Improved rates of cancer control have increased the head and neck cancer survivor population. Cancer survivorship clinics are not widely available in the USA, and longitudinal supportive care for patients undergoing multimodal therapy has not advanced at a pace commensurate with improvements in cancer control. Consequently, a large head and neck cancer survivor population whose quality of life may be chronically and/or permanently diminished presently exists. This lack of awareness perpetuates under-recognition and under-investigation, leaving survivors’ (mostly detrimental) experiences largely uncharted. We conducted a qualitative exploration of survivors’ experiences, aiming to unpack the profound impact of late systemic symptoms on daily life, encompassing work, relationships, and self-identity in the head and neck cancer survivor community. The study included 15 remitted head and neck survivors, ≥12 months from their final treatment, who participated in semi-structured interviews conducted by a medical oncologist. Data analysis comprised qualitative thematic analysis, specifically inductive hierarchical linear modeling, enriched by a deductive approach of anecdotal clinical reporting. Results highlighted that 43.36% of all quotation material discussed in the interviews pertained to chronic emotion disturbance with significant implications for other domains of life. A central symptom cluster comprised impairments in mood/emotions, daily activity, and significant fatigue. Dysfunction in sleep, other medical conditions, and cognitive deficits comprised a secondary cluster. Physical dysfunctionality, encompassing pain, appetite, and eating, and alterations in experienced body temperature, constituted a tertiary cluster, and perhaps were surprisingly the least discussed symptom burden among head and neck cancer survivors. Symptoms causing heightened long-term survivor burden may be considered epiphenomenal to central physical dysfunctionality, albeit being presently the least represented in cancer survivor care programs. Moving forward, the development of targeted and multi-dimensional treatment programs that encompass physical, psychosocial, and spiritual domains are needed to increase clinical specificity and effective holistic long-term solutions that will foster a more compassionate and informed future of care for the cancer survivorship community.
癌症控制率的提高使得头颈癌幸存者群体日益扩大。然而在美国，癌症幸存者专科门诊尚未普及，针对接受多模式治疗患者的长期支持性护理发展速度也未能与癌症控制水平的提升保持同步。因此，目前存在大量生活质量可能长期或永久受损的头颈癌幸存者群体。这种认知缺失导致相关问题持续得不到充分重视和研究，使得幸存者（多为负面）的生存体验长期处于未知状态。本研究对幸存者生存体验展开质性探索，旨在揭示晚期全身症状对头颈癌幸存者日常生活产生的深远影响，涵盖工作、人际关系和自我认同等多个维度。研究纳入15名缓解期头颈癌幸存者，所有参与者距末次治疗时间均≥12个月，由肿瘤内科医师进行半结构化访谈。数据分析采用质性主题分析法，特别运用归纳式分层线性模型，并结合临床案例报告的演绎分析方法加以深化。结果显示，访谈中43.36%的论述内容涉及慢性情绪障碍，且对其他生活领域产生显著影响。核心症状群包括情绪障碍、日常活动能力受损及严重疲劳；睡眠障碍、其他医疗状况和认知缺陷构成次要症状群；而包含疼痛、食欲与进食问题、体感温度变化在内的躯体功能障碍构成第三症状群——令人意外的是，这可能是头颈癌幸存者讨论最少的症状负担。尽管目前癌症幸存者护理项目中对核心躯体功能障碍的关注最少，但引发长期生存负担加重的症状可被视为核心躯体功能障碍的伴随现象。展望未来，需要开发涵盖生理、心理社会及精神领域的靶向多维治疗方案，以提升临床特异性，建立有效的整体性长期解决方案，从而为癌症幸存者群体构建更具人文关怀和科学依据的未来照护体系。
Qualitative Classification of Late Systemic Symptoms in Head and Neck Cancer Survivors
肿瘤(癌症)患者之家