Background: Evidence of the oncological benefit of scheduled follow-up in head and neck squamous cell carcinoma is weak; symptom-oriented self-referral may be an alternative. Patients' preferences regarding follow-up remain poorly investigated. Methods: We conducted a cross-sectional survey among patients undergoing followup at a tertiary outpatient clinic, focusing on their preferences, correlating factors, fear of recurrence, and willingness for participation in a randomized trial on follow-up. Results: Of 101 patients, 89.1% preferred scheduled follow-up to self-referral, 57% favored fewer visits than the current standard, and 85.1% endorsed regular imaging. Recurrence or second primary was associated with preference of intensive followup schedules (P = 0.02). There were trends for women and patients with high fear of recurrence score to favor intensive follow-up. Two-third of the participants declared willingness to participate in a randomized controlled trial. Conclusions: Patients' preferences only partially correspond to current follow-up guidelines. Recruitment for randomized controlled studies evaluating the value of follow-up seems feasible. K E Y W O R D Sfear of recurrence, follow-up, head and neck cancer, patients' preference, selfreferral

Objective: Fear of recurrence (FoR) affects the quality of life of head and neck cancer survivors. Identification of factors predisposing to FoR may help to recognize and treat patients at risk.Materials and Methods: For this exploratory study, 101 disease-free head and neck cancer survivors completed a crosssectional survey in 2017 that included the FoR questionnaire at a random point in time during their follow-up. Additionally, the patients were asked to choose their favorite among four follow-up schedules with or without systematic imaging and varying frequency of visits.Results: Elevated FoR was present in 36.6% of patients. Females and patients ≤65 years showed significantly higher FoR overall scores than males (score difference 3.40; CI 0.49-6.32; p = 0.022) and patients >65 years (score difference 4.25; CI 1.58-6.92; p = 0.002). A history of cancer recurrence or second primary malignancy increased the relative risk (RR) for elevated FoR (RR 1.7; CI 1.01-2.86; p = 0.046). Tumor stage and treatment modality were not significantly associated with elevated FoR or FoR overall score. Higher FoR overall scores were recorded in patients who favored intensive follow-up plans (mean overall FoR score 18 vs. 15; SD 7.7; p = 0.076) and systematic imaging in follow-up (17 vs. 13, SD 7.1; p = 0.034).Conclusion: Fear of recurrence in head and neck cancer patients is associated with female sex, younger age, and history of a past recurrence or second primary malignancy. Due to its high prevalence, it should be addressed in clinical practice and future research.

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