Patient-reported symptoms in the detection of head and neck cancer recurrence: a systematic review

Abstract

Introduction: Patient-initiated follow-up (PIFU) after treatment for head and neck cancer (HNC) relies on the signs and symptoms of recurrence being detectable by patients. We examine the evidence for patient-reported symptoms as an indicator of recurrence.

Methods: A search was conducted via OvidMEDLINE and Embase (2010 to January 2024) plus sources of grey literature for studies which describe patient-reported symptoms and recurrent disease. Findings are reported as per PRISMA guidelines.

Results: Twenty studies were included which were highly heterogenous. The median sensitivity of patient-reported symptoms to detect recurrence is 47.3%. Median specificity, positive-predictive value (PPV) and negative-predictive value (NPV) were 79.3%, 9.3% and 98.0% respectively. New symptoms were generally reported at routine follow-up rather than expedited appointments.

Conclusion: The high specificity and NPV of patient-reported symptoms means recurrence is unlikely in the absence of symptoms. Patient education and collection of prospective data through digital health technologies may increase the effectiveness of PIFU.

Keywords: cancer morbidity; cancer recurrence; head and neck cancer; patient reported outcome (PRO); symptomatic recurrence.

Figure 1

PRISMA flow diagram shows the data sources, excluded records and reasons for exclusion. *Some references screened twice if used by multiple studies or exempt from screening if already included in review. Source: Page MJ, et al. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. This work is licensed under CC BY 4.0. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/.