Targeted autonomic testing for radiation‑induced baroreflex failure in head and neck cancer survivors: index case and early program experience

Radiation‑induced afferent baroreflex failure (R‑ABF) is a highly morbid late effect of neck irradiation in head and neck cancer survivors, and is frequently underrecognized due to nonspecific, fluctuating symptoms. We report an index case in which systematic autonomic evaluation-including adrenergic and cardiovagal assessment-enabled objective diagnosis, severity grading, while physiology‑directed therapy resulted in meaningful symptomatic improvement. The diagnostic trajectory highlights recurrent challenges: prolonged latency from symptom onset to recognition, therapeutic complexity in the setting of cardiovascular comorbidities, and limited access to standardized autonomic testing. In response, we have developed the BARO‑CARE Program, a structured pathway integrating comprehensive autonomic profiling to streamline diagnosis, guide individualized management, and support longitudinal monitoring. This case and early program experience emphasize that even chronic R‑ABF remains therapeutically modifiable when approached with pathophysiologically‑guided care. Programmatic, multidisciplinary models may reduce diagnostic delays and improve outcomes as the survivor population grows.