# Social wellbeing, loneliness, and symptom burden in head and neck cancer survivors: a latent class analysis

## TL;DR

This study identifies different symptom patterns in head and neck cancer survivors and finds that complex symptoms are linked to loneliness and reduced daily activity.

## Contribution

The study introduces a new method to classify symptom patterns and links them to social wellbeing outcomes in HNC survivors.

## Key findings

- Three distinct symptom classes were identified among HNC survivors.
- Complex symptom burden is associated with higher loneliness and activity impairment.
- Tailored care models are needed for survivors with complex symptoms to improve quality of life.

## Abstract

To identify patterns of co-occurring symptoms in a sample of head and neck cancer (HNC) survivors; compare symptom burden among latent classes; and examine associations between symptom classes and social wellbeing outcomes.

This cross-sectional survey of HNC survivors ≥1 year post-diagnosis was conducted in 2020 using a tumor registry at an academic medical center. Primary outcomes were loneliness and activities impairment. Participants reported 19 HNC-specific symptoms using the European Organization for Research and Treatment of Cancer HNC module (EORTC hN-43), and general cancer symptoms (sleep, pain, anxiety, depression, fatigue). Latent class analysis was used to identify subgroups with different symptom patterns. Multivariable regression models were estimated to examine associations between class membership and social wellbeing outcomes.

Three hundred forty-seven survivors (mean age 65.5 ± 11.3 years; 3.72 ± 2.3 years post-diagnosis) completed the survey. Participants were predominantly male (72.6%), White (81.6%), and under age 65 years at diagnosis (59.4%). Three symptom classes were identified: (1) complex symptom burden (45%), (2) oral/sensory symptom dominant (38.9%), and (3) limited symptom impact (15.8%). Membership in the complex symptom burden class was associated with increased activity impairment (β = 28.6, SE = 3.7, p<.001) and increased loneliness (β = 1.1, SE = 0.2, p<.001) compared to the oral/sensory class (most similar to overall sample).

Elevated and complex HNC symptom burden is associated with higher levels of general cancer symptoms and risk for loneliness and reduced engagement in daily activities. Tailored survivorship care models addressing symptom profiles of HNC survivors, particularly those with complex symptom burden, are needed to improve quality of life.