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Program Number: B325
Session Name: Poster Session

Biopsychosocial Outcomes of Head and Neck Cancer Free Flap Patients

Naomi C Wang; Jennifer Diebolt, MD; Kiara Holtkamp; Anh Nguyen; Andrés M Bur, MD; Emily Law, PhD; Frank Materia, PhD; University of Kansas Medical Center

Importance: Head and neck cancer (HNC) is among the most psychologically distressing cancers, with treatment often being both complex and profoundly debilitating. Microvascular free flap surgery for late-stage HNC can permanently impact a patient's ability to speak, eat, and breathe, while also altering facial appearance—critical aspects of personal identity. HNC patients undergoing free flap surgery are five times more likely to experience depression and twice as likely to suffer from anxiety compared to other cancer patients. Additionally, they face a suicide rate that is twice that of other cancer patients. Current understanding of psychosocial aspects of recovery remains limited in scope.

Objective: To understand the biopsychosocial outcomes for HNC free flap patients and identify potential interventions to improve psychosocial recovery.

Design, Setting, and Participants: This mixed-methods study was performed at a single academic tertiary care center including adult patients who underwent microvascular free flap surgery from January 1, 2021 to May 1, 2024. Patients were recruited from a HNC research registry and completed quality of life (QoL) questionnaires at baseline and follow-up visits.  A semi-structured interview guide was developed by three authors with expertise in HNC and psychosocial effects of cancer survivorship. Interviews were conducted at an average of 23 months following surgery (Range, 1– 41 months).  

Main Outcomes and Measures: Thematic analysis of interviews and UW-QOL, visual anxiety scale (VAS), and decision regret scores.

Results: Seventeen participants were interviewed, with a mean age of 70.7 years (SD 5.8). The cohort was predominantly white (94%), married (77%), and retired (82%), and 53% were male. The primary cancer site was the oral cavity (94%), with fibula (53%) and radial forearm (47%) donor sites. Most patients had locally advanced disease (65%) and node-positive status (65%).  

Three primary themes with 12 subthemes emerged: theme 1 was physical and biological factors, with subthemes including (1) changes in physical function; (2) preparedness associated with the anatomical complexities of free flap surgery; (3) changes in body image; and (4) role of others in physical healing. Theme 2 was psycho-behavioral factors, including (1) personal confidence and readiness; (2) attitudes around recovery; (3) attitudes surrounding cancer; (4) mental adjustment to a new functional normal; and (5) engagement with activities. Theme 3 was social support and interpersonal factors, including (1) interactions with the care team; (2) support from close-others; and (3) support from other HNC patients. The average UW-QoL score was 81.2 (SD 11.1) at baseline and 69.4 (SD 16.5) after surgery, while the average VAS score was 56.7 (SD 18.9) at baseline and 32.8 (SD 26.5) after surgery. Most participants had mild (n = 9, 53%) or moderate-severe decision regret (n = 6, 35%).

Proposed interventions included developing a behavioral activation plan, providing inpatient activities and resources, creating a timeline for expected physical changes, and involving HNC patients as sources of information and support. 

Conclusions and Relevance: In this mixed-methods cohort study, patients described peri-operative experiences of head and neck reconstructive free flap surgery. Opportunities to improve psychosocial outcomes were identified, and interventions were proposed to address these needs.

 

 

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