Distress monitoring during surgical treatment of patients with primary head and neck tumors of oral cavity and oropharynx: a prospective pilot study

Patients with head and neck cancer (HNC) frequently experience psychosocial distress, yet its trajectory across the surgical pathway is insufficiently understood. The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) is a rapid screening tool, though its longitudinal behavior and predictive value in surgical HNC care require further study. This prospective study assessed perioperative distress trajectories, explored predictors of elevated distress, and evaluated the feasibility of serial inpatient assessment. Forty-eight patients undergoing curative surgery for primary HNC at a tertiary center were enrolled. Distress was measured using the DT and Problem Checklist at five timepoints: staging admission (ePOS), preoperative (DT1), early postoperative (DT2), approximately day 7 (DT3), and pre-discharge (DTE). Socio-demographic, clinical, and symptom-burden variables were collected. Analyses were descriptive statistics, paired comparisons, subgroup analyses, and correlations (α = 0.05). Mean DT scores were 6.4 (ePOS), 5.7 (DT1), 6.4 (DT2), 5.4 (DT3), and 5.1 (DTE). Clinically relevant distress (DT ≥5) occurred in 59-85%. Higher distress was associated with younger age, lower educational attainment, comorbidity, and greater physical symptom burden. Distress increased more strongly in patients without nicotine or alcohol use. Patients requesting psycho-oncological support at baseline showed greater distress reduction between ePOS and DT2. Completion rates exceeded 90%, and patients rated serial assessment as acceptable. Distress remains elevated during inpatient surgical treatment, with peaks at diagnosis and early postoperative recovery. Serial distress assessment is feasible and may help identify high-risk subgroups. Integrating repeated screening and timely psychosocial support into surgical pathways could improve patient-centered care in HNC.