Risk Factors for Catastrophic Health Events in Head and Neck Cancer: A Scoping Review to Inform Risk Prediction

Background/Objectives: Head and neck cancer (HNC) is associated with unique risks of catastrophic health events throughout the care continuum. This scoping review evaluated distinct domains of catastrophic health events in HNC and the associated risk factors to inform the development of risk prediction models. Methods: Five electronic databases were searched to identify peer-reviewed journal articles published from 2015 to 2025. Eligible studies were primary observational studies involving adults (≥18) with HNC that reported a catastrophic (or similar term) health event and assessed the associated risk factors using multivariable regression modelling. Results: Fifty-six studies involving 941,329 patients with HNC were included. Half (n = 28, 50.0%) of these studies were conducted in North America, followed by Asia and Europe (n = 13 each, 23.2%). Four domains of catastrophic health events were identified: sudden or premature deaths (n = 22, 39.3%), severe treatment-related complications (n = 19, 33.9%), unplanned acute care encounters (n = 22, 39.3%), and severe patient-reported symptoms (n = 6, 10.7%). Across all domains, comorbidity was the most repeatedly identified risk factor, followed by treatment characteristics (e.g., surgery duration), older age, and advanced cancer stage. Conclusions: Risk prediction models in HNC should always include variables of comorbidity. The varied measurability of risk factors requires strategic efforts when developing prediction algorithms for different domains of catastrophic health events.