Rehabilitation: Long-Term Physical and Functional Changes Following Treatment

https://doi.org/10.1016/j.soncn.2009.05.006Get rights and content

Objectives

To describe the life altering issues that survivors of a head and neck cancer report post treatment and discuss multidimensional rehabilitation approaches.

Data Sources

Published journal articles, literature reviews, research reports, book chapters.

Conclusion

Survivors and their family caregivers encounter many changes during the first 3 months following treatment for head and neck cancer, placing them at risk of multiple adjustment difficulties. Progressive weight loss, loss of energy, strength, muscle endurance and decreased functioning severely compromise healthy adjustment and quality of life.

Implications for Nursing Practice

Nurses can help patients and family identify survivorship issues to be managed at home. Planning, exploring, coaching, practicing skills with survivors and their family caregivers, providing specific information, and linking them with resources can help them bridge this transition into extended survivorship.

Section snippets

Survival Rates In Head and Neck Cancer

Squamous cell carcinoma of the head and neck is common worldwide.19 Males are affected significantly more than females, at a ratio ranging from 2:1 to 4:1.20 In the year 2007, there was an estimated 4,350 new cases diagnosed in Canada, with approximately 1,600 deaths attributable to head and neck squamous cell cancer.21 In the United States, there is an annual incidence of approximately 70,620 newly diagnosed cases (15,180 deaths).22 National Cancer Institute reports indicate that 61% of

Physical and Functional Changes

Curative treatments for head and neck cancers are frequently associated with disfigurement and dysfunction that could become permanent. Treatments can contribute to loss of sensory-motor and/or expressive-communicative functions related to speaking, eating, breathing, and physical appearance. Table 1 summarizes the impact of physical and functional changes after treatment for head and neck cancer. Morton reported that more physical and somatic dysfunction is experienced after combined rather

Cancer Cachexia

Cancer cachexia is defined by an aberrant energy and protein balance driven by a variable combination of reduced food intake and hypermetabolism.64 Over its course, cachexia is associated with functional impairment and fatigue. A defining feature is the ongoing loss of skeletal muscle mass, which is not fully reversed by conventional nutritional support. Cachexia is classified as either primary or secondary, depending on its cause. Primary cachexia is principally caused by a tumor-induced

Rehabilitation and Nursing Implications

Cancer rehabilitation is defined as a process whereby the individual within his environment is assisted to obtain optimal (physical, social, psychological, and vocational) functioning within the limits of his disease and situation.73 There are many variations of care models in practice that deliver critical, effective, ongoing, and supportive care required by patients with cancer of the head and neck.74, 75, 76, 77, 78, 79 An integrated cancer rehabilitation team approach may be indicated,

Conclusion

For some patients, recovery following treatment for head and neck cancer is smooth and occurs largely independent of the health services support. These individuals are encouraged to make healthy lifestyle choices, and adhere to scheduled follow-up appointments. Other individuals and family caregivers encounter a range of difficulties of differing degrees of complexity. Some treatment effects and conditions cannot be completely resolved despite the best possible interventions and rehabilitative

Acknowledgment

The authors would like to thank the following for their assistance in preparing and reviewing this manuscript: Judith Ritchie, N, PhD, Andréanne Saucier, MSc, CON(C), Myriam Skrutkowski, N, MSc CON(C), and Elizabeth Beaubien.

Margaret Eades, N, MSc(A), CON(C): Clinical Nurse Specialist (CNS)-Oncology, McGill University Health Centre-Clinical Co-Administrator and CNS Cancer Nutrition and Rehabilitation Program, McGill University Health Centre, Royal Victoria Hospital site, Montreal, Qc.

References (79)

  • S. Hamlet et al.

    Mastication and swallowing in patients with post-irradiation xerostomia

    Int J Radiat Oncol Biol Phys

    (1997)
  • B.R. Pauloski et al.

    Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients

    Otolaryngol Head Neck Surg

    (1998)
  • N.C. Gellrich et al.

    Follow-up in patients with oral cancer

    J Oral Maxillofac Surg

    (2002)
  • N. MacDonald et al.

    Understanding and managing cancer cachexia

    J Am Coll Surg

    (2003)
  • A. de Graeff et al.

    Sociodemographic factors and quality of life as prognostic indicators in head and neck cancer

    Eur J Cancer

    (2001)
  • B.A. Murphy et al.

    Quality of life research in head and neck cancer: a review of the current state of the science

    Crit Rev Oncol Hematol

    (2007)
  • E. Carr

    Head and neck malignancies

  • R. Scarpa et al.

    Surgical management of head and neck malignancies

  • L. Blevins

    Radiation Treatment and Symptom Management

  • J. Sloan et al.

    Chemotherapy

  • E. Hammerlid et al.

    Health-related quality of life in long term head and neck cancer survivors: a comparison with general population norms

    Br J Cancer

    (2001)
  • M.B. Happ et al.

    Communication needs, methods, and perceived voice quality following head and neck surgery: a literature review

    Cancer Nurs

    (2003)
  • A.R. Perry et al.

    An evaluation of functional outcomes (speech, swallowing) in patients attending speech pathology after head and neck cancer treatment(s): results and analysis at 12 months post intervention

    J Laryngol Otol

    (2003)
  • D.P. Goldstein et al.

    Health-related quality of life profiles based on survivorship status for head and neck cancer patients

    Head Neck

    (2007)
  • N.M. Aziz

    Cancer survivorship research: state of knowledge, challenges and opportunities

    Acta Oncol

    (2007)
  • K.L. Haman

    Psychologic distress and head and neck cancer: Part 1 – review of the literature

    J Support Oncol

    (2008)
  • M.J. Dropkin

    Nursing research issues

  • F. Fang et al.

    Quality of life as a survival predictor for patients with advanced head and neck carcinoma treated with radiotherapy

    Cancer

    (2004)
  • M.B. Spaulding

    Recent advances in treatment of head and neck cancer

    ORL Head Neck Nurs

    (2002)
  • A. Jemal et al.

    Cancer statistics, 2009

    CA Cancer J Clin

    (2009)
  • Canadian Cancer Society/National Cancer Institute of Canada: Canadian Cancer Statistics 2008. Available...
  • American Cancer Society

    Cancer facts and figures 2008

    (2008)
  • National Cancer Institute, Surveillance Epidemiology and End Results. Available at:...
  • R.P. Morton

    Studies in the quality of life of head and neck cancer patients: results of a two-year longitudinal study and a comparative cross-sectional survey

    Laryngoscope

    (2003)
  • M.F. de Boer et al.

    Physical and psychosocial correlates of head and neck cancer: a review of the literature

    Otolaryngol Head Neck Surg

    (1999)
  • M.J. Dropkin

    Literature review on quality of life following head and neck surgery

    ORL Head Neck Nurs

    (1998)
  • M.J. Dropkin

    Disfigurement and dysfunction with head and neck cancer surgery

    ORL Head Neck Nurs

    (1998)
  • M.J. Dropkin

    Body image and quality of life after head and neck cancer surgery

    Cancer Pract

    (1999)
  • Cited by (45)

    • Mapping the frequency of malnutrition in patients with head and neck cancer using the GLIM Criteria for the Diagnosis of Malnutrition

      2020, Clinical Nutrition ESPEN
      Citation Excerpt :

      The tumour may cause obstruction of the upper aerodigestive tract due to its location and size, hence making the bolus hard to ingest and swallow [2]. Also, toxicities related to cancer treatment may have a profound impact on food intake [3,4], both in close relation to treatment [5] and in a longer perspective after the termination of treatment [6,7]. The described frequency of malnutrition in patients with HNC varies due to heterogeneity of studied cohorts but also to the fact that different criteria are used to define malnutrition [8–11].

    • It's a question of endurance – Patients with head and neck cancer experiences of <sup>18</sup>F-FDG PET/CT in a fixation mask

      2017, European Journal of Oncology Nursing
      Citation Excerpt :

      Patients may experience functional, social, and existential losses during and after treatment which may alter their life expectations (Lang et al., 2013). The location of the tumor and the treatment causes various side-effects, such as decreased ability to breathe, eat, speak, and altered physical appearance, leading to a need for different kinds of support before, during, and after treatment (Eades et al., 2009; Moore et al., 2014). It has also been recognized that the molding of the fixation mask, the lack of communication during this process, and placement of the fixation mask on the face during radiotherapy may cause feelings of anxiety among patients (Moore et al., 2014).

    • Validation of the University of Washington Quality of Life Chinese Version (UWQOL-C) for head and neck cancer patients in Taiwan

      2017, Journal of the Formosan Medical Association
      Citation Excerpt :

      Psychometric validity is often established with classical test theory, which relies on internal consistency, reliability, and both content and construct validity. Content validity of a translated scale is established by demonstrating that the translated items reflect the most relevant items of a cancer patient's QOL; typically through focus groups of patients as well as experts.21–24 Construct validity would be supported by proving hypothesized associations between the scale of interest and related constructs.

    View all citing articles on Scopus

    Margaret Eades, N, MSc(A), CON(C): Clinical Nurse Specialist (CNS)-Oncology, McGill University Health Centre-Clinical Co-Administrator and CNS Cancer Nutrition and Rehabilitation Program, McGill University Health Centre, Royal Victoria Hospital site, Montreal, Qc.

    Martin Chasen, MBCHB FCP(SA) MPhil (Pall Med): Medical Oncologist and Palliative Care Physician - Clinical Director, Cancer Nutrition and Rehabilitation Program, McGill University Health Centre: Royal Victoria Hospital site and McGill University, Montreal, Qc.

    Ravi Bhargava, MD: Clinical Research Associate, Cancer Nutrition and Rehabilitation Program, McGill University Health Centre: Royal Victoria Hospital site, Montreal, Qc.

    View full text