Neck Disability and Insomnia in Head and Neck Cancer Survivors

Abstract Purpose: Head and neck cancer (HNC) treatments often have a substantial long-term impact on physical appearance, psychological well-being, and physiologic functions. Our study examines the relationship between symptoms of neck disability and insomnia among post-treatment HNC survivors.Methods: Cross-sectional analysis of adult survivors of squamous cell cancer of the oral cavity, oropharynx, and larynx/hypopharynx treated at a single-center, university-affiliated HNC survivorship clinic between August 2018 and March 2021. The primary outcome is Insomnia Severity Index (ISI) score. Multivariable ordinal regression was used to analyze the association between neck disability index (NDI) scores and insomnia.Results: A total of 411 predominantly male(77.9%) survivors with an average age of 63.07±11.53 years, were included in the analysis. Primary cancer sites were oropharynx(48.7%), oral cavity(28.0%), and larynx/hypopharynx(23.3%). Mean ISI and NDI scores were 7.09±6.66(range=0-28) and 8.83±8.06(range=0-38), respectively. After controlling for age, race, treatment modality, tumor site, tumor staging, and time since treatment, the odds of a survivor reporting insomnia was 8.65 times higher in those with mild neck disability(95% OR (4.31, 17.37), p<0.001) and 48.12 times higher in those with moderate to complete neck disability(95% OR (22.35, 103.58), p<0.001) when compared to those with no neck disabilityConclusions: The acute symptom burden of neck disability is shown to be highly associated with insomnia severity. HNC providers should address an array of symptoms for early diagnosis and intervention. Our results support the need for a multidisciplinary care model for post-treatment HNC survivors to facilitate screening, access and early intervention for survivor well-being.