BackgroundQuality of life (QoL) is largely determined by our psychological well-being, yet commonly used somatic QoL measures often emphasize physical symptoms. Consequently, psychological needs in individuals who lack physical comorbidities are often overlooked. The General Well-Being Schedule (GWB) is a validated tool for assessing well-being, without focusing on physical dysfunction or being disease specific. As sensory impairments are strongly linked to reduced QoL, a Swedish GWB could have substantial clinical value.ObjectiveTo translate and culturally adapt the GWB into Swedish following the guidelines of the International Society for Health Economics and Outcomes Research (ISPOR), and to establish adequate content validity of the resulting instrument.MethodsThe GWB was translated into Swedish from English by following the ISPOR guidelines. Forward and backward translations were performed. Both healthcare professionals and patients with olfactory or hearing disorders contributed their opinions on the translation through focus groups, interviews, and ratings. Based on their input, we calculated the Scale Content Validity Index (S-CVI) and the Item Content Validity Index (I-CVI), to measure the questionnaire’s overall content validity and the content validity of each item, respectively.ResultsThe focus groups and interviews resulted in several linguistic and cultural adjustments. Content validity was excellent for the questionnaire as a whole with an S-CVI of 0.91. Out of the 18 questions, 16 had an excellent I-CVI (mean = 0.94).ConclusionThe GWB was successfully translated and culturally adapted for use in Sweden, following the ISPOR guidelines. The excellent content validity of the translation supports the relevance of the translated instrument.

Background: Informal caregivers (ICs), often family members or close friends, provide essential support to individuals with head and neck cancer. However, they are frequently unprepared for the emotional, practical, and medical challenges involved. Web-based applications offer promising opportunities to support ICs, but their long-term adoption and acceptance remain uncertain. Objective: This paper presents the development of Carer eSupport, a web-based application to support ICs' well-being and preparedness for caregiving. We detail the design and functionality of the Carer eSupport application and explain how it responds to both the functional and psychological needs of ICs. Additionally, we report findings from the pilot study and highlight the initial challenges ICs faced when engaging with the application, along with the strategies used to overcome them. Methods: The study involved a multicenter research trial across ear, nose, and throat clinics and oncology and radiotherapy clinics at 4 university hospitals in Sweden. The application was developed through 3 human-centered design (HCD) iterations involving ICs, health care professionals, and researchers in human-computer interaction and cancer care. Results: The results present an overview of the current version of Carer eSupport (developed during the third design iteration), with a focus on features that address the psychological needs of ICs, including competence, autonomy, and a sense of connection to others. The pilot study achieved a 66.7% (20/30) consent rate, a 75% (9/12) successful login rate among participants, and a 13.3% (4/30) attrition rate, meeting the established criteria. The pilot study confirmed the application's readiness for further evaluation in an ongoing randomized controlled trial. It also identified challenges, including the time constraints of ICs, login and authentication issues, limited IT infrastructure, and gaps in digital literacy. Conclusions: Findings from the HCD process and pilot study indicate that a personalized, interactive application like Carer eSupport can provide meaningful support for ICs of individuals with head and neck cancer. The integration of HCD and health care science offers early guidance for developing digital tools that are both evidence-based and empathetic, with potential relevance beyond caregiving contexts. Trial Registration: ClinicalTrials.gov NCT05028452, https://clinicaltrials.gov/study/NCT05028452 and NCT06307418, https://clinicaltrials.gov/study/NCT06307418 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-024-12273-y

Head and neck cancer comprises a heterogeneous group of tumours affecting anatomical sites of the upper aerodigestive tract. Treatment often involves surgery and either radiotherapy or chemoradiotherapy. These treatments are associated with substantial morbidity and may have long-lasting adverse effects on oral health. Oral complications can negatively affect health-related quality of life, nutritional status, and social and work-related functioning. The aim is to evaluate an oral health care programme designed to prevent or mitigate late oral sequalae, and to assess its impact on health-related quality of life, oral health, work ability, nutritional status, healthcare-related economic costs, and psychological well-being. This is a study protocol for a Swedish multicentre, two-armed, superiority randomised controlled trial that has been ethically approved by the Swedish Ethical Review Authority. Patient inclusion commenced in September 2025, with an intended sample of 300 participants. Adult patients (≥ 18 years) planned for curative-intent treatment for head and neck cancer (oral cavity, oropharynx, larynx stage III and IV, hypopharynx, nasopharynx, salivary gland, or unknown primary) are randomised (1:1) to either an oral health care programme (intervention) or standard of care. Exclusion criteria: severe alcoholism, cognitive impairment, or inability to understand the Swedish language. Participants are followed before the start of cancer treatment and at 4 follow-ups: 6 months after completion of treatment, and 1, 2, and 3 years after the 6-month follow-up. The primary outcome measure is health-related quality of life. Secondary outcomes include quantitative oral health indicators, return to work, nutritional status, healthcare-related economic costs, and patient-reported outcome measures focusing on self-reported oral health and psychological well-being (depression, anxiety and stress), and self-efficacy. Oral health follow-up for head and neck cancer survivors often lacks consistency and uniformity. To date, few oral health care interventions for head and neck cancer survivors have been evaluated within the framework of a randomised controlled trial. The findings have the potential to inform clinical practice and contribute to the development of more integrated, evidence-based oral healthcare strategies within routine follow-up for head and neck cancer survivors, with the overarching goal of improving their oral health and long-term quality of life. ClinicalTrials.gov NCT07173270, date 15/9/2025.

Long-term patient-reported outcomes (PROMs) may provide insight into the impact of advances in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). The main aim of the study was to assess and compare PROMs in OPSCC patients treated during two different periods (1998–2006 vs. 2015–2021), reflecting advances in treatment strategies and developments in care. The present study is based on data from two Swedish multicentre studies: the randomised controlled trial ARTSCAN1 (1998–2006) and the observational study NIPHNC (2015–2021). Patients received curative-intent radiotherapy as part of the ARTSCAN or NIPHNC studies. All patients completed PROMs at multiple time points up to 24 months post-treatment. PROMs were assessed using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire EORTC QLQ-H N35 and the Hospital Anxiety and Depression Scale HADS. A total of 363 patients were included, with 161 and 202 patients from ARTSCAN1 and NIPHNC, respectively. At baseline and at all post-radiotherapy time points, the NIPHNC cohort reported fewer symptoms and lower anxiety/depression. At 2 years, both groups showed improvement, though persistent issues like dry mouth and sticky saliva remained common. Comparison of two treatment protocols demonstrates improvements in short- and long-term PROMs over time. Long-term salivary symptoms remain prevalent in patients with OPSCC.

Despite advances in the management of head and neck squamous cell carcinoma (HNSCC), mortality within 6 months of diagnosis remains a substantial clinical challenge. The objectives of this study are: (i) to develop a machine learning (ML) model using data from the Surveillance, Epidemiology, and End Results (SEER) program to assess the influence of patient characteristics, tumor features, and treatment modalities on early mortality in HNSCC; (ii) to explore and compare the prognostic potentials of patient-, tumor, and treatment-related factors across distinct mortality time points-6-month mortality (early mortality), 24-month mortality, and 5-year mortality; and (iii) to externally and independently validate the early mortality model using multicenter data from the Thuringian Cancer Registry (Jena, Germany) and a prospective observational cohort from the Helsinki University Hospital (Helsinki, Finland). We identified 4802 patients with HNSCC from the SEER for model development. Permutation-based feature importance was used to identify risk factors associated with early mortality. External validation was conducted using 1952 cases from the Thuringian Cancer Registry and 58 cases from the Helsinki University Hospital. The ML model achieved a weighted area under curve (AUC) of 0.75 for predicting early mortality in the SEER cohort. External validation yielded weighted AUC values of 0.70 (Germany) and 0.60 (Finland). Aggregate feature importance for early mortality indicated that higher age at diagnosis, presence of earlier primary malignant tumors besides HNSCC, unmarried patients with T1-T3 HNSCC, T3 stage, and having hypopharyngeal or laryngeal cancer, in decreasing order of significance, were important. For 24-month mortality, the associated risk factors in decreasing order of significance were T3 stage, being elderly in terms of age at diagnosis, presence of earlier primary malignant tumors besides HNSCC, having hypopharyngeal or oral cavity cancer, and N3 stage. The associated risk factors for 5-year mortality were found to be the same with those of early mortality with the additional inclusion of T2 stage. Identification of patients at elevated risk of early death supports timely intervention and individualized therapeutic decision-making. The developed ML model identified several risk factors associated with early death and may aid in clinical decision-making with the potential to improve survival outcomes.

Background: Diagnosis and treatment of head and neck squamous cell carcinoma (HNSCC) induces psychological variables and treatment-related toxicity in patients. The evaluation of outcomes is warranted for effective treatment planning and improved disease management. Objectives: This study aimed to build a prognostic system by combining clinicopathological parameters, treatment-related factors, and sociodemographic factors as integrative inputs to build a machine learning (ML) model to estimate the overall survival (OS) of patients with HNSCC. Furthermore, we explored the complementary prognostic potentials of these input parameters. We provide explainability and interpretability using Local Interpretable Model-agnostic Explanations (LIME) and SHapley Additive exPlanations (SHAP) techniques. Methods: A total of 419 patients with HNSCC were recruited from three University Hospitals in Sweden. We compared the performance of TabNet, a state-of-the-art deep learning algorithm for tabular data, with extreme gradient boosting (XGBoost) and voting ensemble to predict OS in patients with HNSCC. Results: Both TabNet and XGBoost showed comparable performance accuracies, with TabNet and XGBoost showing a performance accuracy of 88.1% each and voting ensemble showing an accuracy of 88.7%. The aggregate feature importance showed that p16 (a tumor suppressor protein that plays a crucial role in cell cycle regulation), cancer stage, hemoglobin, age at diagnosis, T class, N class, smoking pack-years, body mass index (BMI), treatment modality, erythrocyte count, and human papillomavirus (HPV) status were the most important parameters for the predictive ability of the model for OS. Furthermore, we found survival trends in this cohort by individually considering parameters such as p16, cancer stage, hemoglobin, age at diagnosis, HPV status, Tumor Nodal Metastasis staging, and socioeconomic factors (marital status, housing, and level of education). In addition, both the LIME and SHAP techniques showed the contribution of each feature to the prediction made by the model. Conclusions: The clinical implementation of an ML model can lead to individualized risk-based therapeutic decision-making. Therefore, validating these models with multiinstitutional datasets and testing them in the context of clinical trials is warranted for safe clinical implementation.

Most head and neck squamous cell carcinoma (HNSCC) cases are diagnosed late, with an increased risk of recurrence and distant metastasis. In recent years, there has been a surge in the development of prognostic and predictive machine learning (ML) models for personalized treatment planning. However, only a small number of these have been externally validated. This study aimed to build a prognostic system by combining clinicopathological parameters and treatment-related factors as integrative inputs to build a machine learning (ML) model using data from the Surveillance, Epidemiology, and End Results (SEER, United States) program. We further validated the developed model using multicenter data obtained from the Thuringian Cancer Registry (Germany) and a multicenter prospective observational study obtained from the Uppsala University Hospital (Sweden) to estimate the overall survival (OS) of patients with HNSCC. Additionally, we explored the complementary prognostic potentials of these input parameters using permutation feature importance (PFI). A total of 40,164 patients with HNSCC were recruited from the SEER database and validated with 3950 cases obtained from the Thuringian Cancer Registry and 323 cases recruited from three University Hospitals in Sweden. We evaluated the prognostic significance of the input variables to predict OS in patients with HNSCC using permutation feature importance. The voting ensemble ML algorithm gave an area under receiving operating characteristics curve (AUC) of 0.76 and an accuracy of 70.0%. Independent external validation of the validation model with data from the Thuringian Cancer Registry and the Uppsala University Hospital gave AUCs of 0.68 and 0.76, with decreased performance accuracy in both cohorts. The PFI analysis of the base model showed that age at diagnosis, T stage, tumor site, marital status, and surgical treatment were the most important parameters for the predictive ability of the model for OS. External independent geographic validation is important for performance reproducibility and model generalization before recommending the model for further clinical evaluation. External independent geographic validation may not necessarily increase the performance accuracy. However, it can reveal and demonstrate the performance of the model outside the development data. A generalized ML can lead to individualized risk-based therapeutic decision-making. While independently validating the model may be possible during model development, data privacy and security-related issues may prevent including it as a prerequisite in the ML model development pipeline.

BACKGROUND:A significant proportion of patients with head and neck squamous cell carcinoma (HNSCC) are malnourished at diagnosis. In this study, we investigated how pretreatment body mass index (BMI) and fat-free mass index (FFMI) correlate with early death, and whether these measurements are useful markers of prognosis for risk stratification of head and neck cancer patients. METHODS:Patients (n = 404) with newly diagnosed, curable HNSCC and WHO performance status 0-2 were prospectively included and met with a study representative before treatment initiation, as well as up to four follow-up visits. All patients provided an estimate of body weight at 6 months prior to diagnosis. Bioelectrical impedance analysis (BIA) was performed for all patients before treatment initiation. RESULTS:Most patients had oropharyngeal (46%), oral cavity (28%), or laryngeal cancer (12%). Forty-five (11%) patients met the standardized criteria for malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) at diagnosis. FFMI at diagnosis was lower in patients who died within 6 and 12 months after the start of treatment than in patients who survived these time points (p = 0.035 and p = 0.005, respectively). CONCLUSIONS:In this study, pretreatment FFMI was an independent prognostic factor for death within 6 and 12 months after the start of treatment in patients with HNSCC. Pretreatment BMI was not an independent risk factor for death within 6 and 12 months after treatment termination. Thus, FFMI may be useful for risk stratification of patients with head and neck cancer.

BACKGROUND:Informal caregivers (ICs) of patients with cancer provide essential and mainly uncompensated care. A self-perceived preparedness to care for the patient is associated with a lower caregiver burden, described as the extent to which caregiving is perceived as having adverse effects on IC functioning and well-being. ICs' well-being is associated with patient-perceived quality of care, suggesting that interventions to optimize ICs' health are essential in order to improve patient care. Head and neck cancer (HNC) is the seventh most common malignant disease in the world. The disease and its treatment have a significant negative impact on the patient's health and quality of life. Symptoms usually interfere with swallowing, food and fluid intake, breathing, speaking, and communication. ICs frequently manage patients' symptoms and side effects, especially problems related to nutrition and oral pain, without being properly prepared. Carer eSupport is an Internet-administered intervention, based on focus group discussions with ICs, developed in collaboration with ICs and healthcare professionals, tested for feasibility, and deemed feasible. This study protocol outlines the methods of investigating the effects of Carer eSupport plus support as usual (SAU) on self-reported preparedness for caregiving, caregiver burden, and well-being in the ICs of patients with HNC, compared with ICs receiving SAU only.METHODS AND ANALYSIS:In this randomized controlled trial, 110 ICs of patients with HNC, undergoing radiotherapy combined with surgery and/or medical oncological treatment, will be randomized (1:1) to Carer eSupport plus SAU or SAU only. Data will be collected at baseline (before randomization), post-intervention (after 18 weeks), and 3 months after post-intervention. The primary outcome is self-reported preparedness for caregiving. Secondary outcomes are self-reported caregiver burden, anxiety, depression, and health-related quality of life. The effect of Carer eSupport plus SAU on preparedness for caregiving and secondary outcomes, compared with SAU only, will be evaluated by intention to treat analyses using linear regression models, mixed-model regression, or analysis of covariance.DISCUSSION:If proven effective, Carer eSupport has the potential to significantly improve ICs' preparedness for caregiving and their wellbeing, thereby improving patient-perceived quality of care and patient wellbeing.TRIAL REGISTRATION:ClinicalTrials.gov; NCT06307418, registered 12.03.2024 (https://clinicaltrials.gov/search? term=NCT06307418).

Background: The Head and Neck Patient Symptom Checklist (HNSC) is a validated 2-part instrument used to ask patients with head and neck cancer about the nutrition impact symptoms they experience (part 1) and how these interfere with their eating (part 2). Purpose: The purpose of this work was to translate and culturally adapt the HNSC into Swedish in accordance with the guidelines of the International Society for Health Economics and Outcomes Research (ISPOR). Methods: The ISPOR guidelines include 10 steps, and these were thoroughly followed. In step 7, 9 health care professionals from the field of head and neck cancer assessed the perceived relevance (content validity) of each item in the HNSC, as well as the full HNSC. A total of 522 participants with head and neck cancer were included and followed up on 7 occasions using the HNSC to assess internal consistency. Results: The HNSC was translated from English into Swedish, ensuring accuracy through forward and backward translation and harmonization in the research team. Content validity for each part of the HNSC was rated excellent (scale content validity index 0.96). Internal consistency demonstrated a good Cronbach's alpha score (>0.8) across the 7 follow-up time points (from baseline [before the start of treatment] and up to 24 months posttreatment). Conclusions: The HNSC has been successfully translated and culturally adapted into Swedish. The HNSC can be used in both clinical practice and research to screen for nutrition impact symptoms and symptoms that interfere with eating in patients with head and neck cancer. Trial registration: ClinicalTrials.gov NCT03343236 (date of registration: November 17, 2017)

Purpose This study aimed to investigate whether malnutrition or nutrition impact symptoms (NIS) affect the possibility of returning to work after treatment for head and neck cancer. Methods Patients of working age with head and neck cancer were followed up from treatment initiation to 3 months ( n = 238), 1 year ( n = 182), and 2 years ( n = 130) after treatment completion. The observed decrease in the number of patients over time was due to retirement, lack of follow-up, or death. Returning to work was dichotomised as yes or no. Malnutrition was diagnosed 7 weeks after treatment initiation using the Global Leadership Initiative on Malnutrition (GLIM) criteria. This time-point corresponds to the end of chemoradiotherapy or radiotherapy (with or without prior surgery), except for patients who underwent exclusive surgery. NIS were scored on a Likert scale (1–5) at each follow-up using the Head and Neck Patient Symptom Checklist © (HNSC © ). Nonparametric tests were used to analyse the ability of patients with/without malnutrition and high/low NIS scores to return to work. Results At 3 months, 1 year, and 2 years after treatment completion, 135/238 (56.7%), 49/182 (26.9%), and 23/130 (17.7%) patients had not returned to work. Patients with malnutrition at 7 weeks after treatment initiation were more likely to not return to work at 3 months than those without malnutrition, 70.5% compared to 47.1% (p < 0.001). At all three follow-up time-points, patients reporting high scores for a number of NIS had more often not returned to work, with this pattern being most distinct at 2 years. Conclusion Malnutrition according to the GLIM criteria at 7 weeks after treatment initiation and NIS assessed by the HNSC © at subsequent follow-ups were predictors of the return-to-work process after treatment for up to 2 years. Trial registration number ClinicalTrials.gov NCT03343236 (date of registration 17/11/2017).

AIMS:To examine the prognostic value of F-18 fluorodeoxyglucose (FDG) uptake in the bone marrow (BM) for disease recurrence and survival in patients with oropharyngeal squamous cell carcinoma (OP-SCC). The secondary aims were to evaluate the prognostic value of PET/CT parameters for the primary oropharyngeal tumor and total tumor burden, and to assess the correlation between FDG uptake variables and serum inflammatory markers. METHODS:This was an observational study of 91 patients with OP-SCC who underwent pretreatment FDG-PET/CT. The patients' blood samples were collected before treatment, and treatment was administered with the intention to cure. The median follow-up time was 40 months. The PET parameters measured were SUVmeanBM for the assessment of BM FDG uptake, SUVmean, SUVmax, total lesion glycolysis (TLG), and metabolic tumor volume (MTV) for the evaluation of primary oropharyngeal tumor and total tumor burden. Blood samples were analyzed to determine each patient's white cell, red cell, and platelet cell counts, hemoglobin, and C-reactive protein level. In a subgroup of 33 patients, blood serum was analyzed to evaluate the expression of serum immune proteins using a proximity extension assay (Olink Proteomics). RESULTS:The univariate analysis revealed that SUVmeanBM and tumor-specific parameters (SUVmaxtumor, SUVmeantotal, SUVmaxtotal, MTVtotal, TLGtotal) were significantly associated with recurrence-free survival (RFS). After adjusting for age, sex, and stage only SUVmeanBM remained significantly associated with RFS. Spearman's correlation identified several correlations between PET parameters and inflammatory markers. CONCLUSIONS:Our results show that several FDG-PET/CT parameters may have a prognostic value of treatment outcome in patients with OP-SCC. However, SUVmeanBM was the only independent PET parameter that showed a prognostic value for RFS in the study cohort. Moreover, the study findings might suggest an association between systemic inflammation and the metabolic activity in the BM.

Informal caregivers (ICs), including the patient's spouse, close relatives, or friends, play an important role in caregiving individuals with head and neck cancer (HNC). AI-based chatbots might offer information and assistance related to caregiving. This study presents the viewpoints of ICs and healthcare professionals (HCPs) on using AI-based chatbots in caring for individuals with HNC. A total of six focus groups were conducted with 15 ICs and 13 HCPs from three Swedish university hospitals. The study uncovers a widespread hesitancy toward the intention to use AI-based chatbots among ICs and HCPs. Factors contributing to this reluctance include their distrust in chatbot-provided information, negative past experiences of using chatbots, and lack of human connection in chatbot interactions. Embracing a holistic approach is crucial when designing chatbots, ensuring active user engagement and incorporating their perspectives into the design process.

PURPOSE:Being an informal caregiver of an individual with head and neck cancer can be demanding. Still, informal caregivers can provide valuable support to patients throughout the disease trajectory. The aim of this study was to explore informal caregivers' views on their challenges and needs in attaining high preparedness for caregiving.METHODS:Fifteen informal caregivers of individuals with head- and neck cancer participated in a focus group discussion or an individual interview. Thematic analysis utilizing an inductive approach was performed.RESULTS:The results describe the challenges that informal caregivers to individuals with head and neck cancer perceive and their needs for support in preparedness for caregiving. Three main themes were found: Challenges of being an informal caregiver, Transformation in life and Informal caregiver' needs of support and sharing care.CONCLUSION:This study contributes to the understanding of the challenges for informal caregivers to individuals with head and neck cancer in increasing preparedness for caregiving. To improve preparedness for caregiving, informal caregivers need education, information and support regarding physical, psychological and social issues for individuals with head and neck cancer.

The main prognostic factors for patients with head and neck cancer are the tumour site and stage, yet immunological and metabolic factors are certainly important, although knowledge is still limited. Expression of the biomarker p16INK4a (p16) in oropharyngeal cancer tumour tissue is one of the few biomarkers for the diagnosis and prognosis of head and neck cancer. The association between p16 expression in the tumour and the systemic immune response in the blood compartment has not been established. This study aimed to assess whether there is a difference in serum immune protein expression profiles between patients with p16+ and p16- head and squamous cell carcinoma (HNCC). The serum immune protein expression profiles, using the Olink® immunoassay, of 132 patients with p16+ and p16- tumours were compared before treatment and one year after treatment. A significant difference in the serum immune protein expression profile was observed both before and one year after treatment. In the p16- group, a low expression of four proteins: IL12RB1, CD28, CCL3, and GZMA before treatment conferred a higher rate of failure. Based on the sustained difference between serum immune proteins, we hypothesise that the immunological system is still adapted to the tumour p16 status one year after tumour eradication or that a fundamental difference exists in the immunological system between patients with p16+ and p16- tumours.

Purpose: To examine how individuals treated for head and neck cancer perceive life one year after the end of treatment and how they experience supportive efforts from health care. Methods: A semi-structured interview study of 21 patients was performed one year after the end of treatment. The patients gave their views concerning physical, psychological, and return-to-work issues, and their experiences concerning rehabilitative efforts from health care and particularly the contact nurse were captured. A thematic analysis was conducted. Results: One year after treatment the patients were still suffering from side effects and from fear of recurrence, but they strived to live as they did before the cancer diagnosis, such as having returned to work and resuming leisure activities. Moreover, the rehabilitative efforts from health care had ended. Having access to a contact nurse, also known as a clinical nurse specialist, was positive, however, the participants lacked regular long-term follow-ups with the contact nurse regarding rehabilitation needs. Improvement possibilities were seen in clarifying the role of the contact nurse and that the contact nurse should show engagement and make the initial contact with the patients. Conclusion: Despite the sequelae from treatment, the patients strived to live as before their diagnosis. By regular, engaged, and long-term follow-ups by the contact nurse, remaining needs may be uncovered, and appropriate individualized support and rehabilitation can be offered.

Striving to return to work is of great importance to many cancer survivors. The purpose of the study is to prospectively investigate the factors that hinder and facilitate return to work (RTW) at 3 and 12 months after the end of treatment in head and neck cancer (HNC) survivors and whether these factors influence the ability to continue working after treatment. Participants (n = 227) aged ≤ 65 years at diagnosis with HNC were included. Data were collected before the start of treatment and at 3 and 12 months after the end of treatment. The Rubin causal model was used for statistical analysis. Within the 3-month follow-up period, 92 participants had RTW and 30 had retired. At the 12-month follow-up, 80 of these participants were still working, another 51 participants had RTW, and five participants working still suffered from cancer. The hindrance to RTW within 3 months was advanced tumour stage (stage III and IV) (p = 0.0038). Hindrances to RTW at the 12-month follow-up were oral cancer (p = 0.0210) and larynx cancer (p = 0.0041), and facilitators were living in a relationship (p = 0.0445) and a white-collar job (p = 0.00267). Participants with early tumour stage (stage I and II) (p = 0.0019) and a white-collar job (p = 0.0185) had earlier RTW. The conclusion is that disease factors were the most important hindrances to RTW, and type of work and living with a spouse or partner were nonclinical factors influencing RTW.

Abstract Purpose To prospectively investigate the factors that hinder and facilitate return to work (RTW) at 3 and 12 months after the end of treatment in head and neck cancer (HNC) survivors and whether these factors influence the ability to continue working after treatment. Methods Participants (n=227) aged ≤65 years at diagnosis with HNC were included. Data were collected before the start of treatment and 3 and 12 months after the end of treatment. The Rubin causal model was used for statistical analysis. Results Within the 3-month follow-up period, 92 participants had RTW and 30 had retired. At the 12-month follow-up, 80 of these participants were still working, another 51 participants had RTW, and five patients working still suffered from cancer. The hindrances to RTW within 3 months were advanced tumour stage (III and IV) (p=0.0159) and multi-modality treatment (p=0.0366). Hindrance to RTW at the 12-month follow-up was oral cancer (p=0.0194), and the facilitator was a white collar job (p=0.0411). Participants living with a spouse or partner had an earlier RTW (p=0.0414). Conclusions A high rate of early RTW was identified, with only 13% dropping out of work in one year. Disease and treatment factors were the most important hindrances to RTW, and type of work and living with a spouse or partner were nonclinical factors influencing RTW. Implications for Cancer Survivors: More research is needed to understand the impact of cancer rehabilitation to facilitate RTW and the economic burden of being on sick leave.

Purpose: Quality of life is a critical aspect in the management of older head and neck cancer patients.It needs to be considered alongside survival benefit, treatment burden, and longer-term outcomes.The purpose was to undertake a systematic review of empirical peer-reviewed studies with a primary focus on factors impacting quality of life for older head and neck cancer patients.Methods: A systematic review, searching 5 electronic databases (PsychoINFO, MEDLINE, CINHAL, Embase, and Scopus) using PRISMA methodology was conducted.Data was appraised using the Newcastle-Ottawa scale and a narrative synthesis performed.Results: Only 10 papers fulfilled the inclusion criteria.Two main themes emerged: 1) Impact of head and neck cancer on quality of life domains and 2) quality of life in treatment decision-making.Conclusions: In an era of progressive personalised care, there is an evident need for more qualitative and quantitative studies focusing on quality of life for older head and neck cancer patients.However, older head and neck cancer patients experience notable differences, especially with poorer physical functioning and greater eating and drinking challenges.Quality of life impacts older patients decision-making, treatment planning and intensifies post-treatment support.