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Psychosocial consequences of head and neck cancer symptom burden after chemoradiation: a mixed-method study

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Abstract

Purpose

Patients with head and neck cancer (HNC) experience significant symptom burden from combination chemotherapy and radiation (chemoradiation) that affects acute and long-term health-related quality of life (HRQOL). However, psychosocial impacts of HNC symptom burden are not well understood. This study examined psychosocial consequences of treatment-related symptom burden from the perspectives of survivors of HNC and HNC healthcare providers.

Methods

This was a cross-sectional, mixed-method study conducted at an NCI-designated comprehensive cancer center. Participants (N = 33) were survivors of HNC who completed a full course of chemoradiation (n = 20) and HNC healthcare providers (n = 13). Participants completed electronic surveys and semi-structured interviews.

Results

Survivors were M = 61 years old (SD = 9) and predominantly male (75%), White (90%), non-Hispanic (100%), and diagnosed with oropharynx cancer (70%). Providers were mostly female (62%), White (46%) or Asian (31%), and non-Hispanic (85%) and included physicians, registered nurses, an advanced practice nurse practitioner, a registered dietician, and a speech-language pathologist. Three qualitative themes emerged: (1) shock, shame, and self-consciousness, (2) diminished relationship satisfaction, and (3) lack of confidence at work. A subset of survivors (20%) reported clinically low social wellbeing, and more than one-third of survivors (35%) reported clinically significant fatigue, depression, anxiety, and cognitive dysfunction.

Conclusion

Survivors of HNC and HNC providers described how treatment-related symptom burden impacts psychosocial identity processes related to body image, patient-caregiver relationships, and professional work. Results can inform the development of supportive interventions to assist survivors and caregivers with navigating the psychosocial challenges of HNC treatment and survivorship.

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Data availability

The data that support this study's findings are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy concerns.

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Acknowledgements

We thank Ms. Kelsey Scheel for her support conducting this study and the survivors and providers who participated.

Funding

This work was supported in part by a Moffitt Cancer Center Innovation Award (MPIs: Oswald, Kirtane), Moffitt’s Participant Research, Interventions, and Measurement (PRISM) Core, and a National Cancer Institute Cancer Center Support Grant (P30CA076292).

Author information

Author notes

  1. Kedar Kirtane and Laura B. Oswald contributed equally.

Authors and Affiliations

  1. Participant Research, Interventions, and Measurement Core, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-AS PRISM, Tampa, FL, USA

    Carley Geiss & Brandy Arredondo

  2. Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA

    Aasha I. Hoogland, Yvelise Rodriguez, Crystal Bryant, Brian D. Gonzalez, Heather S. L. Jim & Laura B. Oswald

  3. Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, USA

    Christine H. Chung, Krupal B. Patel & Kedar Kirtane

Authors
  1. Carley Geiss
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Contributions

Conceptualization: CG, AH, KK, LO; Formal analysis: CG, AH, BA, LO; Investigation: CB, LO; Resources: CC, KP, KK; Data curation: CG, AH, BA; Supervision: BH, HJ, KK, LO; Project administration: YR; Funding acquisition: KK, LO; Writing - original draft: CG, AH, KK, LO; Writing - review & editing: All authors.

Corresponding author

Correspondence to Laura B. Oswald.

Ethics declarations

Competing interests

Dr. Chung receives honoraria from Sanofi and Exelexis for ad hoc Scientific Advisory Board participation. Dr. Gonzalez is a paid consultant for SureMed compliance and KemPharm, and an advisory board member for Elly Health, Inc outside of this work. Dr. Jim is a paid consultant for RedHill BioParma, Janssen Scientific Affairs, and Merck and has grant funding from Kite Pharma outside of this work. Dr. Kirtane owns stock in Seattle Genetics, Oncternal Therapeutics, and Veru. The other authors have no other relevant competing interests to disclose.

Ethics approval

The current research was reviewed by the Institutional Review Board at Advarra and determined to be exempt from oversight due to minimal risk (Pro00045231). All aspects of this study were conducted in accordance with the 1964 Helsinki declaration and later amendments.

Consent to participate

All participants provided verbal consent prior to study enrollment.

Consent for publication

Participants provided verbal consent to have de-identified data published.

Conflict of interest

Dr. Chung receives honoraria from Sanofi and Exelixis for ad hoc scientific advisory board participation. Dr. Gonzalez is a paid consultant for Sure Med Compliance and KemPharm, and an advisory board member for Elly Health, Inc., outside of this work. Dr. Jim is a paid consultant for RedHill Biopharma, Janssen Scientific Affairs, and Merck and has grant funding from Kite Pharma outside of this work. Dr. Kirtane owns stock in Seattle Genetics, Oncternal Therapeutics, and Veru. The other authors have no other relevant competing interests to disclose.

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Geiss, C., Hoogland, A.I., Arredondo, B. et al. Psychosocial consequences of head and neck cancer symptom burden after chemoradiation: a mixed-method study. Support Care Cancer 32, 254 (2024). https://doi.org/10.1007/s00520-024-08424-3

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