Preop Intervention Maximizes QOL in Head and Neck Cancer

Martha Kerr

January 18, 2012

January 18, 2011 — Long-term follow-up shows that early intervention — beginning before treatment — for patients with head and neck cancer can make a difference in their quality of life. However, poor quality of life continues to be a significant issue and has not been the focus of much research into the efficacy of rehabilitation, according to a team from the University of Iowa in Iowa City.

Results of the 5-year outcomes of 337 patients in the Outcomes Assessment Project were published online January 16 in the Archives of Otolaryngology–Head and Neck Cancer.

Gerry F. Funk, MD, and colleagues asked patients to score their ability to eat and speak, their aesthetics, their physical and mental health, and their overall quality of life. Scores were recorded at various time points during 5 years of follow-up.

Researchers analyzed the scores at year 1 to determine what most affected quality of life at year 5.

At 5 years, more than half of patients had difficulty eating, 28.5% reported symptoms of depression, and 17.3% reported "substantial" pain, Dr. Funk's team reports.

At 5 years, 13.6% of patients were still smoking and 38.9% drank alcohol.

The most significant predictors of poor quality of life at 5 years were significant pain and difficulty eating due to poor oropharyngeal functioning at 1 year.

"Our findings indicate that long-term survivors as a group maintain their general health," the authors write, despite the large percentage with poor oropharyngeal functioning. "However, every effort should be made to address the substantial subgroup of these patients with poor health and high levels of pain."

"Managing patient quality of life starts in the pretreatment planning phase," Dr. Funk told Medscape Medical News. "You need to incorporate the best chance of curing the patient with the least chance of detriment to quality of life."

"We need to see patients early to assess their ability to swallow and oropharyngeal function. They should be evaluated pre- and postoperatively by a speech therapist, who should be actively involved during treatment to keep the patient functioning as much as possible. "

"Patients are going to have salivary changes, but these can be managed and patients can get used to the long-term changes," Dr. Funk noted.

"One to 5 years out, we are just trying to get a handle on these things. We are realizing that there is fibrosis and stiffening of the neck and osteonecrosis of the jaw. In addition to speech therapists, we have patients see their dentists. Dentists and dental hygienists have an important role in this process."

"The psychosocial realm is also very important. We need to refer the patient to someone who can deal with that. It can be very comforting for patients to know that they are not the only ones in this situation."

"It is important to remind patients that they are not their cancers," noted Sarah H. Kagan, PhD, RN, Lucy Walker Honorary Term Professor of Gerontological Nursing at the Abramson Cancer Center of the University of Pennsylvania in Philadelphia. "Cancer treatment, especially head and neck cancer treatment, really affects how you live your life.... No matter what happens after the diagnosis, your life changes."

"Early intervention is critical," Dr. Kagan reaffirmed. "It is faulty logic to wait until problems appear." She also recommends early involvement of speech therapists and monitoring the patient's nutritional status, which can be related to swallowing difficulties, depression, and other factors, such as changes in taste.

One other issue Dr. Kagan raised is the high rates of smoking and drinking at the 5-year follow-up point. "These may be symptomatic of depression even before diagnosis. Intervention needs to begin before treatment," she reiterated.

"Educating the patient — taking the mystery out — helps," Dr. Funk said. Knowing exactly what to expect "goes a long way toward improving quality of life."

"Interventions are effective," Dr. Funk asserted. "We looked at a large swath of patients over a long period of time. Patients are becoming much more educated and providers are becoming much more knowledgeable.... We can break treatment sequelae down into segments. Acute symptoms can be expected to last for about 1 to 3 months. We want to minimize long-term symptoms by intervening early."

Dr. Funk and Dr. Kagan have disclosed no relevant financial relationships.

Arch Otolaryngol Head Neck Surg. Published online January 16, 2012. Abstract

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