Objective: To investigate actual driving performance in a group of patients with cancer in the head and neck region. Design: A nonrandomized controlled trial. Participants: Ten patients with cancer in the head and neck region participated in a driving evaluation using a virtual reality driving simulator. Driving performance from the simulator and observer ratings on participants' driving behaviors were compared between a group of patients with cancer in the head and neck region and a group of 50 community control subjects. Main Outcome Measures: Average speed, mean brake reaction time, steering variability, the total number of (fatal and nonfatal) collisions during the 12-minute evaluation course on the driving simulator, and the score of the 18-item Simulator Driving Performance Scale. Results: Using Mann-Whitney U tests, the brake reaction time and the steering variability in the cancer group were significantly longer and larger, respectively, than those in the control group (P=.04) and (P=.02). However, no significant differences were found between the 2 groups in the mean rank scores for average speed, total number of collisions, and Simulator Driving Performance Scale (P>.05 for all). Conclusions: This pilot study provides preliminary evidence indicating inferior driving performance in a group of patients with cancer in the head and neck region when compared with a community control group. Further study is needed to investigate factors attributing to the difference. ©2007 American Medical Association. All rights reserved.