# Patient-reported symptoms in the detection of head and neck cancer recurrence: a systematic review

## TL;DR

This study reviews how well patients can detect head and neck cancer recurrence through reported symptoms, finding that symptoms are not very sensitive but highly specific.

## Contribution

The paper provides a systematic review of patient-reported symptoms for detecting HNC recurrence, highlighting their limitations and potential for improvement.

## Key findings

- The median sensitivity of patient-reported symptoms to detect recurrence is 47.3%.
- Patient-reported symptoms have a high specificity (79.3%) and negative-predictive value (98.0%).
- New symptoms are often reported during routine follow-up rather than urgent appointments.

## Abstract

Patient-initiated follow-up (PIFU) after treatment for head and neck cancer (HNC) relies on the signs and symptoms of recurrence being detectable by patients. We examine the evidence for patient-reported symptoms as an indicator of recurrence.

A search was conducted via OvidMEDLINE and Embase (2010 to January 2024) plus sources of grey literature for studies which describe patient-reported symptoms and recurrent disease. Findings are reported as per PRISMA guidelines.

Twenty studies were included which were highly heterogenous. The median sensitivity of patient-reported symptoms to detect recurrence is 47.3%. Median specificity, positive-predictive value (PPV) and negative-predictive value (NPV) were 79.3%, 9.3% and 98.0% respectively. New symptoms were generally reported at routine follow-up rather than expedited appointments.

The high specificity and NPV of patient-reported symptoms means recurrence is unlikely in the absence of symptoms. Patient education and collection of prospective data through digital health technologies may increase the effectiveness of PIFU.