Symptom trajectories in head and neck cancer from diagnosis to long-term survivorship

Abstract Purpose Patients with head and neck cancer (HNC) experience substantial symptom burden related to both disease and intensive treatments. Understanding long-term symptom patterns may help identify patients at risk for persistent emotional and physical symptom burden. This study evaluated symptom trajectories of anxiety, depression, fear of cancer recurrence (FCR), and oral pain among patients with HNC from diagnosis through long-term survivorship. Methods This secondary analysis included 5411 patients with HNC from the Head and Neck 5000 study in the UK. Latent class growth analysis (LCGA) and growth mixture modeling (GMM) were used to examine changes in symptoms, predictors of class membership, and within-class variability. Results The majority of patients were classified into a mild symptom class for depression (58%), anxiety (48%), and oral pain (62%), whereas the largest FCR class (44%) represented moderate symptoms. Anxiety, FCR, and oral pain followed recovery trajectories characterized by symptom improvement, while depression demonstrated a distinct pattern of worsening symptoms. Across symptoms, nearly 20% of patients belonged to an elevated symptom trajectory. These patients were more likely to be younger in age, have lower income, and report greater weekly alcohol consumption. Patients with HPV-positive HNC experienced faster reductions in anxiety and FCR but greater increases in depression over time. Conclusions Distinct symptom trajectories were observed into long-term survivorship among patients with HNC. Although most patients experienced mild-to-moderate symptoms, a clinically important subgroup remained at elevated risk for persistent symptoms. Implications for Cancer Survivors Early identification of patients at risk for persistent symptoms may facilitate targeted supportive care and behavioral interventions to improve long-term survivorship outcomes.