2 Highlights  Emotions in clinical conversations of cancer patients studied by a coding system and speech prosody  Emotional energy f0 was associated with cues and concerns as coded by VR-CoDES system  An additional aid to study emotional speech with potential to reveal hidden content and meaning AbstractObjective: Emotions, are in part conveyed by varying levels of fundamental frequency of voice pitch (f0). This study tests the hypothesis that patients display heightened levels of emotional arousal (f0) during Verona Coding Definitions of Emotional Sequences (VR-CoDES) cues and concerns versus during neutral statements. Methods:The audio recordings of sixteen head and neck cancer survivors' follow-up consultations were coded for patients' emotional distress. Pitch (f0) of coded cues and concerns, including neutral statements was extracted. These were compared using a hierarchical linear model, nested for patient and pitch range, controlling for statement speech length. Utterance content was also explored. Results:Clustering by patient explained 30% of the variance in utterances f0. Cues and concerns were on average 13.07 Hz higher than neutral statements (p = 0.02). Cues and concerns in these consultations contained content with a high proportion of recurrence fears. Conclusion:The present study highlights the benefits and challenges of adding f0 and potential other prosodic features to the toolkit of coding emotional distress in the health communication setting. Practice implications:The assessment of f0 during clinical conversations can provide additional information for research into emotional expression.3