A Health Promotion Perspective of Living with Head and Neck Cancer

AbstractObjective:Against medical advice, head and neck cancer (HNC) patients have been shown to continue to smoke and misuse alcohol post-diagnosis and treatment. This study aimed to better understand the barriers to and facilitators of health behavior change (HBC) in HNC patients.Method:We conducted nine focus groups following a standard protocol. Eligible patients were diagnosed less than three years previously with a primary HNC and selected using maximum variability sampling (gender, age, cancer stage, smoking, and alcohol misuse). Thematic analysis was conducted using NVivo 10 software.Results:Participants were mostly men (79%), 65 years of age (SD = 10.1), and married/common-law (52%, n = 15). Mean time from diagnosis was 19 months (SD = 12.3, range = 5.0–44.5), and most had advanced cancer (65.5%, n = 19). Participants provided a larger than anticipated definition of health behaviors, encompassing both traditional (smoking, drinking, diet, exercise, UV protection) and HNC-related (e.g., dental hygiene, skin care, speech exercises, using a PEG, gaining weight). The main emerging theme was patient engagement, that is, being proactive in rehabilitation, informed by the medical team, optimistic, flexible, and seeking support when needed. Patients were primarily motivated to stay proactive and engage in positive health behaviors in order to return to normal life and reclaim function, rather than to prevent a cancer recurrence. Barriers to patient engagement included emotional aspects (e.g., anxiety, depression, trauma, demoralization), symptoms (e.g., fatigue, pain), lack of information about HBC, and healthcare providers' authoritarian approach in counseling on HBC. We found some commonalities in barriers and facilitators according to behavior type (i.e., smoking/drinking/UV protection vs. diet/exercise).Significance of Results:This study underlines the key challenges in addressing health behaviors in head and neck oncology, including treatment-related functional impairments, symptom burden, and the disease's emotional toll. This delicate context requires health promotion strategies involving close rehabilitative support from a multidisciplinary team attentive to the many struggles of patients both during treatments and in the longer-term recovery period. Health promotion in HNC should be integrated into routine clinical care and target both traditional and HNC-related behaviors, emphasizing emotional and functional rehabilitation as key components.

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Oral microbiota and mucositis in patients with head and neck cancer undergoing radiotherapy: literature review

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v6i2.1797 ◽

2017 ◽

Vol 6 (2) ◽

Author(s):

Elerson Gaetti Jardim Junior ◽

Adriana de Sales Cunha-Correia ◽

Ana Claudia Okamoto ◽

Ellen Cristina Gaetti-Jardim

Keyword(s):

Health Promotion ◽

Head And Neck Cancer ◽

Dental Caries ◽

Literature Review ◽

Head And Neck ◽

Neck Cancer ◽

Head And Neck Neoplasms ◽

Oral Candidiasis ◽

Oral Microbiota ◽

Secondary Phenomenon

The occurrence and severity of mucositis are the main complaints of patients with head and neck cancer submitted to radiotherapy (RT). This condition appears to be associated with changes in the oral microbiota and other side effects of RT, such as xerostomia and candidiasis. The aim of this study was to evaluate the effect of RT on the oral microbiota and its impact on radioinduced mucositis through literature review. Descriptors were selected for the collection of information in different databases, especially SciELO, BIREME, LILACS and PubMed. It was decided to consider only articles published since 1985. The descriptors radiotherapy, mucositis, dental caries, xerostomia, head and neck neoplasms and health promotion were used. It was selected 91 articles specifically discussing the microbiological aspects of mucositis, dental caries, oral candidiasis and microbial effects on the oral health of cancer patients, and 59 were included in the review. It was observed that microbial contamination is a secondary phenomenon capable of exacerbate the inflammation induced by the interaction of the radiation with the oral tissues, aggravating mucositis mainly in patients who present precarious conditions of oral hygiene, which reinforces the role of preventive dentistry in the follow up of the irradiated patient.Descriptors: Radiotherapy; Mucositis; Dental Caries; Xerostomia; Head And Neck Neoplasms; Health Promotion.

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277 Smoking and Alcohol Use Assessments in Head and Neck Surgical Inpatients: An Audit to Improve Health Promotion

British Journal of Surgery ◽

10.1093/bjs/znab259.030 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

E Crossley ◽

C Findlay ◽

F Sipaul

Keyword(s):

Health Promotion ◽

Head And Neck Cancer ◽

Alcohol Use ◽

Head And Neck ◽

Neck Cancer ◽

Smoking Status ◽

Significant Proportion ◽

Day Case ◽

Retrospective Audit ◽

Discharge Summaries

Abstract Aim Head and neck cancer incidence is expected to rise, with smoking and alcohol consumption the greatest risk factors. The related CQUIN target encourages identification of patients who smoke and drink harmful amounts of alcohol. Locally these questions are integrated into discharge summaries. We aimed to review questionnaire completion and encourage staff to give advice to minimise patients’ future head and neck cancer risk. Method We conducted a retrospective audit of adult patients admitted locally under head and neck surgeons in a three-month period. Local audit standard was completion of the questionnaires in 95% of patients. Intervention was education of ENT juniors (foundation and core trainees) alongside ward-based prompts. Re-audit was conducted for two-months following intervention. Results Initial audit reviewed 99 discharge summaries, and re-audit reviewed 115. Following intervention there was improved documentation of smoking status from 27.3% to 48.7% (n = 27/99 vs n = 56/115) and alcohol use from 36.3% to 51.3% (n = 36/99 vs n = 59/115) respectively. However, even in re-audit a significant proportion were documented as ‘unable' to answer (smoking 41.7%, alcohol 42.6%); of these the majority were day case procedures (smoking n = 35/48, alcohol n = 42/49). Conclusions Staff education can encourage doctors to discuss smoking and alcohol and represents health promotion and a reduction in risk of malignancy. Many day case patients were documented as ‘unable’ to answer; this may reflect that discharge paperwork is frequently completed in the immediate post-operative period. Further improvement could be achieved with educational interventions for registrars and consultants, and consideration of the practical challenges negatively impacting questionnaire completion for day case patients.

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