ABSTRACT Objective Head and neck cancer (HNC) survivors face heightened psychological distress, but it is unclear how distress severity relates to concerns reported on the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) problem list. We examined associations between distress levels and problem list endorsement among HNC patients. Methods We analyzed data from 507 patients with HNC, and grouped DT scores as: no distress (score = 0, n = 134 (26.4%)), mild distress (score = one to three, n = 141 (27.8%)), and clinically meaningful distress (score = 4–10, n = 232 (45.8%)). Frequencies of problem list items and domains were calculated. Spearman's correlation assessed the relationship between distress and total problem burden, and logistic regression evaluated associations between distress severity and problem endorsement, adjusting for demographics and behaviors. Results Distress was weakly but significantly correlated with total problem burden ( r = 0.11, p = 0.016). The most common concerns were pain, eating changes, worry/anxiety, fatigue, nervousness, treatment decisions, fear, sleep, depression, and swelling. Patients with clinically meaningful distress were more likely to endorse worry/anxiety (aOR = 5.05, 95% CI 1.70–15.04) and treatment decisions (aOR = 3.49, 95% CI 1.16–10.53). Distress levels were not associated with pain ( p = 0.26). Conclusions Standard NCCN distress thresholds may miss a substantial proportion of HNC patients with meaningful psychosocial and physical concerns. Pain remains highly prevalent regardless of distress level, highlighting a role for universal pain assessment.
Gao et al. (2026) studied this question.