Trajectory of Symptom Severity Aids Follow-Up in Head and Neck Cancer Treatment


As symptom severity can vary by patient, it is key for nurses to increase assessment for early intervention of patients with head and neck cancer following treatment, according to Meredith Cummings, PhD(c), BSN, RN, OCN.

Trajectory of Symptom Severity Aids Follow-Up in Head and Neck Cancer Treatment

Trajectory of Symptom Severity Aids Follow-Up in Head and Neck Cancer Treatment

Because symptom severity and trajectory vary by patient, early intervention and frequent assessment may aid in understanding the likely path a patient’s symptoms may take following treatment for head and neck cancer, according to Meredith Cummings, Ph.D(c), B.S.N., RN, OCN.

“[This study] provides insight to the possible symptom severity trajectories of patients who are undergoing treatment for cancer,” Cummings, a PhD student at the University of Pittsburgh, said during a presentation of the findings of a secondary analysis of the Enhanced Care Coordination Study (NCT04813172) at the 49th Annual Oncology Nursing Society Congress. “…This study may help us in the journey to more precise health care.”

Using the MD Anderson Symptom Inventory Head and Neck Module (MDASI-HN), the spaghetti plots for both mean core symptom severity per week and mean module symptom severity per week showed many different trajectories “and individuals that are really challenging to identify,” Cummings explained.

When evaluating mean core symptom severity vs time, 41.2% of patients demonstrated low stable trajectories, while 37.9% and 20.0% showed low increasing and moderate increasing trajectories, respectively. With the MDASI-HN module of severity vs time, low stable, low linear increasing, and low non-linear increasing trajectories were shown in 34.5%, 45.0%, and 20.5%, respectively.

“Our results reveal the different severity profiles do exist in patients receiving treatment for having cancer, and those trajectories vary based on the 2 subscales,” Cummings said. “This work highlights the importance of characterizing the subjective experience of individuals with cancer to better understand why some people have more severe symptoms and others do not.”

Cummings noted that patients with head and neck cancer have high symptom severity that worsens with treatment, and, as a result, any uncontrolled symptoms may lead to worse quality of life, unscheduled treatment interruptions, and increase health care utilization. “Little is known about which patients are at higher risk for symptom severity,” she added. “We also know very little about characteristics of these patients, and without this understanding, it will be challenging to develop interventions that could improve your quality of life.”

Therefore, the investigators aimed to identify groups of similar symptom severity trajectories among 177 patients with head and neck cancer who underwent radiation and/or chemotherapy from the UPMC HNC Survivorship Clinic.

Inclusion criteria included 18 years of age or older; a diagnosis of primary squamous cell carcinoma of the paranasal sinuses, nasal cavity, oral cavity, tongue, salivary glands, larynx, and pharynx, including the nasopharynx, oropharynx, and hypopharynx, or unknown primary; and having not begun radiation; however, patients were allowed to have already had surgery. Patients were excluded if they had clinical evidence of distant metastases and prior radiation treatment. Patients were enrolled prior to radiation through 3 months post-treatment.

Using a prospective, repeated measures design, symptoms were measured twice a week using the MDASI-HN (range, 0-10). The 2 MDASI-HN subscales used were mean core symptom severity (pain, fatigue, nausea, disturbed sleep, distress, shortness of breath, difficulty remembering, lack of appetite, drowsiness, dry mouth, sadness, vomiting, and numbness/tingling) and mean module symptom severity (mucus in the mouth and throat, difficulty swallowing or chewing, choking or coughing, difficulty with voice or speech, skin pain/burning/rash, constipation, problems with tasting food, mouth/throat sores, and problems with teeth or gums).

Patients were a mean age of 62 years, and the majority were male (74.3%), White (85.4%), and had stage III to IVc disease (52.9%). In total, 53.4% did not previously undergo surgery, and 90%, 13%, and 4% received cisplatin, carboplatin, or cetuximab, respectively.

To conclude, Cummings highlighted the need for an investigation of predictive factors associated with group membership to better predict patients at high risk for symptom severity, as well as a more granular assessment.

“Future work should include more granular examination of individual symptoms … [that] will continue to characterize those severe symptoms in patients undergoing treatment for cancer, and seek to explore patient treatment and disease-specific predictors for severity as well as genetic predictors,” she added. “With this knowledge, we will be better able to mitigate symptoms for these patients before they become severe.”


Cummings M, Bender C, Sereika S, Cho M, Nilsen M. Trajectories of symptom severity in patients receiving treatment for head and neck cancer. Presented at: 49th Annual Oncology Nursing Society Congress; April 24-28, 2024; Washington D.C.

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