Despite accounting for only 3% of all cancer survivors, patients with head and neck cancers often require significant support and survivorship care. And oncology nurses can expect survivorship to grow with recent improvements in prognosis and treatment options, such as with reductions in human papillomavirus-related oropharyngeal cancers, which tend to affect young people and offer improved long-term survival rates.
As the number of significant late and long-term effects increases, patients may experience reduced quality of life, and studies have shown that they often have at least one unmet need related to the aftereffects of cancer and its treatment.
To address the wide range of late and long-term effects, head and neck cancer survivorship care requires an interprofessional approach, including members from primary care, oncology, otolaryngology, dental health, physical therapy, nutrition, speech and swallowing specialty, psychological specialists, and others on the healthcare team. Several national organizations provide evidence-based guidelines to direct practitioners' work.
Late and Long-Term Effects
Because head and neck cancer is often treated with combination therapies such as chemoradiation and surgery, patients may experience effects from all modalities. Radiation side effects vary depending on the specific target but include fatigue, hearing loss, dysphagia, xerostomia, carotid stenosis, hypothyroidism, strictures, or fistula formation or osteoradionecrosis.
Chemotherapy side effects are dose and agent dependent but generally include fatigue, peripheral neuropathy, fertility problems, sexual changes, and cognitive effects. Less-common late effects are secondary cancers such as myelodysplasia and leukemia. Immunotherapies and targeted agents have additional side effects depending on the agent used, and survivorship care plans should be adjusted as indicated.
Surgery that affects salivary gland function may lead to xerostomia, trismus, or other effects. Patients may experience lymphedema, dysphagia, cranial nerve dysfunction, or dental problems and struggle with cosmetic outcomes.
The many late effects centered in the mouth and throat may result in altered dietary intake. Routinely assess patients’ nutritional status, including weight loss, nutritional deficiencies, and enteral support as needed, and consult with speech language pathologists for chronic dysphagia, trismus, and swallowing difficulties. See sidebar for nutritional support resources.
Ongoing Screening and Prevention
Head and neck cancer survivors require close surveillance and follow-up in the first two years posttreatment when they are most at risk for disease recurrence and secondary cancers. Appropriate candidates may consider genetic testing, especially those whose personal and family history suggest a hereditary cancer syndrome. Cancer survivors generally should follow the recommended cancer screening guidelines for their age and gender, including routine mammograms and colonoscopies. Patients who have a history of smoking may consider a lung cancer screening program.
Lifestyle recommendations include stopping smoking and alcohol use; following a diet high in fruits, vegetables, and whole grains and low in fat, processed foods, and red meat; engaging in regular exercise; maintaining an ideal body weight, and practicing sun safety.