Head and Neck cancers (HNC) include cancers of the oral cavity, pharynx, salivary glands, and larynx. In 2016, approximately 61,760 new cases of HNC were diagnosed in the US. Mortality rates have been declining and the five year survival rate is now estimated to be greater than 64%. Given the prevalence of the disease and current survival rates, understanding HNC-related changes in function and quality of life is critical to developing targeted self-management interventions to optimize function and reduce distress. Head and neck cancer and its treatments has been associated with functional changes and a high symptom burden including pain, decreased head and neck mobility, dysphagia, lymphedema, fatigue, loss of taste, loss of hearing, vertigo, alterations in speech, dry mouth, dental caries, gingival disease, sleep disturbances, cognitive changes, and emotional distress. A growing number of studies suggest that physical activity or exercise training may be a promising intervention to improve function, reduce symptom distress, and maintain quality of life in individuals with HNC. Additionally, restorative activities or exposure to the natural environment may reduce mental fatigue and improve attention in individuals with cancer. The first step to developing targeted approaches to optimize function and preventing disability in individuals with HNC is to examine functional abilities, symptom distress, and quality of life early in the disease trajectory. At this time, only two studies have examined physical function and one study examined cognitive function pre-treatment in individuals with HNC. No studies were found that examined the relationship between function, symptom distress, and quality of life in individuals newly diagnosed with HNC. The purpose of this study is to assess physical function, cognitive function (attention and cognitive control domains), symptom distress, and quality of life patterns from pre-treatment to 3-months after treatment initiation. Additionally, this study will assess the feasibility and acceptability of wearing an activity tracker, a novel method of measuring physical function in HNC. Knowledge gained from this study will contribute to the scientific base for the development of timely self-management interventions directed toward maintaining optimal functioning and reducing distress in individuals with cancer. This study will 1) contribute to the scientific knowledge of physical and cognitive function, symptom distress, and quality of life in HNC, and 2) provide the foundation for developing targeted self-management interventions to optimize function and prevent disability in individuals with HNC. Cancer-related symptoms and preventing disability in individuals with cancer is a research priority of the Oncology Nursing Society and the National Cancer Institute. Developing targeted interventions to improve self-management in individuals with chronic illnesses is a research priority of the National Institute of Nursing Research.
The specific aims and corresponding hypotheses are:

• Specific Aim #1: To determine the feasibility and acceptability of wearing an activity tracker. Hypothesis 1a: Wearing an activity tracker will be feasible and acceptable as demonstrated by the recruitment of individuals with HNC who are willing to participate (achieve 100% recruitment of target goal of 40 subjects), adhere to (<15 % attrition) and complete (>75% of pedometer and self-report measures collected) the study. Additionally, acceptability of wearing an activity tracker will be demonstrated by self-report (positive comments).
• Specific Aim #2: To determine whether identifiable patterns of physical and cognitive function exist early in the disease trajectory in individuals newly diagnosed with HNC. Hypothesis 2a: Compared to pretreatment, individuals with HNC at 3-months post initiation of chemoradiotherapy will show lower physical function on measures of performance. Hypothesis 2b: Compared to pre-treatment, individuals with HNC at 3-months post initiation post initiation of chemotherapy will show lower attention and cognitive control on measures of performance and self-report 3-months post initiation of CRT.
• Specific Aim #3: To determine whether a relationship exists between physical and cognitive function, symptom distress, and quality of life in individuals new diagnosed with HNC. Hypothesis 3a: Physical and cognitive performance will be negatively associated with symptom distress and positively associated with quality of life in individuals newly diagnosed with HNC. Hypothesis 3b: Pretreatment symptom distress (MDASI-HN) and global quality of health will be associated with function 3-months after initiating of CRT.