Oral health-related quality of life in head and neck cancer survivors in Egypt within the first year after radiotherapy: a multivariable analysis

Abstract

Radiotherapy for head and neck cancer (HNC) is frequently associated with debilitating oral complications that severely impact oral health-related quality of life (OHRQoL) in cancer survivors. Although survivorship care is gaining more attention worldwide, there remains a scarcity of data on OHRQoL in low-resource countries. Therefore, we aimed to evaluate OHRQoL among Egyptian head-and-neck cancer survivors during the first year following treatment and identify sociodemographic and clinical predictors influencing symptom severity using the EORTC QLQ-H&N35 tool. This cross-sectional study included 180 HNC survivors within 12 months post-treatment at Ahmed Maher Teaching Hospital, Cairo, Egypt. Participants completed the Arabic EORTC QLQ-H&N35 questionnaire, alongside structured interviews and clinical oral examinations (OHI-S and oral dryness scoring). Data were analyzed using descriptive statistics and multivariate regression (GLM-MANOVA) to determine predictors of OHRQoL impairment. The most severe patient-reported symptoms were dry mouth (mean 53.7 ± 16.6), limited mouth opening (45.4 ± 22.2), and dental-related problems (37.9 ± 18.6). Multivariable analysis identified tumor site and financial status as independent predictors of greater symptom burden, while tooth-brushing frequency showed a marginal association (p = 0.05). Patients with oral cavity tumors and those with lower socioeconomic status consistently reported poorer OHRQoL across multiple symptom domains. This is the first study in Egypt using the EORTC QLQ-H&N35 tool to evaluate OHRQoL in HNC survivors in a comprehensive manner. One year after treatment, Egyptian HNC cancer survivors experience significant OHRQoL impairments, particularly associated with dry mouth, limited mouth opening, and dental pain. Tumor location, socioeconomic factors, and oral hygiene practices significantly influence symptom severity, highlighting the need for targeted supportive care interventions, including structured dental support and rehabilitation strategies tailored for at-risk patient populations in low-resource settings. The study was registered retrospectively on ClinicalTrials.gov (NCT06901401) on March 23, 2025.