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Palliative care for head and neck cancer

According to the National Cancer Institute, head and neck cancer accounts for three to five percent of all cancers in the United States. There are several types of head and neck cancer, classified according to the area in which they occur. Some common types include

Side effects associated with head and neck cancer

Head and neck cancer patients often have more extensive needs than patients with other types of cancer. The disease can cause many unpleasant symptoms, as a result of tumor growth or as a side effect of treatment. Some say these symptoms, along with the very visible nature of the disease, make head and neck cancer more emotionally traumatic than any other type of cancer. Some common side effects of head and neck cancer include:

  • Persistent pain
  • Difficulty swallowing (dysphagia)
  • Dry mouth (xerostomia)
  • Mouth sores (mucositis)
  • Weight loss
  • Voice changes or voice loss
  • Changes in appearance/physical deformities
  • Changes in taste, smell and appetite

Head and neck cancer patients often have difficulty with basic functions, such as eating, chewing, drinking, tasting, breathing and speaking. As a consequence, patients may face anxiety, depression, guilt and low self-esteem. Patients may also require long-term use of a G-tube (to put nutrition into the stomach) or tracheotomy (breathing hole in the neck). These changes can make social and/or private settings distressing and embarrassing.

The importance of palliative care

Palliative care, also called symptom management or supportive care, addresses ways to improve the comfort and quality of life of people with serious illness. Head and neck cancer patients have a particularly high rate of palliative care needs. Focus on these needs has gained increased attention within cancer research.

Bradley Mons, DO, otolaryngologist and head and neck surgeon at our hospital in Tulsa, says for head and neck cancer patients, the goals of palliative care are twofold: (1) to prevent and relieve suffering and (2) to improve quality of life. Palliative care can help reduce side effects of the disease from diagnosis, throughout treatment and beyond.

“This does not limit the patient to pain medicines only,” Dr. Mons says. “There are certain procedures that aim to reduce tumor volume, control local disease, and reconstruct physical defects for the patient. Other issues that need to be addressed include depression and anxiety, as well as economic and caregiver questions. Palliative care addresses these needs.”

Treatment approaches for head and neck cancer

Head and neck cancers are rare, and the anatomy is challenging. Therefore, each disease type requires a different treatment approach, which often involves a combination of surgical resection, chemotherapy and radiation therapy. Fortunately, patients today can benefit from advanced treatment options that help to reduce side effects and improve quality of life.

“New surgical techniques and tools allow for less invasive and quicker recovery. Patients have less dry mouth with improved radiation techniques. Genetic testing allows directed chemotherapy to certain tumors,” says Mons. “We also understand that emotional issues play into the healing process and integrative oncology services are available upfront to treat depression and anxiety,” he adds.

Interdisciplinary team for head and neck cancer

Due to the physical, emotional and psychological challenges of patients and their families, palliative care should involve an interdisciplinary approach. “Our goal should be to help the patient return to as normal a life as possible,” says Dr. Mons.

Patients with head and neck cancers should seek counsel from three types of physicians: a radiation oncologist to discuss radiotherapy, a medical oncologist to discuss chemotherapy, and a head and neck surgeon to discuss possible surgical interventions. Depending on the surgeon’s training, a reconstructive surgeon may need to be involved, as certain surgeries require flaps for improved wound healing.

Other clinicians that should be involved include nutritionists, naturopathic clinicians, psychologists, psychiatrists, pain management practitioners, and other auxiliary support. While these do not “cure” the cancer, they can help make treatment and recovery less stressful and more effective, says Dr. Mons.

Additionally, a dentist should be involved in the care of head and neck patients who will receive radiation therapy, since these patients are at increased risk of osteoradionecrosis, a serious oral health complication. A dentist can check the health of the mouth and review the oral side effects of treatment. A dentist can also help alleviate pain and improve any oral health problems that may increase the risk of complications, like infection.

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