approximately 43,000 new cases of head and neck cancer ( hnc ) are diagnosed each year in the united states . despite changes in treatment regimens ( i.e. , organ preservation protocols and the addition of chemotherapy to primary radiation treatment ) , setting , there has been an increasing interest in trying to understand and maximize patient quality of life ( qol ) . quality of life is a subjective perception by the patient that includes physical , emotional , and social well - being . it is well - established that different subsites within the head and neck have different perceived qol following treatment ; patients with oropharyngeal carcinoma tend to report worse quality of life than do other head and neck cancer patients and have poorer functional outcomes [ 1 , 2 ] . terrell et al . identified a number of factors that have a negative impact on qol including need for gastrostomy and tracheostomy tubes , comorbid medical conditions , addition of chemotherapy to treatment , and need for a neck dissection . a variety of mechanisms have been proposed in the literature to improve patient quality of life , including educational programs , support group meetings , biofeedback therapy , and cognitive behavioral therapy . however , the impact of these interventions has not been extensively studied in head and neck cancer patients . support group therapy is a well - established means of psychosocial intervention in the cancer literature . however , only a handful of studies regarding support group therapy in the head and neck population exist , and the results are mixed [ 4 , 5 ] . the current study was designed to compare hnc patients who participate in a support group to those who do not participate in a support group . we hypothesized that hnc support group patients would do better than their peers who do not participate and that both groups would have lower qol scores than the us population . the institutional review board for human subjects at ucla approved this study ( irb # g06 - 11 - 050 - 01 ) . patients were recruited in two ways : ( 1 ) directly from support for people with oral and head and neck cancer ( spohnc ) support group meetings or ( 2 ) during cancer surveillance follow - up appointments in the clinic of a tertiary referral center . all patients were provided informed consent and a completed questionnaire implied their consent to participate in the study . support for people with oral and head and neck cancer ( spohnc ) is a nonprofit organization run by hnc survivors to help other patients learn more about and cope with their disease . the chapter of spohnc affiliated with our institution is organized by a clinical social worker who also facilitates the support group discussions . patients were asked to fill out the medical outcomes study short form-36 item health survey version 2 ( sf-36v2 , quality metric , inc . , the domains investigated by this instrument are physical functioning ( pf ) , role - physical ( rf ) , bodily pain ( bp ) , general health ( gh ) , vitality ( vt ) , social functioning ( sf ) , role - emotional ( re ) , and mental health ( mh ) . scores can range from 0 ( very poor quality of life ) to 100 ( excellent quality of life ) . the pf domain measures ability to do specific activities , such as walking 100 yards or bathing oneself . the rp domain queries how any physical limitations have impacted the patient 's life , such as cutting back on work hours or accomplishing less than expected . bodily pain ( bp ) asks about the amount of pain and if it has limited activity . the general health ( gh ) domain measures the patient 's perception of their health ; questions include a rating of their health from excellent to poor . other questions in this domain ask the patient to compare their health to others and their expectations for their health . vitality ( v ) queries the patient 's perception of their energy level , such as full of energy to  worn out . social functioning ( sf ) measures how much health - related issues have interfered with social activity . the role emotional ( re ) domain asks the patient to assess how much these health - related issues have impacted the performance of activities . the final question of the instrument asks the respondent to compare their current status to their health one year ago . scoring of the sf-36v2 questionnaires was done according to the method previously described . a supplemental questionnaire , designed by the authors , was also included , which asked patients to self - report the type and location of cancer , method of treatment , and time since completion of treatment . data obtained from the questionnaires was then entered into a microsoft excel spreadsheet which was programmed to perform conversion calculations as described by the scoring instructions . two sets of data were generated : one comparing cancer patients to 1998 us norms and another comparing the different cancer groups to each other . when comparing cancer groups , both unadjusted and adjusted measurements were calculated . adjustments were made for elapsed time since the end of treatment ( in years ) , cancer therapies ( including surgery , radiotherapy , and chemotherapy ) , and cancer location ( oral cavity / oropharynx / other and larynx ) . a 1-sample t - test was performed to determine if the mean score differed significantly from the us norms . in the case of sparse data , the fisher exact test was used to compare categorical variables with 2 levels and monte carlo simulation to compare categorical variables with more than 2 levels . missing values were imputed using the average score based on questions that were answered on the corresponding sf-36v2 scale , but only if at least 50% of the questions were answered . a total of 37 patients completed the sf-36v2 , 21 from the support group and 16 from the nonsupport group . within the support group category , 12 were female ( 60% ) and the average age was 61 years old . there was a statistically significant difference between the two groups as to the location of their primary tumor . forty - five percent of patients in the support group reported an oropharyngeal primary site , while 68% of nonsupport group patients reported an oral cavity primary site ( p = 0.0036 ) . both groups had undergone multimodality therapy ; there was no statistically significant difference between the groups as to the type of therapy rendered ( most patients had undergone surgery and/or radiation therapy with or without chemotherapy ) ( table 1 ) . because the patients provided the information regarding their treatment regimens , specific data regarding radiotherapy dosing and exact chemotherapeutic regimens was not available . however , only 4 domains were statistically significantly different : physical function , role physical , social function , and role emotional ( p = 0.0087 , 0.003 , 0.0015 , and 0.0005 , resp . ) . for role physical , social function , and role emotional , greater than 20% of respondents reported scores 2 standard deviations below the 1998 normative means ( table 2 ) . furthermore , when analyzed separately , support group patients did significantly worse than us norms for physical function , role physical , social function , general health , and role emotional ( table 2 ) . there were 21 patients in the support group cohort and 16 patients in the control cohort . there was no statistically significant difference for any domain between the two groups nor did any domain approach statistical significance ( table 3 ) . as noted above , there were significant differences between the two groups with regard to primary cancer subsite . they are affected physically , emotionally , and socially ; all of which lead to a change in their perceived global quality of life . in this study , we failed to find a statistically significant improvement in patients ' perceived qol when they participate in a head and neck cancer - specific support group . however , many support group participants anecdotally related the comfort they received by being able to speak to others who have very similar concerns and problems . while this aspect of the support group did not appear to impact their overall qol , it is obviously important to many participants to feel they were not alone . not surprisingly , cancer survivors reported decreased quality of life for all domains ; however , only about half of the queried domains were statistically significantly lower . these meetings are held at the hospital , and medical professionals are frequently invited to come to the discussion to talk about recent advances in head and neck cancer or treatment - related issues . this group has been active for a number of years at our institution and participants in the study were recruited directly from the meeting by the authors . a number of the group participants have been regularly active members for many years , while others were relatively new to the support group forum . therefore , the range of time from treatment to questionnaire was highly variable in the support group cohort of this study . however , we feel that recruiting patients directly from a previously constituted support group may more accurately reflect the effect of the support group on those who participate . other studies in the literature have looked at the qol of patients who were asked to participate in a support group . two previous studies created support groups for the patients to participate in , rather than drawing data from patients in preexisting support groups [ 4 , 5 ] . the literature regarding the effect of support group therapy on head and neck patients is somewhat sparse , but there is a fairly large body of work regarding support group participation in patients with breast , lung , and colon cancer . while the results in other cancer groups demonstrate substantial improvement in patients ' perceived qol , our study failed to find a significant difference in qol outcomes between head and neck support group participants and nonparticipants . support group participants were more likely to have oropharyngeal carcinoma , while nonparticipants were more likely to have oral tongue lesions . it is generally agreed that patients with oropharyngeal carcinoma have somewhat poorer qol outcomes than other subsites . thus , this bias toward poorer outcomes may have negated the positive effect of the support group on their qol . the second explanation may lie with the fact that the study group was drawn from a preexisting support group . we did not test for underlying depressive disorders or question patients regarding their psychological coping mechanisms . perhaps those patients who participate regularly in a support group lack some of these coping mechanisms and therefore need the psychological support of the group more than their nonparticipating counterparts . further research into the area is necessary to determine if support group therapy would benefit specific cancer subsite patients differently . it is also possible that different subsites of head and neck cancer require different methods or styles of supportive therapy . lastly , perhaps the choice of instrument affected the ability to detect a difference in the two groups . it is possible that a head and neck specific instrument , such as the university of washington or university of michigan instruments , may be more sensitive in detecting differences between these two cohorts . with regard to the comparison between the cancer patients and us normative values , cancer patients scored lower on the sf-36v2 than us norms ; however , there were only 4 domains where this decrement was statistically significant . the domains most affected by cancer were physical function , role physical , social function , and role emotional . the sf-36v2 instrument has been used in a number of other studies in the head and neck literature . netscher et al . evaluated the quality of life in patients who had undergone microvascular free flap reconstruction after ablative surgery for advanced oropharyngeal carcinoma . when compared to us norms , these patients had poor perceived quality of life both before and 1 year after surgery with regard to ability to work , vitality , social function , and emotional function . these are the same domains that were significantly lower in our study as well . this problem was inherent to the study design , as participants were recruited from an already existing support group , rather than being invited to participate in the group . there are several other spohnc groups in the los angeles area , and further studies with other support groups may be possible . secondly , the two cancer patient cohorts were statistically different with regard to their composition . further studies would need subsite and age - matched controls in order to remove this source of bias . it is possible that the preponderance of oropharyngeal cancer patients in the support group cohort diminished the scores in this group and thus negated any sf-36v2 score improvement in this cohort . we failed to demonstrate an improvement in the perceived quality of life of head and neck cancer patients who participate in a head and neck specific support group when compared to those hnc patients who do not participate . however , the camaraderie that exists within a support group may be important to those who do participate and should not be discouraged . not surprisingly , hnc patients have poorer perceived quality of life when compared to the us population . further research into ways to improve our patients ' posttreatment qol is important , and further study into support groups or educational programs is warranted .