Background <p>Recurrent oropharyngeal cancer (rOPC) presents challenging treatment decision-making. Toxicity from previous treatment, coupled with potential functional and quality of life (QoL) morbidity of further treatment(s) can influence decision-making regarding curative and non-curative treatment.</p> Aim <p>To investigate swallowing and QoL outcomes, treatment-related priorities, and patient experience before and after rOPC treatment.</p> Method <p>Longitudinal, multicentre, mixed method study. Outcomes included the MD Anderson Dysphagia Inventory (MDADI), Performance Status Scale for Head and Neck Cancer (PSS-HN), the University of Washington QoL Questionnaire (UWQoLv4), the Chicago Priority Scale (CPS) and semi-structured interviews.</p> Results <p>The sample included 37 participants (prospective <i>n</i> = 25, retrospective <i>n</i> = 12, females <i>n</i> = 6) with a median age of 63 (range 41–88). The majority (<i>n</i> = 21) had curative intent treatment (surgery <i>n</i> = 20 or radiation <i>n</i> = 1). The remainder had non-curative intent immunotherapy (<i>n</i> = 14) or chemotherapy (<i>n</i> = 2). Swallowing and QoL were impaired at baseline; median MDADI composite score: 60 (IQR: 52.15–81.75), median PSS- HN normalcy of diet: (NoD): 50 and UWQoLv4 global health score (GHS): 60 (IQR 40–60). The PSS-HN NoD score deteriorated to 40 at six months. The MDADI and UWQoL data remained impaired. Triangulation with qualitative data revealed agreement with the PSS data and provided context for the relatively stable QoL. Being cured of cancer and living as long as possible remained the key priorities at all timepoints.</p> Conclusion <p>In this study swallowing deteriorated with treatment for rOPC. Treatment-related priorities remained focused on cure or survival. If the treatment-related goal was achieved, patients adapted and experienced at least stable QoL regardless of swallowing status.</p>