Head and neck cancer (HNC) is among the most common types of cancer. HNC refers to cancers which develop in the head and neck region, including the nasal cavity, oral cavity, pharynx, larynx, and salivary gland [1, 2]. HNC accounts for 3% of all cancers in the United States, with approximately 53,000 US citizens developing HNC annually and 10,800 dying from the disease . In Taiwan, approximately 6,000 HNC cases are diagnosed annually , many of whom are of working-age  and a main source of family income.
Disease progression and the adverse effects of treatment impact the ability of HNC patients to transition back to work after completing treatment, especially in those who perform manual labor [5, 6]. Return to work (RTW) refers to the ability or preparation of an individual to return to a job after a cancer diagnosis or during or after treatment [6–8]. RTW can optimize recovery , help patients maintain their personal identity [10, 11], promote psychosocial well-being , and enhance the development of a healthy lifestyle .
The sequelae of treatment often affect the ability of HNC patients to work. The rate of RTW varies; 65.6–83% of patients RTW within 6 months [13, 14] and 48% RTW within one year after treatment . Patients who RTW earlier benefit from the greater perceived health associated with work, more connections in their social relationships, and a decline in the financial impact of the disease [16, 17].
Barriers to RTW following HNC include the adverse effects of treatment such as fatigue, speech and eating problems, pain, changes in appearance [13, 16], and psychological and health-related distress [13, 16]. Factors shown to facilitate and support a RTW of cancer patients include co-workers’ assistance , flexible schedules , support from employers , a friendly work environment, and positive employment policies .
Although previous studies have explored these issues, most research has focused on patients who survived head and neck cancer (HNC) [5, 20, 21], data from Western countries [14, 22] or India , qualitative research , and the perspective of peers and employer . Therefore, the purposes of this study were to: (1) examine the status of RTW in working-age HNC patients within six months of ending treatment; (2) compare the levels of symptom burden, psychological distress, patient-perceived health status, barriers to RTW, and facilitators of RTW of those who did and did not RTW; and (3) identify the factors associated with barriers to and facilitators of RTW in HNC patients within the first six months post-treatment.