Palliation of head and neck cancer

Oxford Handbook of Palliative Care ◽

10.1093/med/9780198745655.003.0014 ◽

2019 ◽

pp. 433-460

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Severe Pain ◽

Symptom Control ◽

Bleeding Management ◽

Complex Anatomy ◽

Life Threatening ◽

Difficult Area

As a consequence of its location, head and neck cancer can affect breathing, speech, swallowing, and most of the special senses, and can impact massively on quality of life and body image. The head has a particularly complex anatomy in a very restricted space, and tumours have the potential to cause very complex and severe pain, often with a major neuropathic element. Disease in the mouth can lead to fistulae and aspiration pneumonia. Some tumours carry a risk of life-threatening bleeding. Management of all of these and other features of advanced head and neck cancer require skill and knowledge. Head and neck cancer, perhaps more than any other cancer, involves the total person, and requires a multidisciplinary response. This chapter summarizes the clinically important aspects of the main pathologies, and discusses a practical approach to symptom control of this difficult area.

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Supportive Care Needs of Patients with Head and Neck Cancer Referred to Palliative Medicine

Otolaryngology ◽

10.1177/0194599820912029 ◽

2020 ◽

Vol 163 (2) ◽

pp. 356-363

Author(s):

Chen Lin ◽

Stephen Y. Kang ◽

Samantha Donermeyer ◽

Theodoros N. Teknos ◽

Sharla M. Wells-Di Gregorio

Keyword(s):

Quality Of Life ◽

Substance Use ◽

Head And Neck Cancer ◽

Supportive Care ◽

Head And Neck ◽

Neck Cancer ◽

Palliative Medicine ◽

Symptom Control ◽

Case Series

Objective Patients with head and neck cancer (HNC) face a unique set of unmet needs. A subset of these patients experience symptom control challenges related to their disease burden and treatments. A multidisciplinary approach involving palliative medicine is underutilized but crucial to identify and address these concerns. There is limited information on palliative integration with head and neck oncology. Study Design Case series with planned data collection. Setting Academic quaternary care center. Subjects and Methods We provide descriptive analyses of patients with HNC, including psychodiagnostic assessment and validated quality-of-life screening, from patients’ first encounter at outpatient palliative medicine. Results HNC (N = 80) contributed the greatest number of palliative referrals (25%) between 2010 and 2012. This cohort was 74% male and 79% Caucasian with a mean age of 53 years (95% CI, 51.1-54.9) and with stage IV disease of the oral cavity (28%) or oropharynx (31%). Sixty-three percent of patients had no evidence of disease. Seventy-five percent had a psychological history based on DSM-IV criteria ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), and 70% had a history of substance use disorder. The most distressing quality-of-life concerns were pain, housing and financial problems, and xerostomia. Conclusions Patients with HNC who were referred to palliative medicine are burdened by multiple physical, psychological, substance use, and social challenges. We recommend comprehensive cancer-specific screening, such as the James Supportive Care Screening, to triage patients to appropriate supportive care services. Palliative care is one of many services that these patients may need, and it should be utilized at any point of the disease trajectory rather than reserved for end-of-life care.

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