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Psychosocial Issues

Dysphagia resulting from head and neck cancer has psychosocial implications. Patients are often unprepared for the emotions they encounter when mealtime consumption is significantly altered. The inability to participate in mealtimes and dining out as they are accustomed to can be isolating. Increased mealtimes, limited food choices, special food preparation methods, and untidy consumption contribute to avoidance of social food consumption.52 Family relationships can be altered when substantial lifestyle modifications are encountered.53 Patients may become dependent on the medical providers and family members for basic care and emotional support. After cancer recovery, patients may experience distress related to return to work and the alterations in the feeding process. Use of tube feeding, diet modifications, adaptive equipment, or rehabilitative strategies for safe and adequate intake can call attention to themselves and thus become a source of anxiety.

The financial impact of dysphagia is evident in the cost of non-oral tube feeding supplementation. If patients cannot return to oral intake, the financial burden of lifelong tube feeding formula can be significant. Patients are often uninsured or underinsured. Special meal preparation, equipment, and meal supplements can also contribute to added financial burden.

Self-esteem can be affected when normal facial appearance or communication ability is altered by surgery. Altered facial appearance also can lead to social isolation and psychological distress.[54] Pain and fear of disease progression or recurrence can result in physical and psychological symptoms that require interventions from psychosocial and pain management team members. Withdrawal from tobacco and alcohol throughout the treatment process also requires special interventions from the appropriate disciplines. Substance withdrawal can result in behaviors such as anxiety, irritability, and decreased cognition that can affect the success of the swallowing interventions provided by the speech pathologist.

Pretreatment counseling by all team members including the speech pathologist should focus on identifying a patient's unique learning needs, cultural preferences, coping skills,support systems, and financial situation. In addition, information on substance abuse history, cognition, and communication skills will provide an understanding of the patient's ability to participate in the rehabilitation process. Compliance with treatment recommendations is also enhanced when cultural and religious practices are identified and incorporated into the plan of care. Various religions have specific regulations regarding food and food preparation. Patients of varying cultures have food preferences, cooking styles, and customs unique to that ethnic group. Pretreatment counseling about the anticipated swallowing deficits and functional outcomes should be provided. All team members play a critical role in preparing the patient and family for the head and neck cancer intervention.

Posttreatment psychosocial and behavioral interventions by the speech pathologist include treatment of the swallowing disorder and any resulting communication impairment. Education and support about altered body image, lifestyle changes, nutrition, and community resources are provided in close collaboration with the physician, nurse, dietician, social worker, physical therapist, pharmacist, psychiatric professional, and other pertinent team members. Participation in support groups encourages improved coping, socialization, and physical recovery.

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