“…QOL is multifactorial and subjective, and improvement in cancer-related symptoms can be achieved through primary assessment and intervention for problems as they arise [15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35]. For example, the initial measurement of pain after treatment is more likely to predict pain status contributing to a decrease in the overall QOL after primary-stage SCCHN [3,15,17,18,19,24,25,26,27,28,29,30,31,32,33,34,35,38,39,40,41,42]. While such issues are clearly relevant, no studies have used qualitative methods to elucidate factors associated with the under-reporting of suffering in individuals in this patient population.…”