There are a number of challenges facing head and neck cancer patients who present with metastatic or locally recurrent head and neck cancer; such as, limited treatment options, overall poor prognosis, and high symptom burden secondary to tumor and treatment. Disease and symptom management can be difficult, and requires that the potential benefits versus the adverse effects of systemic therapy be weighed very carefully. Individual patient characteristics including performance status, weight loss, symptom burden, comorbidities, and social supports must be taken into consideration. Unfortunately, reliable data describing the impact of therapy on symptom burden and quality of life (QOL) is lacking. Recently completed randomized phase III treatment trials have demonstrated the feasibility of incorporating patient reported outcome measures to assess symptoms and QOL into clinical studies. Nonetheless, obstacles to accurate and thorough QOL reporting remain. Development of tools directed at symptom burden and functional impairment in the metastatic or recurrent head and neck cancer population is needed. Such tools would enhance our ability to assess the impact of treatment, thus optimizing treatment decisions for patients with recurrent and/or metastatic head and neck cancer.