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IMPORTANCE: Although patients with head and neck cancer (HNC) have been shown to experience high distress, few longitudinal studies include a comprehensive evaluation of biopsychosocial factors affecting quality of life (QoL), including genetic risk for depression. OBJECTIVE: To identify factors at the time of cancer diagnosis associated with QoL scores at 3 months after treatment in patients newly diagnosed with a first occurrence of HNC. DESIGN, SETTING, AND PARTICIPANTS: This prospective longitudinal study of 1464 participants with a 3-month follow-up, including structured clinical interviews and self-administered measures was carried out at the Department of Otolaryngology Head and Neck Surgery at 2 tertiary care McGill University Affiliated Hospitals, McGill University Health Centre, and Jewish General Hospital. Eligible patients were adults newly diagnosed within 2 weeks with a primary first occurrence of HNC, had a Karnofsky Performance Scale score higher than 60, and an expected survival of more than 6 months. Two hundred and twenty-three patients (72%) consented to participate and completed the baseline questionnaire, and 71% completed the 3-month follow-up measures. EXPOSURES: An a priori conceptual model including sociodemographics, medical variables, psychosocial risk factors, and a polygenic risk score for depression (PRS-D) was tested. MAIN OUTCOMES AND MEASURES: The Functional Assessment of Cancer Therapy–Head and Neck measured QoL at baseline and at 3 months. RESULTS: Participants were mostly men (68.7%), with a mean (range) age of 62.9 (31-92) years, 36.6% having a university degree, 35.6% living alone, and 71.4% diagnosed with advanced HNC with mostly cancers being of the oropharynx (42.2%), oral cavity (17%), and larynx (16.3%). QoL at 3 months after HNC diagnosis was associated with higher PRS-D (B = −4.71; 95% CI, −9.18 to −0.23), and a diagnosis of major depressive disorder within 2 weeks of an HNC diagnosis (B = −32.24; 95% CI, −51.47 to 13.02), lifetime suicidal ideation (B = −22.39; 95% CI, −36.14 to −8.65), living with someone (B = 12.48; 95% CI, 3.43-21.52), having smoked cigarettes in the past 30 days pre-HNC diagnosis (B = −15.50; 95% CI, −26.07 to −4.93), chemotherapy type (B = −11.13; 95% CI, −21.23 to −1.02), and total radiotherapy dose (Gy) (B = −0.008; 95% CI, −0.01 to −0.002). CONCLUSIONS AND RELEVANCE: This study identified the predictive value of a genetic predisposition to depression on QoL and function immediately after oncologic treatments. These findings highlight the potential importance of genetic profiling pretreatment to identify those most susceptible to experience QoL and functional compromise. Depression is a clear area of public health concern and should be a central focus in the treatment of patients with HNC.

IMPORTANCE: Efforts are underway to deintensified treatment protocols for patients with human papillomavirus virus−associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) to achieve similar excellent oncologic outcomes while reducing treatment-related adverse effects. Transoral robotic surgery (TORS) as primary treatment often requires adjuvant therapy due to the high incidence of nodal metastasis. Treatment with neoadjuvant chemotherapy followed by TORS and neck dissection (NECTORS), reserving radiation therapy for salvage, yields excellent oncologic outcomes. OBJECTIVE: To assess patient-reported quality of life (QOL) and functional outcomes among patients with HPV-OPSCC who undergo NECTORS. DESIGN, SETTINGS, AND PARTICIPANTS: This was a multicenter prospective cohort study of patients with HPV-OPSCC treated with the NECTORS protocol in 2017 to 2022. Consecutive patients with stage III or IVa HPV-OPSCC treated with NECTORS in 2017 to 2022 who had completed the primary QOL questionnaire at baseline and at least once during the 24-month follow-up period were included. Ninety-four patients were eligible, and 67 were included in the analyses. OUTCOME MEASURES: QOL questionnaires at baseline, and at month 1, 3, 6, 12, 18, and 24 posttreatment. Global score on the 30-item European Organization for Research and Treatment of Cancer Core quality of life questionnaire (EORTC QLQ-C30) was the primary outcome; the head and neck extension module (EORTC QLQ-HN35); the MD Anderson Dysphagia Inventory for dysphagia-related QOL; and the Decision Regret Scale were also used. Paired t tests assessed change between the baseline and 12- or 24-month patient-reported outcomes. RESULTS: Among the study population of 67 patients (median [range] age, 63 [58-67] years; 54 [80.6%] male) with HPV-OPSCC, the most frequent cancer subsites were palatine tonsil (41 [61%]) and base of tongue (26 [39%]); none required adjuvant RT. Global QOL at 24 months improved compared with baseline (mean difference, 9.49; 95% CI, 2.45 to 16.53). All EORTC QLQ-C30 functional scores returned to baseline or improved within 3 to 6 months posttreatment and remained stable at 24 months. EORTC QLQ-HN35 symptom scale scores improved or were stable at 24 months. The MD Anderson Dysphagia Inventory scores demonstrated no significant difference between baseline and month 12 for global scores (mean difference, 6.15; 95% CI, −4.18 to 16.49) and composite scores (mean difference, 2.73; 95% CI, −1.62 to 7.09). Median (range) score on the Decision Regret Scale was 5 of 100 (0-30), representing mild overall regret. CONCLUSION AND RELEVANCE: The findings of this multicenter cohort study indicate that use of the NECTORS protocol is associated with excellent QOL outcomes. QOL measures returned to baseline levels or were better than baseline, which represents positive outcomes for patients with HPV-OPSCC who undergo this treatment regimen.

Head and neck cancer is known to be both physically and psychologically challenging. The present review summarizes the literature on the psychosocial effects of head and neck cancer by distinguishing features in the preoperative and postoperative periods. It outlines the importance of an integrated collaborative care approach in clinics as well as areas worthy of further program development.

Despite the frequent occurrence of head and neck cancer (HNC) disfigurement, little is known about its psychosocial impact on patients. This study aimed to understand the lived experience of disfigurement in HNC and explore what patients considered to be its influences. Fourteen disfigured HNC patients participated in a 45-to-120-minute in-depth, semi-structured interview, which was analyzed qualitatively using interpretive phenomenology. A majority of participants (64 percent) were considered to be at an advanced cancer stage (stage III or stage IV). Patients’ experiences revolved around the concept of a ruptured self-image (a discontinuity in sense of self). Forces triggering this ruptured self-image created a sense of “embodied angst”, in which disfigurement served as a constant reminder of the patient's cancer and associated foundational malaise. Other influences fostered a sense of normalcy, balance, and acceptance. Participants oscillated between these two states as they grew to accept their disfigurement. This study's findings could guide supportive interventions aimed at helping patients face head and neck surgery.

Background.Several authors have observed a therapeutic impact of the psychological autopsy on the interviewee, although they do not explicitly define what aspects of the process were helpful. Aims.This article aims to identify these therapeutic effects and to discuss their potential impact on participants’ narratives. Methods.This article derives from 35 psychological autopsy interviews that were conducted to better understand adolescent and young adult suicide. Interviews lasted approximately 6 to 8 h each and consisted of both a battery of questionnaires and open-ended questions. They were mostly conducted with the families of the deceased, including parents and siblings, and on occasion were done with a single family member or friend. The time elapsed since the suicide ranged from 6 to 18 months. Results.Psychological autopsies were helpful to interviewees in allowing them to find meaning in the suicide, to find purpose through their altruistic participation, to obtain psychological support, to experience connectedness with others, to accept the loss as real, and to gain insight into their functioning. Negative reactions to the interviews, albeit uncommon, are also briefly described. Conclusions.We recommend that interviewers receive preparatory training and ongoing supervision while conducting interviews, to assure a reflective and professional stance.

In a companion article, we retrospectively examined the childhood strengths and adverse experiences of a group of orphans given up at or near birth and raised in Quebec institutions. This article examines the relationship of their early experiences to functioning and symptoms in later adulthood. The same follow-up interview of 81 adults (41 women, 40 men) at a mean age of 59.2 years included assessments of their current symptoms and functioning. The mean adult Social and Occupational Functioning Score (57.8; 95% CI, 54.7–61.0) indicated moderate difficulty. Psychiatric symptoms were significantly higher than in a matched population survey sample from Quebec. Mean overall defensive functioning indicated a neurotic (inhibited) level. Total trauma and childhood strengths predicted adult outcomes, but childhood strengths moderated the effects of trauma. Institutionalization of children—if unavoidable—must build in effective safeguards against adverse experiences, especially among children with few strengths, and foster children's strengths to avoid impaired adult outcomes.

•Pregnant patients in SUD treatment have high posttraumatic stress disorder rates.•Policy, economic, physical, and social environments impact prenatal substance use.•Treatment for prenatal SUD must address social and structural barriers.•Trauma-and SUD-informed care training is needed for prenatal SUD health providers.