Home Nurse income Researchers highlight 4 themes in managing head and neck cancer symptoms

Researchers highlight 4 themes in managing head and neck cancer symptoms


A qualitative analysis identified 4 themes that could be improved to help with symptom management in patients with head and neck cancer.

In a qualitative analysis, the researchers identified 4 themes to help improve symptom management of head and neck cancer and can also serve as a guide for better symptom monitoring.

Among the 4 themes were timely management of physical symptoms, information as a tool, barriers to psychosocial support, and external factors aggravating symptom burden. Investigators noted that patients had a varied symptom rating, with some feeling it inspired self-reflection and symptom detection, and others feeling helpless, particularly when their symptom scores were reviewed or highlighted. works inconsistently.

Of a population of 22 patients, 20 agreed to participate. The median age was 59.5 years, 11 patients were male and 13 were Caucasian. Additionally, 11 patients had advanced disease, with the most common sites of disease being the oropharynx and oral cavity. Patients had an annual income of less than CA$40,000.

Rapid management of the physical symptoms of head and neck cancer

Patients who participated listed a number of symptoms ranging from cancer-related symptoms such as pain, fatigue and depressed mood to disease-specific issues such as difficulty breathing or swallowing and mucositis. Most of the population appreciated the use of large interdisciplinary teams to manage their head and neck cancer symptoms. The majority of patients felt that their physical symptoms were adequately addressed by clinicians, while maintaining an open line of communication and allying with practitioners during treatment. Patients also reported that they got along well with the home care nurses and found them a good source of communication.

Patients also discussed concerns about how quickly their physical needs are expressed. In some cases, patients who did not receive prompt symptom management often ended up in the emergency department. It was also mentioned that the Head and Neck Cancer Nursing Line – a line for patients to call and express urgent concerns or questions – could be improved with extended hours. Alternatively, concerns could also be handled by a specialist nurse navigator, a service some patients have found clumsy. It was reported that the service could be improved by enabling email communication and an online or app-based platform.

Information as a symptom management tool

Although some patients said their physical symptoms were being taken care of, others felt their care was not being addressed consistently. In this regard, information needs were seen as a notable gap in care, especially treatment and its impact on patients was important for symptom management. Patients reported feeling empowered when they received adequate information about their disease and the potential impact of treatment.

Patients with unmet information needs reported feeling their symptom burden was greater. Some reported that their information needs were not being met, with patients describing clinic visits as too brief or overwhelming with information. They also expressed frustration with the lack of resources for head and neck cancer. Although some patients often turned to online forums for help and information, the researchers noted that the need for more information was not universal.

Psychosocial support challenges

After diagnosis, patients described feeling distressed and often lonely or isolated. Although open communication with her support network helped with coping, the strategy was not viable for patients who had lost the ability to speak. Some patients have been reported to rely on friends, family, faith or community for support. Most patients said they were aware of available mental health support and services through their treatment center, although those who were interested said the services were often difficult to access.

A notable point was the need for mental health services to be available earlier, with many saying they would like services to be available before treatment begins. It was also reported that some patients would have preferred a reassessment of mental health needs throughout their treatment journey.

External factors intensifying symptom burden

Investigators identified that distance from a patient’s treatment center and COVID-19 restrictions exacerbate symptom burden. Those who were away from the treatment center felt it affected their physical health and disrupted home care, with some patients traveling for several hours a day to receive care. It also introduced the possibility of financial toxicity. Investigators identified an association between distance from treatment centers and emotional distress. The majority of patients reported feeling exhausted from traveling, along with increased anxiety and concerns for safety.

The pandemic has created additional hurdles for patients who needed to undergo in-person treatments. Patients often needed an extra person at appointments for help or to take notes, but most COVID policies prohibited outside visitors.

Investigator’s Final Recommendations

The investigators identified several recommendations for clinicians to increase supportive care:

  • Extend nurse navigator hours of operation to include nights and weekends
  • Provide additional means of communication
  • Increase the dissemination of resources
  • Tailor information to individual needs
  • Offer psycho-oncological resources
  • Reassess mental health needs throughout treatment
  • Recognize increased symptom burden
  • Recognize partners and caregivers as part of the support system
  • Share symptom data with patients
  • Constantly review symptom scores and act accordingly
  • Identify a support person to oversee symptom management


Noel CW, Du YJ, Baran E, et al. Improving outpatient symptom management in patients with head and neck cancer: a qualitative analysis. JAMA Otolaryngol Head and Neck Surgery. Published online March 3, 2022. doi:10.1001/jamaoto.2021.4555