Self-reported Symptoms to Monitor Recurrent Head and Neck Cancer-Analysis of 1,678 Cases

The aim of this article was to study the clinical significance of subjective symptoms of recurrence in patients treated for primary head and neck cancer. Clinical data of 1,678 patients with squamous cell carcinoma of the head and neck admitted at the Department of Oto-rhino-laryngology-Head and Neck Surgery, Oslo University Hospital during a period of 15 years (1983-1997) were analyzed. A total of 525 (31%) patients had recurrence during follow-up, 74% of these within the first two years after primary treatment. Subjective symptoms indicating recurrent disease were reported by 67%. The remaining recurrences were detected in asymptomatic patients at scheduled consultations. Prognosis was better among patients with subjective symptoms of recurrent disease after treatment for primary tumors of the oral cavity and larynx. Those with recurrence from other tumor sites had no difference in prognosis between symptomatic and asymptomatic patients. The high proportion of patients with subjective symptoms indicates that there is a potential to make follow-up routines more effective. Individualized and flexible procedures, taking into account patient's self-reported symptoms, may help speed-up the process and thus improve prognosis. This could also lead to a more efficient use of resources by reducing the number of redundant examinations of low-risk patients.