Importance:Merkel cell carcinoma (MCC) is a rare neuroendocrine malignant neoplasm often affecting the head and neck. Sentinel lymph node biopsy (SLNB) is routinely performed; however, the accuracy and reliability of SLNB for head and neck MCC remains unknown. Objective:To determine the accuracy of SLNB in head and neck MCC and inform pre- and post-SLNB risk stratification. Design, Setting, and Participants:This was a single-center cohort study of patients with clinically node-negative head and neck MCC who underwent SLNB from January 2006 to January 2025; median (IQR) follow-up was 1.9 (0.8-4.6) years. Data analysis was conducted from April to November 2025. Interventions:SLNB outcome and nodal disease status. Main Outcomes and Measures:SLNB accuracy measured by sensitivity, negative predictive value (NPV), and false negative (FN) rate. FN SLNB was defined as regional nodal recurrence at the first site of recurrence after a negative SLNB without concurrent local or in-transit recurrence. Factors associated with failed SLNB (defined as nonvisualization on lymphoscintigraphy, inability to identify the sentinel lymph node intraoperatively, or absence of nodal tissue in the pathology specimen) were evaluated using effect-size measures. Cox proportional hazards model identified factors associated with nodal disease, comparing patients who developed nodal disease (identified by SLNB or subsequent clinical and/or imaging evaluation) with those who did not develop nodal disease during follow-up. Results:Of 86 participants (mean [SD] age, 75.6 [9.6] years; 36 female [41.9%] and 50 male [58.1%] individuals) with clinically node-negative head and neck MCC, 69 (80.2%) underwent SLNB. Occult nodal disease was identified in 19 participants (27.5%). SLNB sensitivity was 52.6% (10 of 19 patients), NPV was 88.6% (31 of 35 patients), and FN rate was 26.7% (4 of 15 patients). SLNB failed in 29.0% (20 of 69 patients), with tumor location, female sex, and older age having medium to large effect on SLNB failure. Lymphovascular invasion, infiltrative growth pattern, and tumor size had the largest effect size on nodal disease with Cox analysis. Conclusions and Relevance:In this large single-site cohort study, SLNB remained a useful tool in head and neck MCC, identifying more than half of occult nodal disease. Given reduced performance in this region, patients with failed SLNB or negative SLNB plus high-risk features may benefit from tailored management, including intensified therapy and surveillance.

Purpose:This systematic review aims to evaluate the functional outcomes of total laryngeal transplantation by synthesizing findings from both preclinical and clinical studies. It focuses on assessing postoperative functional recovery, including swallowing, airway patency, phonation, and speech, while also considering the associated morbidities and immunosuppressive strategies. Methods:A systematic review was conducted for functional outcomes of total laryngeal transplantation through PubMed/MEDLINE, Embase, Scopus, and Web of Science databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Case reports, case series, letters to the editor, reviews, and preclinical studies related to laryngeal transplantation were eligible for inclusion. Methodological quality and risk of bias were assessed via the CAMARADES checklist for preclinical studies and the JBI checklists for clinical studies. Results:Out of n=188 identified studies, n=16 (8.5%) met the inclusion criteria. There were n=13 (81%) clinical and n=3 (19%) preclinical studies. In preclinical models, canine and minipig studies showed partial recovery: electrical stimulation restored vocal fold mobility in n=8 (40%) of canine allografts; some minipigs recovered swallowing, vocalization, and short-term survival post-transplant without immunosuppression, though all canines remained tracheostomy-dependent. Among n=18 (100%) human recipients, speech or phonation was restored fully or partially in n=12 (67%), as well as full or partial oral intake. Here, n=3 patients (17%) died within two years post-VCA, while n=4 (36%) resumed full oral intake. Voice quality was considered as satisfactory or better than pre-VCA in n=6 (55%) patients, whereas airway patency was deemed good or excellent. Nonetheless, no patient regained full vocal fold mobility. However, n=1 (5.6%) patient was able to breathe without a tracheostomy, and n=1 (5.6%) could intermittently cap their tracheostomy tube. Immunosuppressive regimens included tacrolimus (n=18, 100%), mycophenolate mofetil (n=15, 83%), corticosteroids (n=15, 83%), and anti-thymocyte globulin (n=6, 33%), with adjunctive use of leflunomide and stem cells in select cases. Conclusion:Laryngeal transplantation shows promising results in restoring swallowing and phonation, but challenges remain for breathing without tracheostomy. The procedure remains an experimental surgery, still associated with significant morbidity and mortality, and requires lifelong immunosuppression. Future research, including long-term follow-up, larger-scale trials and interdisciplinary collaboration, is essential to further refine this procedure and evaluate its outcomes comprehensively.

OBJECTIVES:Treatment of patients with head and neck squamous cell carcinoma of unknown primary (CUP) is challenging. Given the relative rarity of this condition and the recent use of primary transoral robotic surgery (TORS) in modern diagnostic and treatment algorithms, long-term oncologic outcomes are unclear. The objectives were to evaluate oncologic outcomes of patients treated with TORS for management of CUP. METHODS:This retrospective case series was conducted at a tertiary care academic medical center from 2010 to 2021. All patients with HPV-mediated CUP who underwent TORS-assisted endoscopy were included. CUP was defined as biopsy-proven squamous cell carcinoma in a cervical lymph node with uncertain primary location following standard-of-care clinical and radiologic assessment. Primary outcomes were recurrence-free survival and overall survival. Secondary outcomes included usage of radiation and chemotherapy. RESULTS:In total, 157 patients were included in the study. Median follow-up time was 62 months. Primary tumor was identified in 88% of patients. Surgery alone was performed in 21%, although adjuvant therapy was recommended but declined in 13%. Adjuvant radiation was completed in 46% and adjuvant chemoradiation in 33%. Two-thirds of patients avoided chemoradiation. Overall survival was 94% and recurrence-free survival was 92% at 5 years. CONCLUSION:In the largest reported experience to date of TORS-assisted management of CUP, we demonstrate that this approach facilitates a high rate of identification of occult mucosal malignancies and can eliminate the need for chemotherapy and potentially radiation therapy in select patients without compromising excellent oncologic and functional outcomes. LEVEL OF EVIDENCE: 4:

Objectives (1) To determine the incidence of occult contralateral cervical lymph node metastasis in patients with early-stage HPV-associated base-of-tongue (BOT) oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery; and (2) to compare survival and recurrence in patients who did and did not undergo contralateral neck treatment.Background Contralateral neck management in patients with early-stage HPV+ OPSCC of the BOT treated surgically remains controversial. Despite lacking data, most patients receive surgery and/or radiation to the contralateral neck based on historical incidence of occult lymph node metastasis in OPSCC.Methods A retrospective chart review of patients with AJCC 7th edition pT1-2, pN0-1 HPV+ BOT OPSCC undergoing transoral robotic BOT resection and ipsilateral neck dissection with adjuvant treatment was conducted. The incidence of occult contralateral nodal metastasis was assessed. Overall and disease-free survival were compared between patients who did and did not undergo contralateral neck treatment.Results Of 106 patients meeting inclusion criteria, 46 (43.3%) did not undergo treatment of the contralateral neck with radiation or lymphadenectomy, whereas 29 (27.4%) received radiation alone to the contralateral neck, and 31 (29.2%) underwent elective contralateral neck dissection without identification of occult metastasis in any case. Overall survival (HR: 0.95, 95% CI: 0.23-4.00) and disease-free survival (HR: 1.43, CI: 0.55-3.71) did not significantly differ between patients who did and did not receive treatment to the contralateral neck.Conclusion Risk of occult contralateral cervical lymph node metastasis in patients with early-stage HPV-associated BOT OPSCC treated with primary surgery was low, prompting consideration of forgoing contralateral neck treatment in these patients.

BACKGROUND:Oral potentially malignant disorders (OPMDs) occur in up to 4%-5% of the population, of which oral leukoplakia (OL) is the most common subtype. Predicting high-risk OL remains a challenge. Early diagnosis and effective treatment are thought to be of paramount importance to improve outcomes. METHODS:We searched PubMed and Clinicaltrials.gov data for updates in the clinical management of OL from 2015 to current. RESULTS:Recent publication of large cohorts of patients with OL aids in counseling patients regarding risk of malignant transformation. Management for OL includes surveillance, excision, and laser surgery, as well as local and systemic approaches to chemoprevention. Several new entities show promise regarding candidate biomarkers, chemoprevention agents, and diagnostic adjuncts, though all require further validation. CONCLUSION:This update serves to further inform clinical management of OL and provide impetus for future investigations. TRIAL REGISTRATION:NCT00099021, NCT00951379, NCT05727761, NCT05727761.

Employing label-free fluorescence lifetime imaging for cancer margin delineation during oropharyngeal resection surgery is impeded by molecular alterations from risk factors (alcohol, tobacco, HPV). Improved discrimination is observed in HPV-negative cancer compared to HPV-positive cases.

Importance:Late effects of head and neck cancer (HNC) treatment include profound dysphagia, chronic aspiration, and death. Functional laryngectomy (FL) can improve patient survival and quality of life (QoL); however, removing a failing larynx for a noncancer reason is a difficult decision. Data regarding the ability of FL to improve self-perceptions of voice, swallowing, and QOL in survivors of HNC with intractable aspiration are inconclusive. Objective:To investigate the association of FL with changes in self-reported perceptions of voice, swallowing, oral intake, QoL, and mood in survivors of HNC experiencing profound dysphagia and intractable aspiration. Design, Settings, and Participants:This cohort study was conducted at a single academic institution and included survivors of HNC with profound swallowing dysfunction and intractable aspiration who underwent FL from July 2016 through March 2022. Of the initial 22 patients enrolled, 2 patients (15%) died of aspiration pneumonia before receiving FL. Data analyses were performed from July 2016 through March 2023. Main Outcomes and Measures:Self-reported measures of voice using the VHI (30-item Voice Handicap Index), swallowing using the EAT-10 (10-item Eating Assessment Tool), functional oral intake scale using the FOIS (Functional Oral Intake Scale), and quality of life using the FACT-H&N (Functional Assessment of Cancer Therapy-Head & Neck) were assessed before FL and at 1, 3, and 6 months after FL. Mood states were evaluated using the POMS (Profile of Mood States, second edition), before FL and at 6 months after FL. Results:The study analyses included 20 patients (mean [SD] age, 72.4 (7.0) years; 19 [95%] males and 1 [5%] female) who underwent FL and had complete data across all time points. Among these, 12 patients (60%) had received chemoradiation for oropharyngeal, 7 (35%) for laryngeal, or 1 (5%) for nasopharyngeal cancer. The mean (SD) time from completion of oncologic treatment to FL was 15.5 (5.5) years. Mean (SD) score on the EAT-10 improved from 33.2 (7.4) to 23.1 (10.8) at 1 month; 12.1 (9.1) at 3 months; and 8.3 (7.4) at 6 months, with a large effect size (η2 = 0.72; 95% CI, 0.54-0.80). Mean (SD) score on the FOIS improved from 2.0 (1.5) to 2.9 (1.7) at 1 month; 4.8 (2.5) at 3 months; and 5.2 (1.7) at 6 months, with a large effect size (η2 = 0.6; 95% CI, 0.38-0.71). Improvement in oral intake was achieved in 19 patients (95%), and feeding tubes were removed in 10 of 16 patients (63%) who were feeding tube-dependent; 6 patients (27%) continued to require supplemental tube feedings. Mean (SD) score on the VHI improved from 63.6 (34.0) to 86.9 (33.7) at 1 month; 71.3 (36.1) at 3 months; and 39.7 (26.9) at 6 months, with a large effect size (η2 = 0.42; 95% CI, 0.19-0.56). Seventeen patients (85%) were able to use a tracheoesophageal voice prosthesis for alaryngeal communication. Mean (SD) score on the FACT-H&N improved from 86.2 (17.8) to 93.6 (18.4) at 1 month; 109.0 (18.4) at 3 months; and 121.0 (16.8) at 6 months, with a large effect size (η2 = 0.64; 95% CI, 0.42-0.74). Mean (SD) score on the POMS improved from 58.9 (13.2) at baseline to 44.5 (9.9) at 6 months, with a large effect size (Cohen d = 1.04; 95% CI, 0.48-1.57). None of the patients experienced major complications of FL; 1 patient (5%) had a postoperative pharyngocutaneous fistula. Conclusions and Relevance:The findings of this cohort study indicate that FL was associated with marked improvements in self-perception of voice and swallowing, functional oral intake, QoL, and mood state among survivors of HNC. These findings can serve as a framework for FL counseling among HNC survivors experiencing profound dysphagia and intractable aspiration.

BACKGROUND:The loss of laryngeal function affects breathing, swallowing, and voice, thus severely compromises quality of life. Laryngeal transplantation has long been suggested as a solution for selected highly affected patients with complete laryngeal function loss. OBJECTIVE:To obtain insights regarding the advantages, weaknesses, and limitations of this procedure and facilitate future advances, we collected uniform data from all known laryngeal transplants reported internationally. METHODOLOGY:A case series. Patients were enrolled retrospectively by each institutional hospital or clinic. Eleven patients with complete loss of laryngeal function undergoing total laryngeal transplantation between 1998 and 2018 were recruited. RESULTS:After a minimum of 24 months follow-up, three patients had died (27%), and there were two graft explants in survivors, one total and one partial, due to chronic rejection. In the remaining cases, voice was functional in 62.5% and 50% achieved decannulation. Swallowing was initially restricted, but only one patient was gastrostomy-dependent by 6 months and all had normal or near-normal swallowing by the end of year two after transplantation. Median follow-up was 73 months. Functional (voice, swallowing, airway) recovery peaked between 12 and 24 months. CONCLUSIONS:Laryngeal transplantation is a complex procedure with significant morbidity. Significant improvements in quality of life are possible for highly selected individuals with end-stage laryngeal disorders, including laryngeal neoplasia, but further technical and pharmacological developments are required if the technique is to be more widely applicable. An international registry should be created to provide better quality pooled data for analysis of outcomes of any future laryngeal transplants. LEVEL OF EVIDENCE:4 Laryngoscope, 134:4313-4320, 2024.

Objectives: Early detection and accurate diagnosis of lymph node metastasis (LNM) in head and neck cancer (HNC) are crucial for enhancing patient prognosis and survival rates. Current imaging methods have limitations, necessitating new evaluation of new diagnostic techniques. This study investigates the potential of combining pre-operative CT and intra-operative fluorescence lifetime imaging (FLIm) to enhance LNM prediction in HNC using primary tumor signatures. Methods: CT and FLIm data were collected from 46 HNC patients. A total of 42 FLIm features and 924 CT radiomic features were extracted from the primary tumor site and fused. A support vector machine (SVM) model with a radial basis function kernel was trained to predict LNM. Hyperparameter tuning was conducted using 10-fold nested cross-validation. Prediction performance was evaluated using balanced accuracy (bACC) and the area under the ROC curve (AUC). Results: The model, leveraging combined CT and FLIm features, demonstrated improved testing accuracy (bACC: 0.71, AUC: 0.79) over the CT-only (bACC: 0.58, AUC: 0.67) and FLIm-only (bACC: 0.61, AUC: 0.72) models. Feature selection identified that a subset of 10 FLIm and 10 CT features provided optimal predictive capability. Feature contribution analysis identified high-pass and low-pass wavelet-filtered CT images as well as Laguerre coefficients from FLIm as key predictors. Conclusions: Combining CT and FLIm of the primary tumor improves the prediction of HNC LNM compared to either modality alone. Significance: This study underscores the potential of combining pre-operative radiomics with intra-operative FLIm for more accurate LNM prediction in HNC, offering promise to enhance patient outcomes.

Supplementary Data from A Genetic Expression Profile Associated with Oral Cancer Identifies a Group of Patients at High Risk of Poor Survival

Incomplete surgical resection with residual cancer left in the surgical cavity is a potential sequelae of Transoral Robotic Surgery (TORS). To minimize such risk, surgeons rely on intraoperative frozen sections analysis (IFSA) to locate and remove the remaining tumor. This process, may lead to false negatives and is time-consuming. Mesoscopic fluorescence lifetime imaging (FLIm) of tissue fluorophores (i.e., collagen and metabolic co-factors NADH and FAD) emission has demonstrated the potential to demarcate the extent of head and neck cancer in patients undergoing surgical procedures of the oral cavity and the oropharynx. Here, we demonstrate the first label-free FLIm-based classification using a novelty detection model to identify residual cancer in the surgical cavity of the oropharynx. Due to highly imbalanced label representation in the surgical cavity, the model employed solely FLIm data from healthy surgical cavity tissue for training and classified the residual tumors as an anomaly. FLIm data from N = 22 patients undergoing upper aerodigestive oncologic surgery were used to train and validate the classification model using leave-one-patient-out cross-validation. Our approach identified all patients with positive surgical margins (N = 3) confirmed by pathology. Furthermore, the proposed method reported a point-level sensitivity of 0.75 and a specificity of 0.78 across optically interrogated tissue surface for all N = 22 patients. The results indicate that the FLIm-based classification model can identify residual cancer by directly imaging the surgical cavity, potentially enabling intraoperative surgical guidance for TORS.

Intraoperative identification of head and neck cancer tissue is essential to achieve complete tumor resection and mitigate tumor recurrence. Mesoscopic fluorescence lifetime imaging (FLIm) of intrinsic tissue fluorophores emission has demonstrated the potential to demarcate the extent of the tumor in patients undergoing surgical procedures of the oral cavity and the oropharynx. Here, we report FLIm-based classification methods using standard machine learning models that account for the diverse anatomical and biochemical composition across the head and neck anatomy to improve tumor region identification. Three anatomy-specific binary classification models were developed (i.e., “base of tongue,” “palatine tonsil,” and “oral tongue”). FLIm data from patients (N = 85) undergoing upper aerodigestive oncologic surgery were used to train and validate the classification models using a leave-one-patient-out cross-validation method. These models were evaluated for two classification tasks: (1) to discriminate between healthy and cancer tissue, and (2) to apply the binary classification model trained on healthy and cancer to discriminate dysplasia through transfer learning. This approach achieved superior classification performance compared to models that are anatomy-agnostic; specifically, a ROC-AUC of 0.94 was for the first task and 0.92 for the second. Furthermore, the model demonstrated detection of dysplasia, highlighting the generalization of the FLIm-based classifier. Current findings demonstrate that a classifier that accounts for tumor location can improve the ability to accurately identify surgical margins and underscore FLIm's potential as a tool for surgical guidance in head and neck cancer patients, including those subjects of robotic surgery.

Objectives Head and neck cancer surgeons frequently interact with dying patients with advanced disease and their families, but little is known about their bereavement practices after a patient's death. The aim of this study is to elucidate the frequency of common bereavement practices, cited barriers to bereavement, and predictive physician factors that lead to an increase in bereavement practices among head and neck cancer surgeons. Methods A 20‐item survey was sent to 827 active surgeons of the American Head and Neck Society. Approval was obtained and the survey was distributed through the American Head and Neck Society. Demographics, frequency of common bereavement practices, empathy, and barriers were assessed. Multiple linear regression was performed to determine physician factors associated with more frequent bereavement follow‐up. Results There were 156 respondents (18.9% response rate). Overall, surgeons were more likely to usually/always call (48.5%) or send a letter (42.4%) compared with other practices such as attending funerals (0%), offering family meetings (18.6%), or referring family members to counseling (7.7%). Many barriers were cited as being at least somewhat important: being unaware about a patient's death (67.3%) was the most cited, whereas 51.3% cited a lack of mentorship/training in this area. Scoring higher on empathy questions ( P ≤ .001) was associated with more frequent surgeon bereavement follow‐up with the family of deceased patients. Conclusion There is substantial practice variation among surgeons suggesting a lack of consensus on their roles in bereavement follow‐up. Having higher empathy was predictive of higher engagement. Level of Evidence NA Laryngoscope , 132:1971–1975, 2022

Purpose: The purpose of this study is to examine the use of the Patient Health Questionnaire-2 (PHQ-2) to screen for depression in patients undergoing treatment for head and neck cancer and to evaluate potential patientspecific risk factors that may contribute to depression. Materials and methods: This is a retrospective study at a tertiary-level hospital of outpatient adult patients with head and neck cancer who completed the PHQ-2/9 from 2019 to 2020. Patients were given a PHQ-2 during a surveillance visit. A positive PHQ-2 screen (score = 3) prompted further evaluation with a PHQ-9. Patients were stratified into either low risk (PHQ-2 score < 3) or high risk (PHQ-2 score = 3) for depression. Univariate regression was performed on all variables, and a multivariate logistic regression was performed on statistically significant variables (P < 0.05). Results: In total, 110 patients were included in this study. Fifteen (14 %) patients had a positive PHQ-2 screen with a score = 3 and underwent evaluation with a PHQ-9. The median PHQ-9 score was 15 (6-26). The PHQ-2 = 3 group were significantly younger (59 years vs. 67 years; P = 0.03) and had a greater number of patients with a psychiatric history (33 % vs. 8 %; P < 0.01). Conclusions: There is a strong association between a PHQ-2 score = 3 and detection of depressive symptoms among patients with head and neck cancer. Younger age and pretreatment mental illness are significant risk factors for developing depression following treatment. Early screening and treatment should be considered for all patients to mitigate the burden of depression and suicide in this patient population. Further research is warranted to investigate utilization of the PHQ-2/9 to detect depression and barriers that exist for timely screening and interventions.

INTRODUCTION:Radiofrequency ablation (RFA) has gained significant recent global interest in the treatment of benign thyroid nodules and thyroid cancer. It is a relatively new, minimally invasive, thermal ablation technique that is an alternative to surgery. Several clinical practice guidelines (CPGs), consensus statements, and recommendations currently exist for the use of RFA in the treatment of benign thyroid nodules and thyroid cancers. These documents have considerable variability amongst them, and to date, their quality and methodologic rigor have not been appraised. OBJECTIVE:To identify and perform a quality appraisal of clinical practice guidelines for RFA in the treatment of benign thyroid nodules and thyroid cancer using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. METHODS:A comprehensive literature search was performed in MEDLINE (via PubMed), EMBASE, and SCOPUS databases from inception to November 1, 2021. Four reviewers independently evaluated each guideline using the AGREE II instrument. Scaled domain scores were generated and the threshold used for satisfactory quality was >60%. Additionally, intraclass correlation coefficients (ICCs) were calculated to determine level of agreement between reviewers. RESULTS:Seven guidelines were selected for final evaluation based on inclusion/exclusion criteria. Two guidelines were classified "high" quality, one "average" quality, and the rest "low" quality. The "Clarity and Presentation" (65.68 ± 26.1) and "Editorial Independence" (61.32 ± 25.8) domains received the highest mean scores, while the "Applicability" (32.14 ± 22.8) and "Rigor of Development" (45.02 ± 29.8) domains received the lowest mean scores. ICC statistical analysis showed high magnitude of agreement between reviewers with a range of (0.722-0.944). CONCLUSION:Reflecting upon our quality appraisal, it is evident that the quality and methodologic rigor of RFA guidelines can be improved upon in the future. Our findings also elucidate the existing variability/discrepancies amongst guidelines in the indications and use of RFA.

Background: Novel, non-invasive diagnostic biomarkers that facilitate early intervention in head and neck cancer are urgently needed. Polyamine metabolites have been observed to be elevated in numerous cancer types and correlated with poor prognosis. The aim of this study was to assess the concentration of polyamines in the saliva and urine from head and neck cancer (HNC) patients, compared to healthy controls. Methods: Targeted metabolomic analysis was performed on saliva and urine from 39 HNC patient samples and compared to 89 healthy controls using a quantitative, targeted liquid chromatography mass spectrometry approach. Results: The metabolites N1-acetylspermine (ASP), N8-acetylspermidine (ASD) and N1,N12-diacetylspermine (DAS) were detected at significantly different concentrations in the urine of HNC patients as compared to healthy controls. Only ASP was detected at elevated levels in HNC saliva as compared to healthy controls. Conclusion: These data suggest that assessment of polyamine-based metabolite biomarkers within the saliva and urine warrants further investigation as a potential diagnostic in HNC patients.

The primary standard of care for Head and Neck (H&N) cancer patients is the complete surgical removal of cancer. Tissue classifiers based of autofluorescence lifetime imaging (FLIm) parameters have shown potential to differentiate healthy from cancer tissue in H&N patients and thus enhance the accuracy of this procedure. Here we report how collective autofluorescence trends (100-patient cohort, oral/oropharyngeal cancer) driving healthy vs. tumor contrast depend on anatomical location, patient medical history (e.g. tobacco use) and surgical context (in vivo vs. ex vivo). Accounting for such biological variables may further improve the accuracy of FLIm-guided H&N cancer surgery.

OBJECTIVES:To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship.METHODS:Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence.RESULTS:Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists.CONCLUSION:Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.