 Post-diagnosis duration (months) 40.45 ± 28.29 Human papillomavirus status 0.307 Yes 216 (66.1) 0.854 ± 0.150 No 71 (21.7) 0.837 ± 0.125 Number of recurrences 1.13 ± 4.44 Post-treatment duration (months) 34.35 ± 32.18 Present status 0.004** Under treatment or within 6 months of treatment completion 79 (24.2) 0.807 ± 0.165 More than 6 months post-treatment 247 (75.5) 0.866 ± 0.131 c Treatment modalities Robotic surgery 0.029* No 280 (85.6) 0.846 ± 0.146 Yes 47 (14.4) 0.887 ± 0.101 Other surgery 0.985 No 164 (50.2) 0.854 ± 0.131 Yes 163 (49.8) 0.848 ± 0.152 Radiotherapy 0.220 No 60 (18.3) 0.865 ± 0.120 Yes 267 (81.7) 0.849 ± 0.146 Chemotherapy 0.444 No 124 (37.9) 0.857 ± 0.130 Yes 203 (62.1) 0.848 ± 0.148 Immunotherapy 0.200 No 320 (97.9) 0.854 ± 0.140 Yes 7 (2.1) 0.727 ± 0.175 Targeted therapy - No 326 (99.7) 0.852 ± 0.141 Yes 1 (0.3) 0.593 SD, standard deviation; EQ-5D-5L, EuroQol five-dimension five-level a Variables whose percentages do not sum up to 100% indicate missing values. b Higher values indicate the best possible outcome, with values ranging from 0 to 1. c Treatment was defined as all treatments received during the treatment period. *p < 0.05, **p < 0.01, ***p < 0.001 Symptom burden, evaluated using the EORTC QLQ-C30 and QLQ-H&N35, was highest for xerostomia (42.13 ± 32.60), sticky saliva (29.92 ± 33.20), and dental problems (26.38 ± 32.14), and lowest for nausea/vomiting (7.98 ± 16.49) and diarrhea (9.68 ± 18.44) (Fig. 1 ). 3.2. Health-related quality of life of patients with oropharyngeal cancer The most frequently reported problems were in the domains of pain/discomfort (no problems: 44.88%), anxiety/depression (59.41%), and usual activities (69.31%) (Fig. 2 ). The overall mean EQ-5D-5L score was 0.851 ± 0.141 for all patients. For sociodemographic variables, female patients had significantly lower EQ-5D-5L scores than those of males (0.800 ± 0.156 vs. 0.860 ± 0.137, p = 0.022). Educational level was significantly associated with HRQoL: high school graduates (0.868 ± 0.142, p = 0.005) and college graduates or above (0.863 ± 0.128, p = 0.007) reported higher HRQoL than those with middle school education or below (0.788 ± 0.159). Employment status also showed a significant association, with employed patients reporting higher HRQoL (0.882 ± 0.107) than unemployed patients (0.811 ± 0.169, p < 0.001). Other sociodemographic factors, including marital status, income, and religion, showed no significant associations with HRQoL (Table 1 ). Similarly, clinical variables, including cancer site, TNM stage, HPV status, and recurrence, were not significantly associated with EQ-5D-5L scores. Regarding treatment methods, only robotic surgery was significantly associated with higher EQ-5D-5L scores than non-robotic surgery (0.887 ± 0.101 vs. 0.846 ± 0.146, p = 0.029). In contrast, other surgeries (0.848 ± 0.152 vs. 0.854 ± 0.131, p = 0.985), radiotherapy (0.849 ± 0.146 vs. 0.865 ± 0.120, p = 0.220), chemotherapy (0.848 ± 0.148 vs. 0.857 ± 0.130, p = 0.444), immunotherapy (0.727 ± 0.175 vs. 0.854 ± 0.140, p = 0.200), and targeted therapy (0.593 vs. 0.852 ± 0.141) showed no significant associations with HRQoL (Table 2 ). All symptom-related variables were significantly associated with EQ-5D-5L scores (all p < 0.05). Overall, patients without symptoms reported the highest HRQoL, while those with severe symptoms consistently had the lowest scores. This pattern was particularly pronounced for dysphagia, social eating difficulty, xerostomia, trismus, and sticky saliva. Other symptoms, such as nausea/vomiting, insomnia, constipation, diarrhea, sensory problems, speech difficulties, social contact issues, sexuality, dental problems, and coughing, were significantly associated with HRQoL (Table 3 ). Table 3 HRQoL according to Symptom variables in patients with oropharyngeal cancer Symptom a Category N (%) EQ-5D-5L index b (Mean ± SD) p-value Nausea and vomiting None 220 (79.7) 0.880 ± 0.125 < 0.001 *** Mild 46 (16.7) 0.844 ± 0.112 Moderate 6 (2.2) 0.535 ± 0.382 Severe 4 (1.4) 0.608 ± 0.072 Dyspnea None 187 (97.4) 0.900 ± 0.104 < 0.001 *** Mild 0 (0.0) – Moderate 0 (0.0) – Severe 5 (2.6) 0.249 ± 0.199 Insomnia None 139 (88.0) 0.910 ± 0.118 < 0.001 *** Mild 0 (0.0) – Moderate 0 (0.0) – Severe 19 (12.0) 0.644 ± 0.219 Constipation None 176 (95.1) 0.886 ± 0.125 0.004 ** Mild 0 (0.0) – Moderate 0 (0.0) – Severe 9 (4.9) 0.756 ± 0.222 Diarrhea None 228 (99.1) 0.875 ± 0.133 0.020 * Mild 0 (0.0) – Moderate 0 (0.0) – Severe 2 (0.9) 0.655 ± 0.088 Dysphagia None 121 (43.4) 0.916 ± 0.098 < 0.001 *** Mild 109 (39.1) 0.878 ± 0.096 Moderate 31 (11.1) 0.737 ± 0.131 Severe 18 (6.5) 0.637 ± 0.260 Sensory problems None 152 (63.6) 0.886 ± 0.142 < 0.001 *** Mild 46 (19.2) 0.896 ± 0.095 Moderate 32 (13.4) 0.791 ± 0.119 Severe 9 (3.8) 0.659 ± 0.315 Speech problems None 136 (50.9) 0.907 ± 0.106 < 0.001 *** Mild 93 (34.8) 0.865 ± 0.116 Moderate 25 (9.4) 0.754 ± 0.166 Severe 13 (4.9) 0.584 ± 0.272 Social eating difficulty None 130 (49.2) 0.925 ± 0.094 < 0.001 *** Mild 71 (26.9) 0.869 ± 0.117 Moderate 30 (11.4) 0.744 ± 0.176 Severe 33 (12.5) 0.693 ± 0.190 Social contact difficulty None 172 (60.8) 0.911 ± 0.100 < 0.001 *** Mild 77 (27.2) 0.830 ± 0.129 Moderate 18 (6.4) 0.749 ± 0.136 Severe 16 (5.7) 0.595 ± 0.251 Reduced sexuality None 169 (76.8) 0.885 ± 0.134 < 0.001 *** Mild 20 (9.1) 0.876 ± 0.140 Moderate 12 (5.5) 0.759 ± 0.153 Severe 19 (8.6) 0.726 ± 0.202 Dental problems None 153 (86.0) 0.885 ± 0.134 < 0.001 *** Mild 0 (0.0) – Moderate 0 (0.0) – Severe 25 (14.0) 0.754 ± 0.159 Trismus (opening the mouth) None 186 (92.5) 0.899 ± 0.106 < 0.001 *** Mild 0 (0.0) – Moderate 0 (0.0) – Severe 15 (7.5) 0.705 ± 0.291 Xerostomia (dry mouth) None 73 (63.5) 0.920 ± 0.094 < 0.001 *** Mild 0 (0.0) – Moderate 0 (0.0) – Severe 42 (36.5) 0.734 ± 0.223 Sticky saliva None 139 (83.2) 0.898 ± 0.114 < 0.001 *** Mild 0 (0.0) – Moderate 0 (0.0) – Severe 28 (16.8) 0.685 ± 0.251 Coughing None 146 (92.4) 0.886 ± 0.112 < 0.001 *** Mild 0 (0.0) – Moderate 0 (0.0) – Severe 12 (7.6) 0.724 ± 0.139 SD, standard deviation; EQ-5D-5L, EuroQol five-dimension five-level; HRQoL, health-related quality of life a Variables whose percentages do not sum up to 100% indicate missing values. b Higher values indicate the best possible outcome, with values ranging from 0 to 1. 3.3. Multivariate regression analysis The multivariate linear regression model accounted for 62.2% of the variance in HRQoL (R² = 0.622). Among sociodemographic factors, female sex was independently associated with lower HRQoL (β = − 0.045, p = 0.020), while higher education predicted better outcomes (high school: β = 0.049, p = 0.018; college or above: β = 0.043, p = 0.028). Other factors, including age, household size, marital status, income, and religion, showed no significant association. Similarly, none of the clinical variables (cancer location, TNM stage, HPV infection, recurrence count, or disease duration [post-diagnosis or post-treatment]) were significantly associated with HRQoL. Regarding symptom burden, several symptoms were independent predictors of lower HRQoL. Dyspnea (β = − 0.002, p < 0.001), insomnia (β = − 0.007, p = 0.020), dysphagia (β = − 0.002, p < 0.001), social eating difficulty (β = − 0.001, p = 0.013), social contact difficulty (β = − 0.002, p = 0.001), and trismus (β = − 0.001, p = 0.048) were significantly associated with lower EQ-5D-5L index scores. Conversely, other symptoms such as nausea/vomiting, constipation, diarrhea, sensory (taste/smell) disturbances, speech problems, sexuality, dental issues, xerostomia, sticky saliva, and coughing were not significantly associated with HRQoL in the adjusted mode (Table 4 ). Table 4 Multivariate regression analysis of predictors of HRQoL in patients with oropharyngeal cancer Variable (reference) Category β (SE) p-value 95% CI Intercept – 0.910 (0.064) < 0.001 *** 0.784, 1.035 Sex (ref. male) Female -0.045 (0.019) 0.020 * -0.081, -0.010 Age (years) 0.000 (0.000) 0.217 -0.000, 0.001 Household size (continuous) -0.013 (0.007) 0.079 -0.027, 0.001 Education (ref. middle school or below) High school graduate 0.049 (0.020) 0.018 * 0.008, 0.089 College graduate or above 0.043 (0.020) 0.028 * 0.005, 0.082 Marital state (ref. never married) Married 0.039 (0.027) 0.159 -0.015, 0.092 Other (Separated/Divorced/Widowed) -0.021 (0.029) 0.472 -0.078, 0.036 Income a (ref. < 3,000,000, W 1) ) 3,000,000–<8,000,000 0.009 (0.017) 0.608 -0.024, 0.041 ≥ 8,000,000 0.025 (0.022) 0.263 -0.019, 0.070 Employment (ref. employed) Unemployed -0.011 (0.015) 0.444 -0.043, 0.018 Religion (ref. No) Yes -0.001 (0.013) 0.928 -0.028, 0.026 Cancer site Tonsil (ref. No) Yes -0.016 (0.034) 0.642 -0.082, 0.050 Base of tongue (ref. No) Yes -0.015 (0.030) 0.634 -0.102, 0.064 Soft palate (ref. No) Yes 0.105 (0.054) 0.054 -0.002, 0.212 Posterior pharyngeal wall (ref. No) Yes 0.015 (0.018) 0.397 -0.021, 0.052 TNM classification (ref. Stage I) Stage II -0.012 (0.016) 0.473 -0.043, 0.020 Stage III 0.008 (0.018) 0.675 -0.028, 0.044 Stage IV 0.009 (0.025) 0.733 -0.042, 0.059 Post-diagnosis duration (months) 0.000 (0.000) 0.217 -0.000, 0.001 Human papillomavirus infection (ref. Positive) Negative 0.014 (0.017) 0.439 -0.021, 0.048 Recurrence count -0.005 (0.009) 0.634 -0.023, 0.014 Post-treatment duration (months) -0.000 (0.000) 0.637 -0.001, 0.001 Treatment methods Robotic surgery (ref. No) Yes 0.045 (0.020) 0.025 * 0.006, 0.085 Other surgery (ref. No) Yes 0.030 (0.019) 0.115 -0.007, 0.067 Radiation therapy (ref. No) Yes -0.010 (0.019) 0.61 -0.046, 0.027 Chemotherapy (ref. No) Yes 0.023 (0.017) 0.186 -0.011, 0.057 Immunotherapy (ref. No) Yes -0.013 (0.047) 0.789 -0.105, 0.079 Targeted therapy (ref. No) Yes -0.146 (0.127) 0.25 -0.396, 0.103 Symptoms Nausea and vomiting -0.000 (0.000) 0.349 -0.001, 0.000 Dyspnea -0.002 (0.000) < 0.001 *** -0.002, -0.001 Insomnia -0.007 (0.003) 0.020 * -0.013, -0.001 Constipation -0.000 (0.000) 0.516 -0.001, 0.001 Diarrhea -0.000 (0.000) 0.201 -0.001, 0.000 Dysphagia -0.002 (0.000) < 0.001 *** -0.003, -0.001 Senses problems (taste/smell) 0.000 (0.000) 0.367 -0.001, 0.001 Speech problems 0.000 (0.000) 0.938 -0.001, 0.001 Social eating difficulty -0.001 (0.000) 0.013 * -0.002, -0.000 Social contact difficulty -0.002 (0.001) 0.001 ** -0.004, -0.001 Reduced sexuality 0.000 (0.000) 0.494 -0.000, 0.001 Dental problems -0.000 (0.000) 0.945 -0.001, 0.001 Trismus -0.001 (0.000) 0.048 * -0.002, -0.000 Xerostomia 0.000 (0.000) 0.144 -0.001, 0.001 Sticky saliva -0.000 (0.000) 0.133 -0.001, 0.001 Coughing -0.000 (0.000) 0.909 -0.001, 0.001 R-squared 0.622 SD, standard deviation; CI, confidence interval; HRQoL, health-related quality of life; SE, standard error a 1,000 Korean won ( W ) = 0.70 dollar ( $ ) *p < 0.05, **p < 0.01, ***p < 0.00 4. Discussion This multicenter study shows several determinants of HRQoL in patients with oropharyngeal cancer. Female sex correlated with lower HRQoL, while higher educational attainment was linked to better outcomes. Among treatment modalities, robotic surgery demonstrated a positive correlation with HRQoL. Symptom-related factors, including dyspnea, insomnia, dysphagia, social eating difficulty, social contact difficulty, reduced sexuality, and trismus, were independent predictors of poorer HRQoL. Collectively, the multivariate model accounted for 62.2% of the variance, indicating strong explanatory capacity. Regarding treatment, robotic surgery had the largest positive effect on HRQoL, with a regression coefficient of 0.045. The finding that patients who underwent robotic surgery at least once during the treatment period exhibited higher HRQoL is consistent with those of previous studies showing improved swallowing and speech function, alongside reduced long-term functional impairment compared with conventional techniques. Fernando Danelon et al. report that patients treated with transoral robotic surgery (TORS) alone achieved significantly higher Performance Status Scale eating and diet scores at 6 months than those who received TORS combined with chemoradiation ( 11 ). Similarly, Virginie Achim et al. report that patients undergoing TORS alone experience better long-term recovery, less weight loss, and fewer swallowing difficulties than those who received adjuvant therapy following TORS ( 12 ). In this study, several symptoms—dyspnea, insomnia, dysphagia, social eating difficulty, social contact difficulty, reduced sexuality, and trismus—were significant independent predictors of poorer HRQoL. This highlights the cumulative influence of symptom burden among oropharyngeal cancer survivors, consistent with prior evidence. Kelsey Smith et al. report insomnia as a common adverse effect of radiotherapy in patients with head and neck cancer, negatively influencing quality of life ( 13 ). Similarly, Wan Leung et al. ( 14 ) report that social contact difficulty is significantly linked to reduced quality of life among survivors of head and neck cancer who underwent radiation therapy, particularly those with oropharyngeal cancer. This phenomenon is potentially attributed to elevated levels of depression, anxiety, and fatigue commonly experienced by patients with head and neck cancer ( 5 ). Dyspnea is significantly associated with prior radiotherapy among individuals with hypopharyngeal cancer ( 14 ). Joanne M. Patterson et al. highlight dysphagia and social eating difficulties as persistent challenges for survivors; patients with oropharyngeal cancer, in particular, exhibit poorer recovery trajectories than those with other head and neck tumor sites, achieving only partial recovery after 1 year ( 15 ). Nina Pauli et al. further demonstrate that trismus significantly impairs HRQoL and interferes with daily functioning in patients with head and neck cancer ( 16 ). In the general Korean population, women (0.932) report lower HRQoL than men (0.956), representing a statistically significant difference of approximately 0.024 ( 17 ). In this cohort of patients with oropharyngeal cancer, this sex gap was even wider (0.060). Supplementary analyses revealed distinct sex-specific patterns, with female patients showing greater declines in EuroQol 5-Dimension 5-Level (EQ-5D-5L) scores across symptom severity categories, particularly in dysphagia, insomnia, speech, and social domains. These findings suggest that symptom burden may disproportionately affect women, highlighting the need for sex-specific supportive care (Additional file 1). The findings are partly consistent with those of prior research. Eleni M. et al. identify determinants of HRQoL in patients with oropharyngeal cancer and similarly report that female patients experience lower HRQoL than male patients ( 18 ). This disparity may be explained by sex-specific differences in the effect of dysphagia, a key symptom influencing HRQoL, which could contribute to the observed variation in HRQoL indices between men and women. Similarly, Nur Demiral et al. highlight the role of socioeconomic factors, including education, in shaping post-treatment HRQoL, with higher educational levels consistently linked to better outcomes in patients with head and neck cancer ( 19 ). In that study, lower educational attainment independently correlates with work disability, which was identified as a potential contributor to reduced HRQoL. These findings hold several implications for clinical practice. First, symptom-focused care should be incorporated early in the treatment course, with emphasis on swallowing rehabilitation and targeted interventions for insomnia, dyspnea, and trismus ( 20 ). Second, although the results support the potential benefits of robotic surgery in preserving HRQoL, treatment decisions should balance oncologic control with functional outcomes, taking into account procedure-specific trade-offs. Third, patients presenting with a higher symptom burden represent a vulnerable subgroup who may benefit from pre-treatment counseling, structured rehabilitation, and comprehensive post-treatment survivorship programs. Furthermore, early screening and timely management of social eating and social contact difficulties should be prioritized in survivorship care, given their significant influence on long-term psychosocial well-being ( 14 , 15 ). Research on HRQoL among patients with head and neck cancer in Asia remains limited. According to World Health Organization data, the age-standardized incidence rate of oropharyngeal cancer per 100,000 population is 0.77 in Korea, 0.97 in Japan, and 0.33 in China, significantly lower than that in the United States (2.6), Canada (2.2), and the United Kingdom (2.6) ( 21 ). This relatively low incidence has historically contributed to limited academic and policy attention within the region. However, recent lifestyle changes in economically developed Asian countries such as Japan, China, and Korea have led to a significant rise in incidence, with annual increases exceeding 3%. Continued research on HRQoL is therefore crucial to support evidence-based clinical practice and guide policy formulation. Furthermore, given that HRQoL is strongly influenced by sociocultural and healthcare factors, data collection across diverse regions remains crucial. This study has some limitations. The cross-sectional design precludes causal inference, making it difficult to differentiate between treatment-related and disease-related symptoms. The reliance on self-reported HRQoL data also introduces potential recall and reporting biases. Additionally, follow-up schedules were not standardized, as HRQoL was assessed at a single but variable time point after diagnosis, which may have led to underestimation or overestimation of specific symptom domains. Finally, the sample was relatively small; therefore, future studies should include larger, prospectively followed cohorts to validate these findings. Despite these limitations, the study has significant strengths. Data was collected from 14 hospitals across different regions of Korea, enhancing the geographic representativeness of the sample. As of 2021, approximately 13,000 individuals were living with oropharyngeal cancer in Korea, with an average disease duration of 3 years ( 22 ). The present cohort represented approximately 2.1% of this population. The cancer stage distribution in this cohort closely reflected that of the national statistics: localized disease (37.0% vs. 34.4%), regional or distant disease (51.5% vs. 58.6%), and unknown stage (10.8% vs. 7.0%). Furthermore, this study is among the few comprehensive HRQoL investigations of patients with oropharyngeal cancer in Asia. The findings are largely consistent with those reported in Western populations. The use of EQ-5D-5L provided a validated, preference-based measure, facilitating comparison with population norms and international cohorts, and has been validated in patients with oropharyngeal cancer ( 7 ). Finally, the inclusion of sociodemographic, clinical (including treatment-related), and symptom-related variables enabled a comprehensive assessment of HRQoL determinants. 5. Conclusions This study highlights the multifactorial nature of HRQoL in oropharyngeal cancer, influenced by sociodemographic, clinical (including treatment-related), and symptom-related factors. With improving survival rates, long-term HRQoL has emerged as a critical concern. Enhancing survivorship outcomes requires early symptom management, structured rehabilitation, and the adoption of minimally invasive treatment approaches where appropriate. Future prospective cohort and interventional studies are needed to elucidate causal pathways and guide personalized survivorship strategies that balance oncologic control with sustained HRQoL. Abbreviations HRQoL, health-related quality of life; EQ-5D-5L, EuroQol 5-Dimension 5-Level; HPV, human papillomavirus; EORTC QLQ-C30 and EORTC QLQ-H&N35; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Head and Neck 35 Oropharyngeal cancer: A type of head and neck cancer that develops in the oropharynx, the middle part of the throat behind the mouth, including the tonsils and base of the tongue. Health-related quality of life (HRQoL): A measure of how a person’s health condition affects their physical, psychological, and social well-being. EuroQol 5-Dimension 5-Level (EQ-5D-5L): A standardized instrument used to assess HRQoL across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, each rated at five levels of severity. EORTC QLQ-C30: A questionnaire developed by the European Organisation for Research and Treatment of Cancer to evaluate the quality of life of cancer patients across multiple symptom and function domains. EORTC QLQ-H&N35: A supplementary questionnaire specific to head and neck cancer patients, assessing symptoms such as swallowing difficulties, dry mouth, and speech problems. Social eating difficulty: Challenges in eating with others due to physical or psychological effects of treatment, often affecting social participation and emotional well-being. Declarations Ethics approval and consent to participate Ethical approval was obtained from the Central Research Ethics Committee of Kongju National University (approval number: KNU_IRB_2023-49), and additional institutional review board approvals from participating hospitals are summarized in Additional file 2. All participants provided informed consent to participate in the study. Consent for publication The datasets generated and/or analyzed during the current study are not publicly available due to the inclusion of patient information that could compromise participant privacy, but are available from the corresponding author on reasonable request. Availability of data and materials The datasets generated and analyzed during the current study are not publicly available due to confidentiality agreements concerning patient information. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Korea Disease Control and Prevention Agency [grant number 2023-10-012]. Authors’ contributions JEA conceptualized the study, curated and analyzed the data, and drafted the original manuscript. BSK and KJC contributed to data collection and investigation. SYY supervised the study, validated the findings, acquired funding, and contributed to the review and editing of the manuscript. All authors read and approved the final manuscript. Acknowledgements Not applicable References Lorenzoni V, Chaturvedi AK, Vignat J, Laversanne M, Bray F, Vaccarella S. The current burden of oropharyngeal cancer: a global assessment based on GLOBOCAN 2020. Cancer Epidemiol Biomarkers Prev. 2022;31:2054–62. Zumsteg ZS, Luu M, Rosenberg PS, Elrod JK, Bray F, Vaccarella S, et al. Global epidemiologic patterns of oropharyngeal cancer incidence trends. J Natl Cancer Inst. 2023;115:1544–54. van der Laan HP, Van den Bosch L, Schuit E, Steenbakkers RJ, van der Schaaf A, Langendijk JA. Impact of radiation-induced toxicities on quality of life of patients treated for head and neck cancer. Radiother Oncol. 2021;160:47–53. de Melo NB, de Sousa VM, de Melo DP, Gomes DQC, Bento PM. Oral health related quality of life and determinant factors in patients with head and neck cancer. Med Oral Patol Oral Cir Bucal. 2019;24:e281. Hammermüller C, Hinz A, Dietz A, Wichmann G, Pirlich M, Berger T, et al. Depression, anxiety, fatigue, and quality of life in a large sample of patients suffering from head and neck cancer in comparison with the general population. BMC Cancer. 2021;21:94. Palma DA, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, et al. Assessment of toxic effects and survival in treatment deescalation with radiotherapy vs transoral surgery for HPV-associated oropharyngeal squamous cell carcinoma: the ORATOR2 phase 2 randomized clinical trial. JAMA Oncol. 2022;8:845–51. Kim MJ, Koo BS, Cho KJ, Lee SH, Lee AY, Hong GU, et al. Health-related quality-of-life assessment in patients with oropharyngeal cancer: A comparison of EQ-5D-5L and EORTC instruments. Oral Oncol. 2025;165:107342. Kim SH, Ahn J, Ock M, Shin S, Park J, Luo N, et al. The EQ-5D-5L valuation study in Korea. Qual Life Res. 2016;25:1845–52. van Reenen M, Janssen B. EQ-5D-5L user guide: basic information on how to use the EQ-5D-5L instrument. Rotterdam: EuroQol Research Foundation; 2015. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129–36. Leonhardt FD, Quon H, Abrahão M, O'Malley BW Jr, Weinstein GS. Transoral robotic surgery for oropharyngeal carcinoma and its impact on patient-reported quality of life and function. Head Neck. 2012;34:146–54. Achim V, Bolognone RK, Palmer AD, Graville DJ, Light TJ, Li R, et al. Long-term functional and quality-of-life outcomes after transoral robotic surgery in patients with oropharyngeal cancer. JAMA Otolaryngol Head Neck Surg. 2018;144:18–27. Iovoli AJ, Smith K, Yu H, Kluczynski MA, Jungquist CR, Ray AD, et al. Association of Insomnia and Obstructive Sleep Apnea with Worse Oral Mucositis and Quality of Life in Head and Neck Cancer Patients Undergoing Radiation Therapy. Cancers. 2024;16:1335. Wan Leung S, Lee TF, Chien CY, Chao PJ, Tsai WL, Fang FM. Health-related quality of life in 640 head and neck cancer survivors after radiotherapy using EORTC QLQ-C30 and QLQ-H&N35 questionnaires. BMC Cancer. 2011;11:128. Patterson JM, Lu L, Watson LJ, Harding S, Ness AR, Thomas S, et al. Trends in, and predictors of, swallowing and social eating outcomes in head and neck cancer survivors: a longitudinal analysis of head and neck 5000. Oral Oncol. 2021;118:105344. Pauli N, Johnson J, Finizia C, Andrell P. The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer. Acta Oncol. 2013;52:1137–45. Kim TH, Jo MW, Lee SI, Kim SH, Chung SM. Psychometric properties of the EQ-5D-5L in the general population of South Korea. Qual Life Res. 2013;22:2245–53. Rettig EM, D'Souza G, Thompson CB, Koch WM, Eisele DW, Fakhry C. Health-related quality of life before and after head and neck squamous cell carcinoma: Analysis of the Surveillance, Epidemiology, and End Results–Medicare Health Outcomes Survey linkage. Cancer. 2016;122:1861–70. Demiral AN, Şen M, Demiral Y, Kınay M. The effect of socioeconomic factors on quality of life after treatment in patients with head and neck cancer. Int J Radiat Oncol Biol Phys. 2008;70:23–7. Vester S, Muhr A, Meier J, Suess C, Kummer P, Kuenzel J. Prehabilitation of dysphagia in the therapy of head and neck cancer-a systematic review of the literature and evidence evaluation. Front Oncol. 2023;13:1273430. International Agency for Research on Cancer. Data sources and methods. http://gco.iarc.fr/today/data-sources-methods (2024). Accessed 20 Feb 2025. National Cancer Center. Annual report of cancer statistics in Korea in 2021. 2023. Additional Declarations No competing interests reported. Supplementary Files AdditionalFile1.docx Additional file 1 File format: .docx Title of data: Health-related quality of life based on symptoms and sex in patients with oropharyngeal cancer Description of data: This table presents HRQoL scores stratified according to symptom severity and sex among patients with oropharyngeal cancer. AdditionalFile2.docx Additional file 2. File format: .docx Title of data: Institutional Review Board Approval Numbers Description of data: This file summarizes the IRB approval numbers from all participating hospitals included in the study. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 30 Dec, 2025 Reviewers agreed at journal 29 Dec, 2025 Reviewers agreed at journal 28 Dec, 2025 Reviewers invited by journal 26 Dec, 2025 Editor invited by journal 04 Nov, 2025 Editor assigned by journal 03 Nov, 2025 Submission checks completed at journal 03 Nov, 2025 First submitted to journal 31 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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1","display":"","copyAsset":false,"role":"figure","size":267033,"visible":true,"origin":"","legend":"\u003cp\u003eSymptom scores in patients with oropharyngeal cancer\u003c/p\u003e\n\u003cp\u003e*Symptom scores were converted to a 0–100 scale, with lower values indicating better outcomes and higher values representing greater symptom burden. SD, standard deviation\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7997928/v1/e349b13d5351f773f29f45d3.png"},{"id":99224206,"identity":"a31e84d9-d5bd-4b47-b205-72b93a630856","added_by":"auto","created_at":"2025-12-30 10:04:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":267892,"visible":true,"origin":"","legend":"\u003cp\u003eQuality of life of patients with oropharyngeal cancer using EQ-5D-5L\u003c/p\u003e\n\u003cp\u003eEQ-5D-5L, EuroQol five-dimension five-level\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7997928/v1/32b5765fd55a2e64bdd70c5c.png"},{"id":99323661,"identity":"5f0e2faf-4d0e-498f-8b6a-2ae188254b9f","added_by":"auto","created_at":"2025-12-31 16:45:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1816599,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7997928/v1/912c4918-d766-4f7a-88df-2fa6173c1e15.pdf"},{"id":99319380,"identity":"937c4559-4fd5-466c-b566-bfd4bacb396c","added_by":"auto","created_at":"2025-12-31 16:37:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":31751,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 1\u003c/p\u003e\n\u003cp\u003eFile format: .docx\u003c/p\u003e\n\u003cp\u003eTitle of data: Health-related quality of life based on symptoms and sex in patients with oropharyngeal cancer\u003c/p\u003e\n\u003cp\u003eDescription of data: This table presents HRQoL scores stratified according to symptom severity and sex among patients with oropharyngeal cancer.\u003c/p\u003e","description":"","filename":"AdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7997928/v1/1bf568d94b384cb4df82a562.docx"},{"id":99224198,"identity":"06e95c78-3d25-47ea-8160-d8092d2f3251","added_by":"auto","created_at":"2025-12-30 10:04:42","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":21192,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 2.\u003c/p\u003e\n\u003cp\u003eFile format: .docx\u003c/p\u003e\n\u003cp\u003eTitle of data: Institutional Review Board Approval Numbers\u003c/p\u003e\n\u003cp\u003eDescription of data: This file summarizes the IRB approval numbers from all participating hospitals included in the study.\u003c/p\u003e","description":"","filename":"AdditionalFile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7997928/v1/a56b5a5d01fad879670a4792.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Treatment- and Symptom-Related Determinants of Health-Related Quality of Life in Patients with Oropharyngeal Cancer","fulltext":[{"header":"1. Background","content":"\u003cp\u003eOropharyngeal cancer, a malignancy of the oropharynx primarily linked to human papillomavirus (HPV) infection, accounted for approximately 98,400 new cases and 48,100 deaths worldwide in 2020, according to the Global Cancer Observatory (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Epidemiologic analyses indicate its incidence is steadily increasing across multiple regions over recent decades, with annual increases exceeding 3% in several high-income countries (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Consequently, oropharyngeal cancer represents a growing global health burden.\u003c/p\u003e \u003cp\u003eHealth-related quality of life (HRQoL) is a critical concern for patients with oropharyngeal cancer. Despite substantial improvements in survival due to treatment, many long-term survivors still experience functional impairments such as dysphagia and xerostomia that significantly compromise their HRQoL(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Additionally, HRQoL varies considerably across sociocultural and healthcare contexts (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), underscoring the importance of measuring quality of life in various countries. Although several studies have comprehensively examined factors influencing HRQoL in patients with oropharyngeal cancer (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), data on Asian populations remain limited.\u003c/p\u003e \u003cp\u003eMoreover, while randomized trials such as the ORATOR2 phase II study have emphasized the importance of preserving quality of life between de-escalation treatments, including radiotherapy and transoral surgery (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), evidence directly linking treatment modalities, and with EuroQol 5-Dimension 5-Level (EQ-5D-5L)-based HRQoL in real-world clinical practice remains limited.\u003c/p\u003e \u003cp\u003eBoth disease-specific instruments, such as the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Head and Neck 35 (EORTC QLQ-H\u0026amp;N35), and generic tools such as the EQ-5D-5L are commonly used to assess HRQoL. A recent multi-institutional Korean study reports that the EQ-5D-5L shows strong explanatory validity compared to those of EORTC measures, highlighting its value for assessing HRQoL in patients with oropharyngeal cancer. Moreover, the EQ-5D-5L provides a standardized, validated single-index measure, offering a convenient means to quantify overall HRQoL (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, this study aims to utilize the EQ-5D-5L to assess HRQoL and identify sociodemographic, clinical, and symptom-related factors associated with HRQoL in patients with oropharyngeal cancer. Given the limited real-world data on HRQoL among Asian patients with oropharyngeal cancer, this study aims to fill this gap and contribute evidence to guide patient-centered clinical care.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Participants\u003c/h2\u003e \u003cp\u003eThis study included adult patients with oropharyngeal cancer who visited outpatient clinics for treatment or follow-up and provided informed consent. Overall, 327 patients were enrolled, exceeding the minimum sample size of 167 estimated using G*Power software (version 3.1.9.7; Heinrich-Heine-Universit\u0026auml;t D\u0026uuml;sseldorf, Germany). The estimation assumed an effect size of 0.15, a significance level of 0.05, a statistical power of 0.80, and a 10% allowance for potential attrition.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Survey\u003c/h2\u003e \u003cp\u003eThis study was conducted across 14 hospitals in Korea from August 2023 to March 2024. Data were collected using a structured questionnaire assessing HRQoL and related influencing factors in patients with oropharyngeal cancer. The survey was administered during outpatient visits, completed anonymously, and required approximately 20 min to complete.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Health-related quality of life\u003c/h2\u003e \u003cp\u003eHRQoL was assessed using the EQ-5D-5L instrument, which measures five dimensions\u0026mdash;mobility, self-care, usual activities, pain/discomfort, and anxiety/depression\u0026mdash;each rated on five response levels. Index scores were calculated using the Korean value set established in 2014. The resulting values ranged from 0 to 1, with higher scores indicating better quality of life (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In this study, the EQ-5D-5L index was used as the dependent variable.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Independent variables\u003c/h2\u003e \u003cp\u003eIndependent variables were selected according to the World Health Organization biopsychosocial framework and categorized into three domains: sociodemographic, clinical, and symptom-related factors (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Sociodemographic variables included sex, age, household size, education, marital status, income, employment status, and religion. Clinical variables comprised TNM stage, cancer site (tonsil, base of tongue, soft palate, or posterior pharyngeal wall), HPV status, post-diagnosis duration, recurrence history, post-treatment duration, and treatment modalities (robotic surgery, other surgery, radiotherapy, chemotherapy, immunotherapy, and targeted therapy). Symptom-related factors included dyspnea, nausea/vomiting, insomnia, constipation, diarrhea, swallowing difficulty, sensory changes (taste/smell), speech, social eating, social contact, sexuality, dental problems, mouth opening limitation, xerostomia, sticky saliva, and coughing. Symptom scores were calculated and transformed into a 0\u0026ndash;100 scale following the EORTC QLQ-C30 and QLQ-H\u0026amp;N35 scoring manual. And Higher scores indicated greater symptom severity. For analytical purposes, transformed scores were categorized into four severity levels: none (0), mild (1\u0026ndash;33), moderate (34\u0026ndash;66), and severe (67\u0026ndash;100). Symptom variables overlapping with EQ-5D-5L dimensions (pain/discomfort, anxiety, and depression) were excluded to avoid redundancy. Symptom variables were derived from the EORTC QLQ-C30 and QLQ-H\u0026amp;N35 questionnaires.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Statistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics (frequencies, percentages, means, and standard deviations) were calculated to summarize the general characteristics of participants. Group differences in HRQoL were analyzed using independent t-tests or one-way ANOVA, depending on the number of comparison groups. For variables with more than two categories, post hoc tests were performed to identify pairwise differences. Two-way ANOVA was performed to examine the effects of sex and symptom severity on HRQoL to account for potential interaction effects, as symptom impact may vary by sex. Multivariable regression was conducted to adjust for confounders and identify independent factors associated with HRQoL. All statistical analyses were performed using Python (version 3.11).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Characteristic of research participants\u003c/h2\u003e \u003cp\u003eIn total, 327 patients with oropharyngeal cancer were included in the analysis. The mean age was 63.96\u0026thinsp;\u0026plusmn;\u0026thinsp;10.53 years. Among them, 278 (85.0%) were male, while 49 (15.0%) were female. Regarding education, 57 (17.4%) completed middle school or below, 114 (34.9%) were high school graduates, and 156 (47.7%) held a college degree or higher. Most participants were married or in common-law partnerships 245 (74.9%), while 19 (5.8%) had never married and 63 (19.3%) were separated, divorced, or widowed. The average household size was 2.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16. Regarding household income, 118 patients (36.1%) reported\u0026thinsp;\u0026lt;\u0026thinsp;3,000,000 KRW, 153 (46.8%) reported\u0026thinsp;\u0026ge;\u0026thinsp;3,000,000 and \u0026lt;\u0026thinsp;8,000,000 KRW, and 56 (17.1%) reported\u0026thinsp;\u0026ge;\u0026thinsp;8,000,000 KRW. Overall, 186 participants (56.9%) were employed, whereas 141 (43.1%) were unemployed. Religious affiliation was reported by 128 participants (39.1%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic variables of patients with oropharyngeal cancer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEQ-5D-5L index\u003csup\u003ec\u003c/sup\u003e (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.851\u0026thinsp;\u0026plusmn;\u0026thinsp;0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.022*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e278 (85.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.860\u0026thinsp;\u0026plusmn;\u0026thinsp;0.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.800\u0026thinsp;\u0026plusmn;\u0026thinsp;0.156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63.96\u0026thinsp;\u0026plusmn;\u0026thinsp;10.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle school or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.788\u0026thinsp;\u0026plusmn;\u0026thinsp;0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e114 (34.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.868\u0026thinsp;\u0026plusmn;\u0026thinsp;0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege graduate or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e156 (47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.863\u0026thinsp;\u0026plusmn;\u0026thinsp;0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.960\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.879\u0026thinsp;\u0026plusmn;\u0026thinsp;0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried (including common-law)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e245 (74.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.852\u0026thinsp;\u0026plusmn;\u0026thinsp;0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther (Separated/divorced/widowed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63 (19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.840\u0026thinsp;\u0026plusmn;\u0026thinsp;0.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncome (Korean Won\u003csup\u003eb\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 3,000,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118 (36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.834\u0026thinsp;\u0026plusmn;\u0026thinsp;0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge; 3,000,000 to \u0026lt;\u0026thinsp;8,000,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e153 (46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.860\u0026thinsp;\u0026plusmn;\u0026thinsp;0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge; 8,000,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.865\u0026thinsp;\u0026plusmn;\u0026thinsp;0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.882\u0026thinsp;\u0026plusmn;\u0026thinsp;0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.811\u0026thinsp;\u0026plusmn;\u0026thinsp;0.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.556\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e199 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.854\u0026thinsp;\u0026plusmn;\u0026thinsp;0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e128 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.847\u0026thinsp;\u0026plusmn;\u0026thinsp;0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eSD, standard deviation; EQ-5D-5L, EuroQol five-dimension five-level\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003eVariables whose percentages do not sum up to 100% indicate missing values.\u003c/p\u003e \u003cp\u003e \u003csup\u003eb\u003c/sup\u003e1,000 Korean won (\u003cs\u003eW\u003c/s\u003e)\u0026thinsp;=\u0026thinsp;0.70 dollar (\u003cspan\u003e$\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003csup\u003ec\u003c/sup\u003eHigher values indicate the best possible outcome, with values ranging from 0 to 1.\u003c/p\u003e \u003cp\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003eRegarding clinical characteristics, the primary tumor site was the tonsil in 248 patients (75.8%), base of the tongue in 51 (15.6%), soft palate in 16 (4.9%), and posterior pharyngeal wall in 7 (2.1%). At diagnosis, 119 patients (36.4%) had TNM stage I disease, 97 (29.7%) stage II, 68 (20.8%) stage III, and 43 (13.1%) stage IV. The mean post-diagnosis duration was 40.45\u0026thinsp;\u0026plusmn;\u0026thinsp;28.29 months. HPV infection was confirmed in 216 patients (66.1%) and absent in 71 (21.7%). The mean number of recurrences was 1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.44, and the mean post-treatment duration was 34.35\u0026thinsp;\u0026plusmn;\u0026thinsp;32.18 months. Seventy-nine (24.2%) patients were still under treatment or within 6 months of completing treatment, while 247 (75.5%) patients were more than 6 months post-treatment. Regarding treatment modalities, 47 patients (14.4%) underwent robotic surgery and showed significantly higher EQ-5D-5L index scores than those who did not (0.887\u0026thinsp;\u0026plusmn;\u0026thinsp;0.101 vs. 0.846\u0026thinsp;\u0026plusmn;\u0026thinsp;0.146, p\u0026thinsp;=\u0026thinsp;0.029). Other treatments included conventional surgery in 163 patients (49.8%), radiotherapy in 267 (81.7%), and chemotherapy in 203 (62.1%). Immunotherapy and targeted therapy were less common, administered to 7 (2.1%) and 1 (0.3%) patients, respectively. These treatments were not significantly associated with differences in EQ-5D-5L scores (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical variables of patients with oropharyngeal cancer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEQ-5D-5L index\u003csup\u003eb\u003c/sup\u003e (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eCancer site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTonsil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.833\u0026thinsp;\u0026plusmn;\u0026thinsp;0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e248 (75.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.857\u0026thinsp;\u0026plusmn;\u0026thinsp;0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eBase of tongue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e276 (84.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.853\u0026thinsp;\u0026plusmn;\u0026thinsp;0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.842\u0026thinsp;\u0026plusmn;\u0026thinsp;0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSoft palate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e311 (95.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.854\u0026thinsp;\u0026plusmn;\u0026thinsp;0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.805\u0026thinsp;\u0026plusmn;\u0026thinsp;0.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePosterior pharyngeal wall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.799\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e320 (97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.852\u0026thinsp;\u0026plusmn;\u0026thinsp;0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.842\u0026thinsp;\u0026plusmn;\u0026thinsp;0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTNM classification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.391\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.858\u0026thinsp;\u0026plusmn;\u0026thinsp;0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.854\u0026thinsp;\u0026plusmn;\u0026thinsp;0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.858\u0026thinsp;\u0026plusmn;\u0026thinsp;0.145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.816\u0026thinsp;\u0026plusmn;\u0026thinsp;0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-diagnosis duration (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e40.45\u0026thinsp;\u0026plusmn;\u0026thinsp;28.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eHuman papillomavirus status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.307\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e216 (66.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.854\u0026thinsp;\u0026plusmn;\u0026thinsp;0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.837\u0026thinsp;\u0026plusmn;\u0026thinsp;0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of recurrences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-treatment duration (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e34.35\u0026thinsp;\u0026plusmn;\u0026thinsp;32.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePresent status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnder treatment or within 6 months of treatment completion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.807\u0026thinsp;\u0026plusmn;\u0026thinsp;0.165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 6 months post-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e247 (75.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.866\u0026thinsp;\u0026plusmn;\u0026thinsp;0.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003ec\u003c/sup\u003eTreatment modalities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eRobotic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.029*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e280 (85.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.846\u0026thinsp;\u0026plusmn;\u0026thinsp;0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.887\u0026thinsp;\u0026plusmn;\u0026thinsp;0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eOther surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e164 (50.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.854\u0026thinsp;\u0026plusmn;\u0026thinsp;0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163 (49.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.848\u0026thinsp;\u0026plusmn;\u0026thinsp;0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eRadiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (18.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.865\u0026thinsp;\u0026plusmn;\u0026thinsp;0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e267 (81.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.849\u0026thinsp;\u0026plusmn;\u0026thinsp;0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124 (37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.857\u0026thinsp;\u0026plusmn;\u0026thinsp;0.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e203 (62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.848\u0026thinsp;\u0026plusmn;\u0026thinsp;0.148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eImmunotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e320 (97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.854\u0026thinsp;\u0026plusmn;\u0026thinsp;0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.727\u0026thinsp;\u0026plusmn;\u0026thinsp;0.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTargeted therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e326 (99.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.852\u0026thinsp;\u0026plusmn;\u0026thinsp;0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eSD, standard deviation; EQ-5D-5L, EuroQol five-dimension five-level\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003eVariables whose percentages do not sum up to 100% indicate missing values.\u003c/p\u003e \u003cp\u003e \u003csup\u003eb\u003c/sup\u003eHigher values indicate the best possible outcome, with values ranging from 0 to 1.\u003c/p\u003e \u003cp\u003e \u003csup\u003ec\u003c/sup\u003eTreatment was defined as all treatments received during the treatment period.\u003c/p\u003e \u003cp\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003eSymptom burden, evaluated using the EORTC QLQ-C30 and QLQ-H\u0026amp;N35, was highest for xerostomia (42.13\u0026thinsp;\u0026plusmn;\u0026thinsp;32.60), sticky saliva (29.92\u0026thinsp;\u0026plusmn;\u0026thinsp;33.20), and dental problems (26.38\u0026thinsp;\u0026plusmn;\u0026thinsp;32.14), and lowest for nausea/vomiting (7.98\u0026thinsp;\u0026plusmn;\u0026thinsp;16.49) and diarrhea (9.68\u0026thinsp;\u0026plusmn;\u0026thinsp;18.44) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Health-related quality of life of patients with oropharyngeal cancer\u003c/h2\u003e \u003cp\u003eThe most frequently reported problems were in the domains of pain/discomfort (no problems: 44.88%), anxiety/depression (59.41%), and usual activities (69.31%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe overall mean EQ-5D-5L score was 0.851\u0026thinsp;\u0026plusmn;\u0026thinsp;0.141 for all patients. For sociodemographic variables, female patients had significantly lower EQ-5D-5L scores than those of males (0.800\u0026thinsp;\u0026plusmn;\u0026thinsp;0.156 vs. 0.860\u0026thinsp;\u0026plusmn;\u0026thinsp;0.137, p\u0026thinsp;=\u0026thinsp;0.022). Educational level was significantly associated with HRQoL: high school graduates (0.868\u0026thinsp;\u0026plusmn;\u0026thinsp;0.142, p\u0026thinsp;=\u0026thinsp;0.005) and college graduates or above (0.863\u0026thinsp;\u0026plusmn;\u0026thinsp;0.128, p\u0026thinsp;=\u0026thinsp;0.007) reported higher HRQoL than those with middle school education or below (0.788\u0026thinsp;\u0026plusmn;\u0026thinsp;0.159). Employment status also showed a significant association, with employed patients reporting higher HRQoL (0.882\u0026thinsp;\u0026plusmn;\u0026thinsp;0.107) than unemployed patients (0.811\u0026thinsp;\u0026plusmn;\u0026thinsp;0.169, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Other sociodemographic factors, including marital status, income, and religion, showed no significant associations with HRQoL (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Similarly, clinical variables, including cancer site, TNM stage, HPV status, and recurrence, were not significantly associated with EQ-5D-5L scores. Regarding treatment methods, only robotic surgery was significantly associated with higher EQ-5D-5L scores than non-robotic surgery (0.887\u0026thinsp;\u0026plusmn;\u0026thinsp;0.101 vs. 0.846\u0026thinsp;\u0026plusmn;\u0026thinsp;0.146, p\u0026thinsp;=\u0026thinsp;0.029). In contrast, other surgeries (0.848\u0026thinsp;\u0026plusmn;\u0026thinsp;0.152 vs. 0.854\u0026thinsp;\u0026plusmn;\u0026thinsp;0.131, p\u0026thinsp;=\u0026thinsp;0.985), radiotherapy (0.849\u0026thinsp;\u0026plusmn;\u0026thinsp;0.146 vs. 0.865\u0026thinsp;\u0026plusmn;\u0026thinsp;0.120, p\u0026thinsp;=\u0026thinsp;0.220), chemotherapy (0.848\u0026thinsp;\u0026plusmn;\u0026thinsp;0.148 vs. 0.857\u0026thinsp;\u0026plusmn;\u0026thinsp;0.130, p\u0026thinsp;=\u0026thinsp;0.444), immunotherapy (0.727\u0026thinsp;\u0026plusmn;\u0026thinsp;0.175 vs. 0.854\u0026thinsp;\u0026plusmn;\u0026thinsp;0.140, p\u0026thinsp;=\u0026thinsp;0.200), and targeted therapy (0.593 vs. 0.852\u0026thinsp;\u0026plusmn;\u0026thinsp;0.141) showed no significant associations with HRQoL (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAll symptom-related variables were significantly associated with EQ-5D-5L scores (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Overall, patients without symptoms reported the highest HRQoL, while those with severe symptoms consistently had the lowest scores. This pattern was particularly pronounced for dysphagia, social eating difficulty, xerostomia, trismus, and sticky saliva. Other symptoms, such as nausea/vomiting, insomnia, constipation, diarrhea, sensory problems, speech difficulties, social contact issues, sexuality, dental problems, and coughing, were significantly associated with HRQoL (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHRQoL according to Symptom variables in patients with oropharyngeal cancer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptom\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEQ-5D-5L index\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eNausea and vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e220 (79.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.880\u0026thinsp;\u0026plusmn;\u0026thinsp;0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.844\u0026thinsp;\u0026plusmn;\u0026thinsp;0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.535\u0026thinsp;\u0026plusmn;\u0026thinsp;0.382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.608\u0026thinsp;\u0026plusmn;\u0026thinsp;0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e187 (97.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.900\u0026thinsp;\u0026plusmn;\u0026thinsp;0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.249\u0026thinsp;\u0026plusmn;\u0026thinsp;0.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eInsomnia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e139 (88.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.910\u0026thinsp;\u0026plusmn;\u0026thinsp;0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.644\u0026thinsp;\u0026plusmn;\u0026thinsp;0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e176 (95.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.886\u0026thinsp;\u0026plusmn;\u0026thinsp;0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004 **\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.756\u0026thinsp;\u0026plusmn;\u0026thinsp;0.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDiarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e228 (99.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.875\u0026thinsp;\u0026plusmn;\u0026thinsp;0.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.020 *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.655\u0026thinsp;\u0026plusmn;\u0026thinsp;0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDysphagia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121 (43.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.916\u0026thinsp;\u0026plusmn;\u0026thinsp;0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.878\u0026thinsp;\u0026plusmn;\u0026thinsp;0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.737\u0026thinsp;\u0026plusmn;\u0026thinsp;0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.637\u0026thinsp;\u0026plusmn;\u0026thinsp;0.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSensory problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.886\u0026thinsp;\u0026plusmn;\u0026thinsp;0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.896\u0026thinsp;\u0026plusmn;\u0026thinsp;0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.791\u0026thinsp;\u0026plusmn;\u0026thinsp;0.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.659\u0026thinsp;\u0026plusmn;\u0026thinsp;0.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSpeech problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e136 (50.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.907\u0026thinsp;\u0026plusmn;\u0026thinsp;0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.865\u0026thinsp;\u0026plusmn;\u0026thinsp;0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.754\u0026thinsp;\u0026plusmn;\u0026thinsp;0.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.584\u0026thinsp;\u0026plusmn;\u0026thinsp;0.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSocial eating difficulty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e130 (49.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.925\u0026thinsp;\u0026plusmn;\u0026thinsp;0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71 (26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.869\u0026thinsp;\u0026plusmn;\u0026thinsp;0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.744\u0026thinsp;\u0026plusmn;\u0026thinsp;0.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.693\u0026thinsp;\u0026plusmn;\u0026thinsp;0.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSocial contact difficulty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172 (60.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.911\u0026thinsp;\u0026plusmn;\u0026thinsp;0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77 (27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.830\u0026thinsp;\u0026plusmn;\u0026thinsp;0.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.749\u0026thinsp;\u0026plusmn;\u0026thinsp;0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.595\u0026thinsp;\u0026plusmn;\u0026thinsp;0.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eReduced sexuality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169 (76.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.885\u0026thinsp;\u0026plusmn;\u0026thinsp;0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.876\u0026thinsp;\u0026plusmn;\u0026thinsp;0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.759\u0026thinsp;\u0026plusmn;\u0026thinsp;0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.726\u0026thinsp;\u0026plusmn;\u0026thinsp;0.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDental problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e153 (86.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.885\u0026thinsp;\u0026plusmn;\u0026thinsp;0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.754\u0026thinsp;\u0026plusmn;\u0026thinsp;0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eTrismus (opening the mouth)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e186 (92.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.899\u0026thinsp;\u0026plusmn;\u0026thinsp;0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.705\u0026thinsp;\u0026plusmn;\u0026thinsp;0.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eXerostomia (dry mouth)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73 (63.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.920\u0026thinsp;\u0026plusmn;\u0026thinsp;0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42 (36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.734\u0026thinsp;\u0026plusmn;\u0026thinsp;0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSticky saliva\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e139 (83.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.898\u0026thinsp;\u0026plusmn;\u0026thinsp;0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.685\u0026thinsp;\u0026plusmn;\u0026thinsp;0.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCoughing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e146 (92.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.886\u0026thinsp;\u0026plusmn;\u0026thinsp;0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.724\u0026thinsp;\u0026plusmn;\u0026thinsp;0.139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSD, standard deviation; EQ-5D-5L, EuroQol five-dimension five-level; HRQoL, health-related quality of life\u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003eVariables whose percentages do not sum up to 100% indicate missing values.\u003c/p\u003e \u003cp\u003e \u003csup\u003eb\u003c/sup\u003eHigher values indicate the best possible outcome, with values ranging from 0 to 1.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Multivariate regression analysis\u003c/h2\u003e \u003cp\u003eThe multivariate linear regression model accounted for 62.2% of the variance in HRQoL (R\u0026sup2; = 0.622). Among sociodemographic factors, female sex was independently associated with lower HRQoL (β = \u0026minus;\u0026thinsp;0.045, p\u0026thinsp;=\u0026thinsp;0.020), while higher education predicted better outcomes (high school: β\u0026thinsp;=\u0026thinsp;0.049, p\u0026thinsp;=\u0026thinsp;0.018; college or above: β\u0026thinsp;=\u0026thinsp;0.043, p\u0026thinsp;=\u0026thinsp;0.028). Other factors, including age, household size, marital status, income, and religion, showed no significant association. Similarly, none of the clinical variables (cancer location, TNM stage, HPV infection, recurrence count, or disease duration [post-diagnosis or post-treatment]) were significantly associated with HRQoL.\u003c/p\u003e \u003cp\u003eRegarding symptom burden, several symptoms were independent predictors of lower HRQoL. Dyspnea (β = \u0026minus;\u0026thinsp;0.002, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), insomnia (β = \u0026minus;\u0026thinsp;0.007, p\u0026thinsp;=\u0026thinsp;0.020), dysphagia (β = \u0026minus;\u0026thinsp;0.002, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), social eating difficulty (β = \u0026minus;\u0026thinsp;0.001, p\u0026thinsp;=\u0026thinsp;0.013), social contact difficulty (β = \u0026minus;\u0026thinsp;0.002, p\u0026thinsp;=\u0026thinsp;0.001), and trismus (β = \u0026minus;\u0026thinsp;0.001, p\u0026thinsp;=\u0026thinsp;0.048) were significantly associated with lower EQ-5D-5L index scores. Conversely, other symptoms such as nausea/vomiting, constipation, diarrhea, sensory (taste/smell) disturbances, speech problems, sexuality, dental issues, xerostomia, sticky saliva, and coughing were not significantly associated with HRQoL in the adjusted mode (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate regression analysis of predictors of HRQoL in patients with oropharyngeal cancer\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable (reference)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eβ (SE)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.910 (0.064)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.784, 1.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (ref. male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.045 (0.019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.020 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.081, -0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.000, 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold size (continuous)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.013 (0.007)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.027, 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducation (ref. middle school or below)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.049 (0.020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008, 0.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege graduate or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.043 (0.020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.028 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005, 0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital state (ref. never married)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039 (0.027)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.015, 0.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther (Separated/Divorced/Widowed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.021 (0.029)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.078, 0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIncome\u003csup\u003ea\u003c/sup\u003e (ref. \u0026lt; 3,000,000, \u003cs\u003eW\u003c/s\u003e\u003csup\u003e1)\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,000,000\u0026ndash;\u0026lt;8,000,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.009 (0.017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.608\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.024, 0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;8,000,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.025 (0.022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.019, 0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment (ref. employed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.011 (0.015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.043, 0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion (ref. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.001 (0.013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.028, 0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTonsil (ref. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.016 (0.034)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.082, 0.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBase of tongue (ref. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.015 (0.030)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.102, 0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoft palate (ref. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.105 (0.054)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.002, 0.212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosterior pharyngeal wall (ref. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.015 (0.018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.021, 0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTNM classification (ref. Stage I)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.012 (0.016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.043, 0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.008 (0.018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.028, 0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.009 (0.025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.733\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.042, 0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-diagnosis duration (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.000, 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHuman papillomavirus infection (ref. Positive)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.014 (0.017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.021, 0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecurrence count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.005 (0.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.023, 0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-treatment duration (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.001, 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRobotic surgery (ref. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.045 (0.020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.025 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.006, 0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther surgery (ref. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.030 (0.019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.007, 0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRadiation therapy (ref. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.010 (0.019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.046, 0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy (ref. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.023 (0.017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.011, 0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunotherapy (ref. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.013 (0.047)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.105, 0.079\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTargeted therapy (ref. No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.146 (0.127)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.396, 0.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea and vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.001, 0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.002 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.002, -0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsomnia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.007 (0.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.020 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.013, -0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.001, 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiarrhea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.001, 0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDysphagia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.002 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 ***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.003, -0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenses problems (taste/smell)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.001, 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpeech problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.938\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.001, 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial eating difficulty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.001 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.013 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.002, -0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial contact difficulty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.002 (0.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001 **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.004, -0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced sexuality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.000, 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDental problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.001, 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrismus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.001 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.048 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.002, -0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eXerostomia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.001, 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSticky saliva\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.001, 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoughing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.000 (0.000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.001, 0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR-squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSD, standard deviation; CI, confidence interval; HRQoL, health-related quality of life; SE, standard error\u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003e1,000 Korean won (\u003cs\u003eW\u003c/s\u003e)\u0026thinsp;=\u0026thinsp;0.70 dollar (\u003cspan\u003e$\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.00\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis multicenter study shows several determinants of HRQoL in patients with oropharyngeal cancer. Female sex correlated with lower HRQoL, while higher educational attainment was linked to better outcomes. Among treatment modalities, robotic surgery demonstrated a positive correlation with HRQoL. Symptom-related factors, including dyspnea, insomnia, dysphagia, social eating difficulty, social contact difficulty, reduced sexuality, and trismus, were independent predictors of poorer HRQoL. Collectively, the multivariate model accounted for 62.2% of the variance, indicating strong explanatory capacity.\u003c/p\u003e \u003cp\u003eRegarding treatment, robotic surgery had the largest positive effect on HRQoL, with a regression coefficient of 0.045. The finding that patients who underwent robotic surgery at least once during the treatment period exhibited higher HRQoL is consistent with those of previous studies showing improved swallowing and speech function, alongside reduced long-term functional impairment compared with conventional techniques. Fernando Danelon et al. report that patients treated with transoral robotic surgery (TORS) alone achieved significantly higher Performance Status Scale eating and diet scores at 6 months than those who received TORS combined with chemoradiation (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Similarly, Virginie Achim et al. report that patients undergoing TORS alone experience better long-term recovery, less weight loss, and fewer swallowing difficulties than those who received adjuvant therapy following TORS (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, several symptoms\u0026mdash;dyspnea, insomnia, dysphagia, social eating difficulty, social contact difficulty, reduced sexuality, and trismus\u0026mdash;were significant independent predictors of poorer HRQoL. This highlights the cumulative influence of symptom burden among oropharyngeal cancer survivors, consistent with prior evidence. Kelsey Smith et al. report insomnia as a common adverse effect of radiotherapy in patients with head and neck cancer, negatively influencing quality of life (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Similarly, Wan Leung et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) report that social contact difficulty is significantly linked to reduced quality of life among survivors of head and neck cancer who underwent radiation therapy, particularly those with oropharyngeal cancer. This phenomenon is potentially attributed to elevated levels of depression, anxiety, and fatigue commonly experienced by patients with head and neck cancer (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Dyspnea is significantly associated with prior radiotherapy among individuals with hypopharyngeal cancer (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Joanne M. Patterson et al. highlight dysphagia and social eating difficulties as persistent challenges for survivors; patients with oropharyngeal cancer, in particular, exhibit poorer recovery trajectories than those with other head and neck tumor sites, achieving only partial recovery after 1 year (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Nina Pauli et al. further demonstrate that trismus significantly impairs HRQoL and interferes with daily functioning in patients with head and neck cancer (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the general Korean population, women (0.932) report lower HRQoL than men (0.956), representing a statistically significant difference of approximately 0.024 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In this cohort of patients with oropharyngeal cancer, this sex gap was even wider (0.060). Supplementary analyses revealed distinct sex-specific patterns, with female patients showing greater declines in EuroQol 5-Dimension 5-Level (EQ-5D-5L) scores across symptom severity categories, particularly in dysphagia, insomnia, speech, and social domains. These findings suggest that symptom burden may disproportionately affect women, highlighting the need for sex-specific supportive care (Additional file 1). The findings are partly consistent with those of prior research. Eleni M. et al. identify determinants of HRQoL in patients with oropharyngeal cancer and similarly report that female patients experience lower HRQoL than male patients (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This disparity may be explained by sex-specific differences in the effect of dysphagia, a key symptom influencing HRQoL, which could contribute to the observed variation in HRQoL indices between men and women. Similarly, Nur Demiral et al. highlight the role of socioeconomic factors, including education, in shaping post-treatment HRQoL, with higher educational levels consistently linked to better outcomes in patients with head and neck cancer (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In that study, lower educational attainment independently correlates with work disability, which was identified as a potential contributor to reduced HRQoL.\u003c/p\u003e \u003cp\u003eThese findings hold several implications for clinical practice. First, symptom-focused care should be incorporated early in the treatment course, with emphasis on swallowing rehabilitation and targeted interventions for insomnia, dyspnea, and trismus (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Second, although the results support the potential benefits of robotic surgery in preserving HRQoL, treatment decisions should balance oncologic control with functional outcomes, taking into account procedure-specific trade-offs. Third, patients presenting with a higher symptom burden represent a vulnerable subgroup who may benefit from pre-treatment counseling, structured rehabilitation, and comprehensive post-treatment survivorship programs. Furthermore, early screening and timely management of social eating and social contact difficulties should be prioritized in survivorship care, given their significant influence on long-term psychosocial well-being (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResearch on HRQoL among patients with head and neck cancer in Asia remains limited. According to World Health Organization data, the age-standardized incidence rate of oropharyngeal cancer per 100,000 population is 0.77 in Korea, 0.97 in Japan, and 0.33 in China, significantly lower than that in the United States (2.6), Canada (2.2), and the United Kingdom (2.6) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This relatively low incidence has historically contributed to limited academic and policy attention within the region. However, recent lifestyle changes in economically developed Asian countries such as Japan, China, and Korea have led to a significant rise in incidence, with annual increases exceeding 3%. Continued research on HRQoL is therefore crucial to support evidence-based clinical practice and guide policy formulation. Furthermore, given that HRQoL is strongly influenced by sociocultural and healthcare factors, data collection across diverse regions remains crucial.\u003c/p\u003e \u003cp\u003eThis study has some limitations. The cross-sectional design precludes causal inference, making it difficult to differentiate between treatment-related and disease-related symptoms. The reliance on self-reported HRQoL data also introduces potential recall and reporting biases. Additionally, follow-up schedules were not standardized, as HRQoL was assessed at a single but variable time point after diagnosis, which may have led to underestimation or overestimation of specific symptom domains. Finally, the sample was relatively small; therefore, future studies should include larger, prospectively followed cohorts to validate these findings.\u003c/p\u003e \u003cp\u003eDespite these limitations, the study has significant strengths. Data was collected from 14 hospitals across different regions of Korea, enhancing the geographic representativeness of the sample. As of 2021, approximately 13,000 individuals were living with oropharyngeal cancer in Korea, with an average disease duration of 3 years (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The present cohort represented approximately 2.1% of this population. The cancer stage distribution in this cohort closely reflected that of the national statistics: localized disease (37.0% vs. 34.4%), regional or distant disease (51.5% vs. 58.6%), and unknown stage (10.8% vs. 7.0%). Furthermore, this study is among the few comprehensive HRQoL investigations of patients with oropharyngeal cancer in Asia. The findings are largely consistent with those reported in Western populations. The use of EQ-5D-5L provided a validated, preference-based measure, facilitating comparison with population norms and international cohorts, and has been validated in patients with oropharyngeal cancer (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Finally, the inclusion of sociodemographic, clinical (including treatment-related), and symptom-related variables enabled a comprehensive assessment of HRQoL determinants.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis study highlights the multifactorial nature of HRQoL in oropharyngeal cancer, influenced by sociodemographic, clinical (including treatment-related), and symptom-related factors. With improving survival rates, long-term HRQoL has emerged as a critical concern. Enhancing survivorship outcomes requires early symptom management, structured rehabilitation, and the adoption of minimally invasive treatment approaches where appropriate. Future prospective cohort and interventional studies are needed to elucidate causal pathways and guide personalized survivorship strategies that balance oncologic control with sustained HRQoL.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHRQoL, health-related quality of life; EQ-5D-5L, EuroQol 5-Dimension 5-Level; HPV, human papillomavirus; EORTC QLQ-C30 and EORTC QLQ-H\u0026amp;N35; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Head and Neck 35\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eOropharyngeal cancer:\u0026nbsp;\u003c/strong\u003eA type of head and neck cancer that develops in the oropharynx, the middle part of the throat behind the mouth, including the tonsils and base of the tongue.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth-related quality of life (HRQoL):\u0026nbsp;\u003c/strong\u003eA measure of how a person\u0026rsquo;s health condition affects their physical, psychological, and social well-being.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEuroQol 5-Dimension 5-Level (EQ-5D-5L):\u0026nbsp;\u003c/strong\u003eA standardized instrument used to assess HRQoL across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, each rated at five levels of severity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEORTC QLQ-C30:\u0026nbsp;\u003c/strong\u003eA questionnaire developed by the European Organisation for Research and Treatment of Cancer to evaluate the quality of life of cancer patients across multiple symptom and function domains.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEORTC QLQ-H\u0026amp;N35:\u0026nbsp;\u003c/strong\u003eA supplementary questionnaire specific to head and neck cancer patients, assessing symptoms such as swallowing difficulties, dry mouth, and speech problems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial eating difficulty:\u0026nbsp;\u003c/strong\u003eChallenges in eating with others due to physical or psychological effects of treatment, often affecting social participation and emotional well-being.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Central Research Ethics Committee of Kongju National University (approval number: KNU_IRB_2023-49), and additional institutional review board approvals from participating hospitals are summarized in Additional file 2. All participants provided informed consent to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to the inclusion of patient information that could compromise participant privacy, but are available from the corresponding\u0026nbsp;author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability\u003c/strong\u003e \u003cstrong\u003eof data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to confidentiality agreements concerning patient information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Korea Disease Control and Prevention Agency [grant number 2023-10-012].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJEA conceptualized the study, curated and analyzed the data, and drafted the original manuscript. BSK and KJC contributed to data collection and investigation. SYY supervised the study, validated the findings, acquired funding, and contributed to the review and editing of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLorenzoni V, Chaturvedi AK, Vignat J, Laversanne M, Bray F, Vaccarella S. The current burden of oropharyngeal cancer: a global assessment based on GLOBOCAN 2020. Cancer Epidemiol Biomarkers Prev. 2022;31:2054\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZumsteg ZS, Luu M, Rosenberg PS, Elrod JK, Bray F, Vaccarella S, et al. Global epidemiologic patterns of oropharyngeal cancer incidence trends. J Natl Cancer Inst. 2023;115:1544\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Laan HP, Van den Bosch L, Schuit E, Steenbakkers RJ, van der Schaaf A, Langendijk JA. Impact of radiation-induced toxicities on quality of life of patients treated for head and neck cancer. Radiother Oncol. 2021;160:47\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Melo NB, de Sousa VM, de Melo DP, Gomes DQC, Bento PM. Oral health related quality of life and determinant factors in patients with head and neck cancer. Med Oral Patol Oral Cir Bucal. 2019;24:e281.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHammerm\u0026uuml;ller C, Hinz A, Dietz A, Wichmann G, Pirlich M, Berger T, et al. Depression, anxiety, fatigue, and quality of life in a large sample of patients suffering from head and neck cancer in comparison with the general population. BMC Cancer. 2021;21:94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalma DA, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, et al. Assessment of toxic effects and survival in treatment deescalation with radiotherapy vs transoral surgery for HPV-associated oropharyngeal squamous cell carcinoma: the ORATOR2 phase 2 randomized clinical trial. JAMA Oncol. 2022;8:845\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim MJ, Koo BS, Cho KJ, Lee SH, Lee AY, Hong GU, et al. Health-related quality-of-life assessment in patients with oropharyngeal cancer: A comparison of EQ-5D-5L and EORTC instruments. Oral Oncol. 2025;165:107342.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim SH, Ahn J, Ock M, Shin S, Park J, Luo N, et al. The EQ-5D-5L valuation study in Korea. Qual Life Res. 2016;25:1845\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Reenen M, Janssen B. EQ-5D-5L user guide: basic information on how to use the EQ-5D-5L instrument. Rotterdam: EuroQol Research Foundation; 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEngel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeonhardt FD, Quon H, Abrah\u0026atilde;o M, O'Malley BW Jr, Weinstein GS. Transoral robotic surgery for oropharyngeal carcinoma and its impact on patient-reported quality of life and function. Head Neck. 2012;34:146\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAchim V, Bolognone RK, Palmer AD, Graville DJ, Light TJ, Li R, et al. Long-term functional and quality-of-life outcomes after transoral robotic surgery in patients with oropharyngeal cancer. JAMA Otolaryngol Head Neck Surg. 2018;144:18\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIovoli AJ, Smith K, Yu H, Kluczynski MA, Jungquist CR, Ray AD, et al. Association of Insomnia and Obstructive Sleep Apnea with Worse Oral Mucositis and Quality of Life in Head and Neck Cancer Patients Undergoing Radiation Therapy. Cancers. 2024;16:1335.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWan Leung S, Lee TF, Chien CY, Chao PJ, Tsai WL, Fang FM. Health-related quality of life in 640 head and neck cancer survivors after radiotherapy using EORTC QLQ-C30 and QLQ-H\u0026amp;N35 questionnaires. BMC Cancer. 2011;11:128.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatterson JM, Lu L, Watson LJ, Harding S, Ness AR, Thomas S, et al. Trends in, and predictors of, swallowing and social eating outcomes in head and neck cancer survivors: a longitudinal analysis of head and neck 5000. Oral Oncol. 2021;118:105344.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePauli N, Johnson J, Finizia C, Andrell P. The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer. Acta Oncol. 2013;52:1137\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim TH, Jo MW, Lee SI, Kim SH, Chung SM. Psychometric properties of the EQ-5D-5L in the general population of South Korea. Qual Life Res. 2013;22:2245\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRettig EM, D'Souza G, Thompson CB, Koch WM, Eisele DW, Fakhry C. Health-related quality of life before and after head and neck squamous cell carcinoma: Analysis of the Surveillance, Epidemiology, and End Results\u0026ndash;Medicare Health Outcomes Survey linkage. Cancer. 2016;122:1861\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemiral AN, Şen M, Demiral Y, Kınay M. The effect of socioeconomic factors on quality of life after treatment in patients with head and neck cancer. Int J Radiat Oncol Biol Phys. 2008;70:23\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVester S, Muhr A, Meier J, Suess C, Kummer P, Kuenzel J. Prehabilitation of dysphagia in the therapy of head and neck cancer-a systematic review of the literature and evidence evaluation. Front Oncol. 2023;13:1273430.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInternational Agency for Research on Cancer. Data sources and methods. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://gco.iarc.fr/today/data-sources-methods\u003c/span\u003e\u003cspan address=\"http://gco.iarc.fr/today/data-sources-methods\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024). Accessed 20 Feb 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Cancer Center. Annual report of cancer statistics in Korea in 2021. 2023.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Oropharyngeal cancer, Health-related quality of life, Regression analysis, Predictive factors, EQ-5D-5L","lastPublishedDoi":"10.21203/rs.3.rs-7997928/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7997928/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOropharyngeal cancer, an oropharynx malignancy primarily linked to human papillomavirus infection, has seen substantial improvements with advances in treatment. However, many long-term survivors still experience functional impairments such as dysphagia and xerostomia that significantly reduce health-related quality of life (HRQoL). This study aims to identify treatment- and symptom-related factors associated with HRQoL in patients with oropharyngeal cancer.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis multicenter cross-sectional study enrolled 327 patients with oropharyngeal cancer from 14 hospitals in Korea. HRQoL was assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) instrument, and independent variables were categorized into sociodemographic, clinical, and symptom-related domains. Descriptive statistics, t-tests, ANOVA, and multivariate linear regression were used to identify factors associated with HRQoL.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean EQ-5D-5L index was 0.851\u0026thinsp;\u0026plusmn;\u0026thinsp;0.141. Female patients exhibited significantly lower HRQoL than that of males (p\u0026thinsp;=\u0026thinsp;0.022), while higher educational attainment and employment were associated with better HRQoL (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Robotic surgery correlated positively with HRQoL (β\u0026thinsp;=\u0026thinsp;0.045, p\u0026thinsp;=\u0026thinsp;0.025). Dyspnea, insomnia, dysphagia, social eating and contact difficulties, and trismus were independent predictors of poorer HRQoL. The final regression model accounted for 62.2% of the variance (R\u0026sup2; = 0.622).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study identified key determinants of HRQoL in patients with oropharyngeal cancer, emphasizing the influence of sex, education, robotic surgery, and symptom burden. Early integration of symptom-focused care is recommended, with particular emphasis on managing swallowing difficulties, insomnia, and social functioning. These findings underscore the need to incorporate HRQoL into survivorship programs and optimize treatment strategies that balance oncologic control with long-term quality of life.\u003c/p\u003e","manuscriptTitle":"Treatment- and Symptom-Related Determinants of Health-Related Quality of Life in Patients with Oropharyngeal Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 10:04:37","doi":"10.21203/rs.3.rs-7997928/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-30T19:41:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154864950758434932012306308378786618158","date":"2025-12-29T17:38:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337133980187343575062940827255530569042","date":"2025-12-28T20:22:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-26T07:04:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-04T11:18:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-03T08:35:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-03T08:32:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-10-31T11:19:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"95081542-a6cb-4999-9a24-98ff5d75a235","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-30T10:04:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 10:04:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7997928","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7997928","identity":"rs-7997928","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}