2316 - Impact of Household Income on Symptom Burden and Quality of Life in Long-Term Head and Neck Cancer Survivors

Purpose/Objective(s): Radiation Therapy (RT) is a critical treatment for locally advanced head and neck cancer (LAHNC) but has long-term side effects. Income is known to influence cancer outcomes, yet its impact on post-RT symptom burden remains understudied. We hypothesize that lower income is associated with higher symptom burden and reduced quality of life (QoL).

Materials/Methods: This observational study included LAHNC patients >2 years post-RT. Household income was self-reported and divided into five brackets. Symptom burden was evaluated via EORTC QLQ-H&N35, EORTC QLQ-C30 v3, and FACT-Cog v3. Participants missing income data or symptom responses were excluded from analysis. One-way ANOVA with Welch’s test assessed income-based differences. Games-Howell post-hoc test was used if variance was violated (Levene’s p<0.05); otherwise, Tukey’s test was applied.

Results: A total of 203 participants reported income and answered QoL and symptom burden questions. In the H&N35 survey, a higher score indicates more symptoms. In the C30 survey, a higher score indicates a higher level of functioning. In all comparisons where the group Welch ANOVA was significant, the pairwise comparison between the <$20k group had significantly worse outcomes than the =$100k group. Many symptoms were significantly worse in the <$20k group compared to all higher-income groups (e.g., eating, speech, daily function, and QoL). Additionally, the $20k-$50k group showed significant differences from the =$100k group in daily activities, perceived cognitive impairments, and QoL.

Conclusion: Patients with household incomes <$20k report lower QoL and greater symptom burden, including difficulties with eating, speech, daily function, and perceived cognitive impairments, compared to higher-income patients. While a correlation between income and symptom burden is observed, further research is needed to identify the causative factors behind these differences. Understanding these factors is critical for improving survivorship care in this population.