Functional Decline After Multimodal Treatment of Oral Squamous Cell Carcinoma: A Prospective Longitudinal Study Using the Eastern Cooperative Oncology Group (ECOG) Scale

Background and aimCurative treatment of oral squamous cell carcinoma (OSCC) is often physically demanding, and the functional cost of therapy is not always reflected in oncological outcome measures alone.However, prospective evidence describing longitudinal changes in functional performance among patients undergoing curative treatment for OSCC, particularly in South Asian populations, remains limited.This prospective study aimed to evaluate longitudinal changes in Eastern Cooperative Oncology Group performance status among patients undergoing curative surgical treatment for OSCC.Specifically, Eastern Cooperative Oncology Group performance status (ECOG PS) was assessed before treatment, one month after surgery, and one month after completion of adjuvant therapy when indicated.This study also compared changes in performance status across treatment stages and explored clinical factors associated with functional deterioration.We hypothesized that multimodal treatment for OSCC would result in a significant decline in functional performance, with the magnitude of deterioration varying according to baseline performance status, treatment intensity, and reconstructive procedures. MethodsIn this longitudinal study conducted over one year (May 2024 to June 2025) at the Department of Oral and Maxillofacial Surgery, Bangladesh Medical University, we purposively enrolled 36 histopathologically confirmed OSCC patients undergoing curative surgery, with adjuvant therapy as indicated.ECOG PS was assessed by a semi-structured interview before treatment and one month after completion of surgery or, where applicable, one month after adjuvant therapy.We used paired-samples t-tests, Pearson correlations, and chi-square/unpaired Student's t-tests as appropriate (SPSS version 27.0 {Armonk, NY: IBM Corp.}; p<0.05 significant). ResultsMean age was 55.6±10.7 years; 21 (58.3%) were female, and homemakers formed the largest single occupational group (n=20, 55.5%).A total of 15 patients (41.7%) had surgery alone, 13 (36.1%)had surgery plus radiotherapy, and eight (22.2%) had surgery plus chemoradiotherapy.Mean ECOG PS rose from 0.58±0.60 at baseline to 1.78±1.53after treatment (mean change: +1.19±1.21;p<0.001).Deterioration occurred in 12 of 15 (80.0%) patients treated with surgery alone, eight of 13 (61.5%)patients receiving surgery plus radiotherapy, and seven of eight (87.5%)patients receiving surgery, radiotherapy, and chemotherapy.Higher baseline PS predicted greater absolute deterioration (R 2 =0.448 between pre-and post-treatment scores).Five patients (13.9%) died; both patients with baseline PS 2 died, compared with three of 34 patients with baseline PS 0-1.Score deterioration was most pronounced after reconstruction with distant free flaps (nine of 10 {90.0%} patients) and least pronounced after local flap reconstruction (three of seven {42.9%} patients). ConclusionCurative treatment of OSCC is associated with a clinically meaningful decline in functional performance status, disproportionately affecting patients who already present with impaired baseline status.Pretreatment ECOG PS should be incorporated into shared decision-making and rehabilitation planning for OSCC patients.