Unmet supportive care needs among head and neck cancer survivors in China: multicenter cross-sectional study

Survival after head and neck cancer treatment has improved, shifting attention toward survivorship quality and post-treatment service gaps. Evidence from China that quantifies unmet supportive care needs using standardized instruments across multiple regions remains limited.

We conducted a multicenter cross-sectional study in three tertiary hospitals in East, Middle, and Southwest China. Adults with histologically confirmed head and neck cancer were recruited during routine follow-up 3 to 24 months after curative-intent treatment. Supportive care needs were assessed with the Supportive Care Needs Survey Short Form (SCNS-SF34) and the head and neck module (SCNS-HNC), and head and neck-related quality of life was measured with University of Washington Quality of Life version 4 (UW-QOL v4). The primary outcome was any moderate-to-high unmet need on SCNS-SF34. We reported overall and hospital-specific prevalence, domain-level burden, and correlates from mixed-effects logistic regression with hospital clustering interpreted cautiously because only three centers were included.

Among 1,407 surveyed survivors, 1,239 questionnaires were valid for analysis (88.1%). Overall, 78.2% reported at least one moderate-to-high unmet need. Health system and information (34.2%) and psychological needs (31.2%) were the most prevalent SCNS-SF34 domains. Dry mouth or sticky saliva (54.6%) and swallowing difficulties (36.8%) were the leading head and neck-specific unmet needs. The median number of moderate-to-high SCNS-SF34 needs per patient was 3 (IQR 2 to 5). Lower UW-QOL composite score (per 10-point decrease: aOR 1.61), rural residence (aOR 1.25), monthly household income below 5,000 CNY (aOR 1.45), stage III to IV disease (aOR 1.25), and multimorbidity of at least two comorbidities (aOR 1.83) were associated with higher odds of unmet needs. In a hospital fixed-effect sensitivity model, the direction and magnitude of the main patient-level associations were materially unchanged.

Unmet supportive care needs were common among Chinese head and neck cancer survivors in early survivorship, particularly in information, psychological, salivary, and swallowing domains. The observed associations suggest that routine needs screening and multidisciplinary follow-up pathways may help identify survivors who are more likely to report substantial unmet needs, especially in socioeconomically vulnerable groups. Any service-level interpretation should remain cautious because the evidence is observational and based on three tertiary centers.