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Background <p>Head and neck cancer (HNC) patients undergoing radiotherapy experience complex, dynamic symptom burdens that challenge conventional supportive care models. Integrative, symptom-guided approaches may enhance patient outcomes, yet real-world evidence on their implementation and impact remains limited.</p> Methods <p>In this pilot implementation study, 30 patients with head and neck squamous cell carcinoma receiving intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) were prospectively enrolled. Symptom assessment was conducted using the EORTC QLQ-H&amp;N35 and MDASI-HN questionnaires at baseline, twice weekly during RT, and at 4, 8, and 12 weeks post-RT. Patients were stratified into Green, Yellow, and Red zones based on the severity of mucositis, dysphagia, and fatigue, triggering protocolized multidisciplinary interventions. Statistical analyses included Chi-square tests, repeated measures ANOVA, and effect size estimation.</p> Results <p>By week 4 of radiotherapy (IMRT/VMAT), 56.7% of patients developed moderate mucositis (Yellow zone), while none reached severe (Red zone) status. In contrast, dysphagia emerged as the most significant toxicity, with 43.3% classified as severe and 33.3% as moderate, correlating with increased nutritional interventions (<i>p</i> = 0.003, Cramér’s V = 0.49). Fatigue was also prominent: 40.0% of patients entered the severe zone, and 50.0% the moderate zone, closely clustering with pain and appetite loss. Chi-square analysis demonstrated a significant association between symptom type and zone distribution (χ² = 23.1, df = 4, <i>p</i> = 0.001), confirming the heterogeneity and dynamic evolution of symptom burden. The integrative supportive care model facilitated timely escalation of interventions, reducing unplanned treatment breaks and acute care utilization.</p> Conclusions <p>A symptom-guided, integrative supportive care protocol for HNC patients receiving IMRT or VMAT was feasible and effective in this pilot cohort, enabling early detection and tailored management of high-burden toxicities. Proactive intervention led to improved treatment adherence and functional outcomes. Larger, randomized studies are warranted to validate clinical benefits and guide broader implementation. toward sustainable implementation by integrating stakeholder-informed diagnostics into oncologic care protocols. This framework provides a replicable model for high-impact healthcare translation across complex clinical settings.</p>

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Symptom-Guided Integrative Supportive Care for Head and Neck Cancer Patients Undergoing Radiotherapy: a Pilot Implementation Study

  • 期刊论文

  • 发表日期：

    2026年2月12日

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  • Noor Abdul-Hussein Hassan,
  • Zeena Muhammad Fahmi A. Hadi,
  • Mahdi Abdulkarim Hamood,
  • Harish Srinivas Thokala

摘要

Background

Head and neck cancer (HNC) patients undergoing radiotherapy experience complex, dynamic symptom burdens that challenge conventional supportive care models. Integrative, symptom-guided approaches may enhance patient outcomes, yet real-world evidence on their implementation and impact remains limited.

Methods

In this pilot implementation study, 30 patients with head and neck squamous cell carcinoma receiving intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) were prospectively enrolled. Symptom assessment was conducted using the EORTC QLQ-H&N35 and MDASI-HN questionnaires at baseline, twice weekly during RT, and at 4, 8, and 12 weeks post-RT. Patients were stratified into Green, Yellow, and Red zones based on the severity of mucositis, dysphagia, and fatigue, triggering protocolized multidisciplinary interventions. Statistical analyses included Chi-square tests, repeated measures ANOVA, and effect size estimation.

Results

By week 4 of radiotherapy (IMRT/VMAT), 56.7% of patients developed moderate mucositis (Yellow zone), while none reached severe (Red zone) status. In contrast, dysphagia emerged as the most significant toxicity, with 43.3% classified as severe and 33.3% as moderate, correlating with increased nutritional interventions (p = 0.003, Cramér’s V = 0.49). Fatigue was also prominent: 40.0% of patients entered the severe zone, and 50.0% the moderate zone, closely clustering with pain and appetite loss. Chi-square analysis demonstrated a significant association between symptom type and zone distribution (χ² = 23.1, df = 4, p = 0.001), confirming the heterogeneity and dynamic evolution of symptom burden. The integrative supportive care model facilitated timely escalation of interventions, reducing unplanned treatment breaks and acute care utilization.

Conclusions

A symptom-guided, integrative supportive care protocol for HNC patients receiving IMRT or VMAT was feasible and effective in this pilot cohort, enabling early detection and tailored management of high-burden toxicities. Proactive intervention led to improved treatment adherence and functional outcomes. Larger, randomized studies are warranted to validate clinical benefits and guide broader implementation. toward sustainable implementation by integrating stakeholder-informed diagnostics into oncologic care protocols. This framework provides a replicable model for high-impact healthcare translation across complex clinical settings.