Head and Neck cancer -14- Long Term Care

HEAD & NECK CANCER PART-14

(All the articles published in past are available at www.shyamhemoncclinic.com/blog/)
Question: Thank you Chiragbhai for explaining about various types of thyroid cancer, role of surgery, radio iodine treatment, and new targeted therapies. It was interesting to note that it is one of the most rapidly rising cancers, but reassuring to know that cure rates are very high in general with timely surgery and proper post operative management depending on stage. Now we have covered all major cancers in head and neck region. Any other cancer type we need to cover in this area?
Ans: We have not covered cancers of nasal cavity and paranasal sinuses. However these are very uncommon and treatment principles are similar to other common sites in head and neck region. What is most important for our readers however is to know about monitoring and care in long term after treatment. As we have a very high incidence of head and neck cancers, and survival is improving, most doctors will have these patients in their follow up. With longer survival, their follow up with oncologist will reduce but will continue with primary care doctors (such as physician, ENT surgeon, family practitioner, dentist…).
Que: Agree. I think this is perhaps the most important knowledge for non oncologists, who are our main readers. How can they add value to these patients’ lives?
Ans: A number of important issues, as listed below should be kept in mind for patients who have survived head and neck cancer:
1. Continue to counsel them intermittently about role of avoiding tobacco in any form, and alcohol. Even family members, relatives, and friends should also be counseled for the same. Young adults are the most important population to focus for prevention of addiction.
2. Second primary cancers i.e. risk of new cancer in same region or in areas affected by tobacco is about 20 percent in five years. These include head and neck region, lung, esophagus mainly, and occasionally other parts of gastrointestinal tract or urological organs. Patients should have very regular monitoring by their surgeon or ENT specialist to detect second cancers in early stages, especially for first three to five years. This risk is enhanced markedly by continued tobacco or alcohol exposure.
3. Nutrition: a large number of patients suffer from poor nutrition due to changes in oropharyngeal anatomy and function from effects of cancer and its treatments. Apart from Surgical effects, Radiotherapy may lead to xerostomia (dry mouth due to lack of saliva) making it difficult to eat, or may lead to stenosis causing dysphagia. About 20% patients need long term tube feeding. Trismus – poor mouth opening – is extremely common due to either submucous fibrosis from effects of tobacco/gutkha or due to cancer or its treatment. This adds to poor oral intake.
4. Dental issues: very common again in these patients due to effects of treatment. Oral ulcers, loss of teeth, poor oral hygience etc are very common, and can be addressed by regular dental evaluation and motivating patients.
5. Depression and other psychosocial issues: Disfiguring post treatment may lead significant number of patients to avoid social contact, difficulty with job etc leading to various issues including depression.
6. Speech: poor speech quality is very common after surgery in certain areas, and sometimes after radiotherapy. Larynx cancer survivors have the biggest issue with speech. Patients should be encouraged to seek speech therapists help and use of new technologies to improve their communication and hence better social life, job prospects etc.
7. Other issues: chronic pain is also fairly common, and need continued care including issues of addiction from long term narcotic use.
Improvement in surgical techniques, radiation techniques, use of more chemoradiation instead of surgery for many sites, and overall better prevention and management of complications, has led to much better results compared to 20-30 years ago. However, since advance stage at diagnosis is common in India, long term effects of cancer and treatment for such stages continues to be an important problem. In USA/Europe, often there are specialized multidisciplinary long term care clinics for such patients, and in fact for many cancer types. In absence of such clinics, role of primary care doctors becomes even more important in India.

February 14th 2016.

Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 079 26754001. Diplomate American Board of Oncology and Hematology. Ahmedabad. drchiragashah@gmail.com Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad. www.shyamhemoncclinic.com