Trajectories of distress and threshold-triggered supportive care in head and neck cancer patients undergoing curative radiotherapy: a prospective observational study.

objectiveTo prospectively evaluate trajectories of psychological distress, symptom burden, and quality of life longitudinally, in patients with head and neck cancer undergoing curative-intent radiotherapy, while assessing the feasibility of a predefined threshold-triggered supportive care framework in routine radiotherapy practice.

methodsOur prospective observational cohort study, conducted at a single tertiary care-centre, enrolled 100 adult patients, who were diagnosed with head and neck cancers and were subsequently planned for definitive or adjuvant RT between January and December 2023. Psychological distress was assessed using the Hospital Anxiety and Depression Scale (HADS) and NCCN Distress Thermometer (NCCN-DT), the overall symptom burden was measured using the Edmonton Symptom Assessment Scale (ESAS), and quality of life using the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N). Assessments were performed at baseline, once weekly during radiotherapy, at the time of RT completion, and at 1 and 3 months post-RT completion. A structured supportive care protocol was activated using predefined screening thresholds. Longitudinal changes were analysed using repeated-measures methods and paired non-parametric comparisons.

resultsMedian HADS increased from 4.0 (2.0-7.0) at baseline to 7.0 (4.0-9.5) at week 2, before declining to 2.0 (0.0-6.0) at 3 months post-RT completion (p < 0.001). NCCN-DT and ESAS scores worsened during treatment and improved after RT completion. FACT-H&N scores declined from 128 (120-138) at baseline to 98.5 (84-117) at treatment completion, with recovery to 126 (117-138) at 3 months post-RT completion (p < 0.001). Enteral feeding support increased from 24% at baseline to 44% by RT treatment completion. Supportive care activation was recorded in 68% of patients. An exploratory analysis using early week-2 screening positivity identified a higher-burden subgroup with greater distress and lower FACT-H&N scores during treatment, but substantial recovery by 3 months.

conclusionsPsychological distress among patients undergoing curative-intent head and neck radiotherapy is dynamic, with peaks early in the treatment course, and is often closely aligned with symptom burden and treatment-related functional decline. The use of a structured, threshold-triggered supportive care framework is feasible in routine radiotherapy workflows, assisting in the identification of patients who require timely multidisciplinary support. Given the observational design and absence of a comparator arm, findings may be interpreted as associative rather than causal.