Palliative Care in Advanced Head and Neck Cancer: Multidisciplinary Management and End-of-Life Decision-Making

Head and neck cancers (HNCs) represent a heterogeneous group of malignancies with high morbidity and complex functional impairment. Despite advances in multimodal therapy, many patients present with advanced or incurable disease, demanding early integration of palliative care. To review the epidemiology, symptom burden, and best practices in palliative care for patients with advanced HNC, highlighting strategies for symptom management, communication, and end-of-life decision-making. A narrative review of current literature, clinical guidelines (National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), UK National Multidisciplinary Guidelines), and key studies on palliative interventions in HNC was conducted. Emphasis was placed on early integration of palliative care, multidisciplinary management, and evidence-based approaches to symptom control. HNC patients experience high symptom burden, including pain, dysphagia, airway compromise, hemorrhage, and psychological distress. Early palliative care integration improves symptom control, quality of life, and alignment of treatment with patient goals. Multidisciplinary approaches involving surgeons, oncologists, palliative specialists, speech therapists, dietitians, and psychosocial support are essential. Sentinel clinical events should trigger structured discussions on prognosis, treatment objectives, and end-of-life preferences. Advance care planning, including documentation of "do not resuscitate" (DNR) orders and preferred location of death, is critical in the terminal phase. Effective palliative care in HNC requires early, proactive, and multidisciplinary strategies that balance disease-directed therapy with patient-centered goals. Standardization of care pathways and ongoing evaluation of emerging evidence are essential to optimize symptom management, facilitate informed decision-making, and enhance quality of life for patients with advanced diseases.