BACKGROUND: Head and neck cancer (HNC) patients suffer from a series of complications due to changes in body image caused by radiotherapy, resulting in patients' unwillingness to participate in society and a strong sense of social alienation. Social alienation not only affects the physical and mental health and quality of life of individuals but also increases the pressure on the families and society of HNC patients, which may lead to a series of social problems. Therefore, this study explores social alienation in patients with HNC treated at our center and analyses its influencing factors, to provide a basis for the development of relevant nursing interventions. METHODS: In this study, 236 patients with HNC who were treated in a tertiary hospital in northeast China from September 2023 to June 2024 were investigated by a convenient sampling method. The survey was conducted using general demographic information, the General Alienation Scale (GAS), the Fear of Progress Questionnaire-Short Form (FoP-Q-SF), the Self-Perceived Burden Scale (SPBS), and the Social Support Scale (SRSS). Data were collected by paper scale. The data were processed by SPSS26.0 software, and the influencing factors of patients' social alienation were analyzed by single-factor analysis and multiple linear regression. The writing process of this article follows the STROBE principle. RESULTS: The total GAS score of patients with radiotherapy for HNC was 33.45 ± 5.77, which was in the upper-middle level. Fear of disease progression and self-perceived burden were significantly positively correlated with social alienation (r = 0.414, p <
0.01
r = 0.422, p <
0.01), and social support was significantly negatively correlated with social alienation (r=-0.342, p <
0.01). Multiple linear regression analysis showed that retirement (β = 0.156, p <
0.01), education level (β=-0.123, p = 0.029), number of radiotherapy treatments (β = 0.120, p = 0.033), fear of disease progression (β = 0.228, p <
0.01), self-perceived burden (β = 0.228, p <
0.01), and social support (β=- 0.222, p <
0.01) were the main influences on social alienation in radiotherapy patients with HNC (t value is -3.894 to 3.252, p <
0.05), explaining 31.9% of the total variance. CONCLUSION: The social alienation in patients undergoing radiotherapy for HNC is at a moderately high level. Clinical medical staff should pay attention to the social alienation of HNC patients, pay more attention to patients who are in the retirement stage, with low education level and undergoing radiotherapy. By alleviating patients' fear of disease progression, reducing self-perceived burden, and enhancing social support, healthcare providers can effectively reduce their level of social alienation. CLINICAL TRIAL NUMBER: Not applicable.