Trajectories of Distress and the Impact of Early Supportive Care in Head and Neck Cancer Patients Undergoing Curative Radiotherapy

Abstract Objective: To prospectively evaluate distress trajectories in head and neck cancer patients receiving curative-intent radiotherapy using multiple validated screening tools, and to determine the impact of early supportive care triggered by predefined distress thresholds on psychological outcomes and quality of life. Methods : In this single-centre prospective observational study, 100 adults with histologically confirmed head and neck cancers planned for definitive or adjuvant radiotherapy were enrolled. Distress and symptom burden were assessed using the Hospital Anxiety and Depression Scale (HADS), NCCN-Distress Thermometer (DT), Edmonton Symptom Assessment Scale (ESAS), and Functional Assessment of Cancer Therapy – Head and Neck (FACT-H&N) at baseline, weekly during radiotherapy, at treatment completion, and at 1 and 3 months post-treatment. A structured early supportive care protocol was activated when patients demonstrated a ≥2-point rise in HADS, a DT score ≥4, or clinically meaningful ESAS worsening. Interventions included optimised analgesia, nutritional support, mucositis management, fatigue and sleep strategies, and brief psycho-oncological counselling. Longitudinal changes were analysed using repeated-measures ANOVA and Wilcoxon signed-rank tests. Results: Distress peaked at week 2 of radiotherapy, with median HADS rising from 4.0 at baseline to 7.0, and NCCN-DT scores increasing from 3 to 6. ESAS demonstrated parallel escalation in pain, dysphagia, mucositis, fatigue and sleep disturbance. By 3 months post-radiotherapy, HADS and DT scores declined significantly below baseline, and FACT-H&N scores improved across physical, functional and emotional domains. Early supportive care was triggered in 68% of patients and was associated with more rapid post-treatment distress reduction. Radiotherapy completion rates were high (97%), and unplanned treatment breaks were infrequent (12%). Conclusions : Distress in head and neck cancer patients undergoing curative-intent radiotherapy follows a predictable trajectory, peaking early in treatment and driven predominantly by treatment-related symptom clusters. Routine distress screening combined with a threshold-triggered early supportive care protocol is feasible, clinically impactful, and associated with meaningful improvements in psychological wellbeing and quality of life. Distress screening should be considered an integral component of contemporary radiotherapy practice for head and neck cancers.