Development and Application of a Nurse-Led Preemptive Symptom Management Protocol for Head and Neck Cancer Patients Undergoing Radiation Therapy

The number of patients who missed five or more consecutive radiations and the reasons for this are recorded during radiotherapy.

Rehospitalization was defined as any unplanned hospital admission within 3 months after completing radiotherapy for reasons unrelated to antitumor treatment.

European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 (EORTC QLQ-C30). This is a 30-item questionnaire assessing quality of life in cancer patients through functional scales, symptom scales, and a global health status scale. Scores are transformed to a 0-100 scale. For functional scales and global health status, higher scores indicate better quality of life; for symptom scales, higher scores indicate worse symptoms.

European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Head and Neck Cancer Module (EORTC QLQ-H&N35). This is a 35-item module specifically designed for patients with head and neck cancer, assessing symptoms and side effects related to the disease and treatment. All items are scored on a 0-100 scale, where higher scores represent worse symptoms or more problems.

The symptom burden of the patients was evaluated using the M.D. Anderson Symptom Inventory (MDASI). This is a brief, multi-symptom assessment tool comprising 13 core symptom items and 6 interference items. Each item is rated on an 11-point numeric scale ranging from 0 to 10. For all items, higher scores indicate greater symptom severity or greater interference with daily functioning.

This 7-item subscale assesses anxiety symptoms. Each item is rated on a 4-point scale (0 to 3), and scores are summed to yield a total score ranging from 0 to 21. Higher scores indicate greater anxiety severity (worse outcome).

This 7-item subscale assesses depressive symptoms. Each item is rated on a 4-point scale (0 to 3), and scores are summed to yield a total score ranging from 0 to 21. Higher scores indicate greater depression severity (worse outcome).

Adverse events were assessed and graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 5.0. Each adverse event is assigned a grade from 1 to 5, where Grade 1 indicates mild symptoms, Grade 2 moderate, Grade 3 severe or medically significant, Grade 4 life-threatening consequences, and Grade 5 death related to the adverse event. Higher grades represent greater severity (worse outcome).

Tumor response was evaluated using the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1). Based on this criteria, tumor response is categorized into one of four ordinal categories: Complete Response (CR), Partial Response (PR), Stable Disease (SD), or Progressive Disease (PD). CR and PR represent objective tumor response (better outcome), while PD represents disease progression (worse outcome).