{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:52:15Z","timestamp":1786978335311,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Head and neck cancer (HNC) survivors face heightened psychological distress, but it is unclear how distress severity relates to concerns reported on the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) problem list. We examined associations between distress levels and problem list endorsement among HNC patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analyzed data from 507 patients with HNC, and grouped DT scores as: no distress (score\u00a0=\u00a00,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0134 (26.4%)), mild distress (score\u00a0=\u00a0one to three,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0141 (27.8%)), and clinically meaningful distress (score\u00a0=\u00a04\u201310,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0232 (45.8%)). Frequencies of problem list items and domains were calculated. Spearman's correlation assessed the relationship between distress and total problem burden, and logistic regression evaluated associations between distress severity and problem endorsement, adjusting for demographics and behaviors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Distress was weakly but significantly correlated with total problem burden (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a00.11,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.016). The most common concerns were pain, eating changes, worry\/anxiety, fatigue, nervousness, treatment decisions, fear, sleep, depression, and swelling. Patients with clinically meaningful distress were more likely to endorse worry\/anxiety (aOR\u00a0=\u00a05.05, 95% CI 1.70\u201315.04) and treatment decisions (aOR\u00a0=\u00a03.49, 95% CI 1.16\u201310.53). Distress levels were not associated with pain (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.26).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Standard NCCN distress thresholds may miss a substantial proportion of HNC patients with meaningful psychosocial and physical concerns. Pain remains highly prevalent regardless of distress level, highlighting a role for universal pain assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70426","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T07:37:02Z","timestamp":1774424222000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association of Distress Severity and Problem Burden in Patients With Head and Neck Cancer"],"prefix":"10.1002","volume":"35","author":[{"given":"May Z.","family":"Gao","sequence":"first","affiliation":[{"name":"Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra E.","family":"Hunter","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa C.","family":"White","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheyenne","family":"Corbett","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russel R.","family":"Kahmke","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute Duke University  Durham North Carolina USA"},{"name":"Department of Head and Neck Surgery &amp; Communication Sciences Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Jiang","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute Duke University  Durham North Carolina USA"},{"name":"Department of Head and Neck Surgery &amp; Communication Sciences Duke University School of Medicine  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1390-9753","authenticated-orcid":false,"given":"Nosayaba","family":"Osazuwa\u2010Peters","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute Duke University  Durham North Carolina USA"},{"name":"Department of Head and Neck Surgery &amp; Communication Sciences Duke University School of Medicine  Durham North Carolina USA"},{"name":"Department of Population Health Sciences Duke University School of Medicine  Durham North Carolina USA"},{"name":"Duke Global Health Institute  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010019\u201004768\u20103"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2019.06.1203"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31675"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2012.12.005"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.31557\/apjcp.2022.23.6.1827"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2015.61.3836"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0029940"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2022.0004"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764\u2010025\u201001807\u20103"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1188\/17.ONF.329\u2010336"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2024.4357"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/15598276241304373"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/0284186x.2012.745949"},{"issue":"2","key":"e_1_2_10_15_1","first-page":"175","article-title":"Use of the Distress Thermometer in Clinical Practice","volume":"10","author":"Ownby K. 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