Patient-reported cognitive impairment in head and neck cancer survivors and relationship to symptom burden.

534 Background: Cognitive difficulties are emerging as a significant concern among survivors of head and neck cancer (HNC), affecting multiple dimensions of quality of life and functional abilities. The purpose of this study was to characterize the prevalence and severity of post-treatment cognitive impairment in a sample of head and neck cancer survivors and examine sociodemographic, clinical, and symptom factors associated with reduced cognitive function. Methods: This cross-sectional survey study included individuals who were diagnosed with head and neck cancer within the past 6 years and recruited from an institutional tumor registry. Self-reported cognitive function was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function short form. Chronic symptoms were assessed using the European Organization for Research and Treatment of Cancer-Head and Neck (EORTC HN-43), PROMIS and Insomnia Sleep Index tools. We characterized symptom burden and used multivariable linear regression models to examine associations between sociodemographic, clinical, and symptom factors and reduced cognitive function. Results: The survey was completed by 347 respondents, who were predominantly male (72.6%) with a mean age of 65.5 ± 11.3 years and an average time since diagnosis of 3.72 ± 2.3 years. Reduced cognitive function was reported by 27.6% of survivors, with 15.4% (T⩽ 45), 10.4% (T⩽ 40), and 1.8% (T⩽ 35) reporting mild, moderate, and severe levels, respectively. In an adjusted linear regression model (F(12,178) = 18.02, p < .001, adjusted R 2 = 0.52), poorer cognitive function was significantly associated with higher levels of anxiety (β = -0.40, p < .001), fatigue (β = -0.21, p < .01), insomnia (β = -0.22, p < .01), and social isolation (β = -0.23, p < .001). Conclusions: This study demonstrates that a subset of survivors of head and neck cancers report reduced cognitive function, which is consistent with reports in survivors of other cancer types. The findings indicate that cognitive symptoms are particularly associated with higher levels of anxiety, fatigue, insomnia, and social isolation. As the use of multimodal approaches continues to expand, further investigation on the multiple contributing factors to diminished cognitive function is warranted to guide approaches to assessment and supportive care.