Self-Reported Cancer-Related Cognitive Impairment and Psychosocial Symptom Burden in Survivors of Head and Neck Cancer.

BACKGROUND

Cancer-related cognitive impairment (CRCI) is an increasingly recognized survivorship concern, yet its prevalence and associated clinical and psychosocial factors among survivors of head and neck cancer (HNC) remain poorly characterized.

METHODS

This cross-sectional study recruited survivors of HNC, who were at least 1-year post-diagnosis, from an institutional tumor registry to complete a comprehensive survey. Self-reported cognitive function was assessed using the PROMIS Cognitive Function Short Form 8a, with a T-score < 40 indicating cognitive impairment. Symptom burden was assessed using the EORTC QLQ-HN43, PROMIS short forms, and the Insomnia Severity Index. Social role functioning was assessed using the PROMIS Satisfaction with Participation in Social Roles short form. Multivariable linear and logistic regression examined factors independently associated with self-reported cognitive impairment.

RESULTS

Of 337 survey respondents, 41 survivors (12.2%) met criteria for self-reported moderate to severe cognitive impairment. Cognitively impaired survivors reported significantly higher symptom burden and lower social role functioning than survivors within normal limits. In multivariable linear regression (R2 = 0.520), poorer cognitive function was significantly associated with anxiety (β = -0.362, p < 0.001), fatigue (β = -0.223, p < 0.001), sleep disturbance (β = -0.261, p < 0.001), and social isolation (β = -0.178, p = 0.002). In logistic regression, anxiety (OR = 1.07, p = 0.035), fatigue (OR = 1.08, p = 0.021), and high-intensity treatment (OR = 2.62, p = 0.028) were independently associated with impairment.

CONCLUSIONS

Approximately one in eight HNC survivors reported moderate-to-severe cognitive impairment. Self-reported cognitive difficulty was associated with psychosocial symptom burden and multimodal treatment, and co-occurred with poorer social role functioning. These findings support concurrent assessment of cognitive and psychosocial symptoms in HNC survivorship care.