Insomnia associated with patient-reported outcomes in head and neck cancer survivors

To investigate the prevalence and risk factors of insomnia and to explore associations between insomnia and patient-reported outcomes in head and neck cancer (HNC) survivors.

Cross-sectional analysis was performed on questionnaires completed by survivors with primary squamous cell carcinoma of the oral cavity, oropharynx, or laryngopharynx seen in a multidisciplinary HNC survivorship clinic from August 2018 to August 2022 at a single academic medical center. Insomnia, quality of life (QOL), and symptoms of dysphagia severity, anxiety, and depression were assessed using the Insomnia Severity Index, University of Washington QOL, Eating Assessment Tool-10, Generalized Anxiety Disorder 7-item, and Patient Health Questionnaire-8. Multivariable regression analysis and trend tests were used to evaluate these relationships.

A total of 827 HNC survivors, median 9 months post-treatment, were included. Tumors were most commonly oropharyngeal (51.0%), T stage 1-2 (57.3%), and treated by surgery with adjuvant radiation/chemoradiation (45.5%). Of the survivors, 21.4% of patients reported subthreshold insomnia, and 13.1% had clinical insomnia. Insomnia was associated with worse physical and social-emotional QOL scores and greater symptoms of anxiety, depression, dysphagia, and neck disability (all p < 0.001).

The prevalence of insomnia among HNC survivors is 34.5%. Insomnia was associated with decreased QOL and higher symptom burden, including anxiety, depression, dysphagia, and neck disability.

Screening for insomnia should be considered in HNC survivorship care to identify individuals who may benefit from comprehensive interventions that include sleep-focused strategies, which could also improve patient-reported outcomes.