Health-related social needs and symptom burden among survivors of head and neck cancer in the HN-STAR trial (WF-1805CD).

540Background: Head and neck cancer survivors (HNCS) face high symptom burden and unmet health-related social needs (HRSN), yet few studies examine the co-occurrence of these issues. We investigated the association between HRSN and 4 commonly co-occurring symptoms (pain, fatigue, insomnia, emotional distress) among patients in HN-STAR, a site-randomized controlled trial of a web-based survivorship care tool. Methods: HN-STAR (NCT04208490) was conducted across 28 Wake Forest NCI Community Oncology Research Program practices. Participants were adult, disease-free HNCS, < 2 years post-treatment completion. At pre-intervention baseline, participants self-reported HRSN (housing, financial, transportation, and low health literacy) and symptoms. Housing, financial, and transportation needs were queried using the National Comprehensive Cancer Network Distress Thermometer (yes/no). Low health literacy was defined as ≤ “somewhat confident” completing medical forms. Four psychoneurological symptoms (pain, fatigue, insomnia, and distress) came from the EORTC QLQ-C30 and were scored using thresholds for clinical significance. The number of clinically significant symptoms was categorized as low (0-1) vs. moderate-high (2-4) symptom burden. We used a binomial generalized linear mixed model controlling for within-practice correlation to investigate associations between symptom burden and ≥1 HRSN along with demographic variables (age, sex, race/ethnicity). Stepwise selection identified the best-fitting model. Results: Of 351 HNCS (mean age 63.7 years; 76.1% non-Hispanic white; 76.6% male; 60.8% married/partnered), 135 (38.5%) experienced ≥1 HRSN and 121 (34.5%) had moderate-high symptom burden. The most common HRSNs were low health literacy (21.1%) and financial problems (19.1%). Pain (36.7%) and emotional distress (31.1%) were the most common clinically significant symptoms. In adjusted analyses, females vs. males (45% vs. 30%; OR 2.1 (95% CI (1.2, 3.6), p = 0.006) and those with ≥1 HRSN vs. none (45% vs. 27%; OR 2.3 (95% CI (1.4, 3.6), p < 0.001) had higher odds of moderate-high symptom burden. Conclusions: In a large, diverse, community-treated HNCS population experiencing a high degree of psychoneurological symptom burden and HRSN after treatment, females and those with ≥1 HRSN were more than twice as likely to experience moderate-high symptom burden. Addressing HRSN may improve symptom burden in this population. Clinical trial information: NCT04208490.

Duke Scholars

Author Kevin Charles Oeffinger Medicine, Medical Oncology