Head and Neck Cancer Patients Face Multiple Quality-of-Life Issues

Even when their cancers are cured or in remission, patients with head and neck cancers face multiple challenges that can impinge on their quality of life (QOL). These patients cannot easily mask effects of their treatments: Surgery can result in speech dysfunction and/or facial disfigurement, and even organ-sparing chemoradiation treatments produce dysphagia, dry mouth, and dental damage. As they adjust to the new normal of life after cancer treatment, many head and neck cancer patients may become anxious, isolated, and depressed. With any change comes loss, said Jacqueline Zahora, LCSW, an oncology social worker with the New York-based cancer support organization Cancer Care. A lot of these patients are grieving for the way they used to be, or the way they used to look, or the way they used to be able to interact with the world.

Whereas the first goal of treatment for head and neck cancers is to cure the cancer, the second is to mitigate side effects, said Mike Yao, MD, Assistant Professor and Program Director of the Department of Otolaryngology, Head and Neck Surgery at the University of Illinois in Chicago. Whether part of the treatment team or as referring physicians, ENT specialists can apprise themselves of the challenges facing patients and the array of medical and psychosocial supports available to them.

Counseling before Treatment

It is important, said William I. Wei, MD, Professor of Surgery, and W. Mong Chair in Otorhinolaryngology at the University of Hong Kong, to tell patients of all possible side effects before treatment begins. Standard treatments for cancers of the larynx and pharynx usually entailed a laryngectomy and resultant loss of normal speech. Now, with targeted chemoradiation, organ preservation is accomplished. But the organ preservation comes with a price: Sometimes function is affected.

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Figure. Oncology Social Worker Dorothy Gold (center) consults with colleagues and clients at the Milton J. Dance Jr. Head and Neck Rehabilitation Center.

At the Queen Mary Hospital in Hong Kong, where Dr. Wei is Chief of Service in the Department of ENT, treatment complications tend to set in early for those with large cancers of the head and neck treated with concurrent chemotherapy. Fibrosis and edema affect swallowing, and when they cannot swallow or eat, patients become depressed.

Quality of life-wise, dysphagia is probably one of the worst things that can happen to these individuals, said Natasha Mirza, MD, Associate Professor in Otolaryngology, Head and Neck Surgery at the University of Pennsylvania and Director of the Penn Center for Voice and Swallowing. At her center, she has followed patients treated with radiosensitizing chemotherapy and found that approximately 87% of patients required gastrostomy tube placement with 23% feeding tube-dependent 12 months after completion of their treatment.