Rehabilitation for the Head and Neck Cancer Patient
Rehabilitation for the Head and Neck Cancer Patient
Although head and neck cancer accounts for only about 5% of all malignancies, the functional and cosmetic changes that result from the tumor or its treatment pose a challenge to the health-care community. In todays health-care environment, we are being forced or at least encouraged to decrease the length of hospital stay for patients following all types of surgical procedures. As a result, the inpatient census for most units has decreased substantially, causing many specialized patient care units to close.
Head and neck surgical units have been drastically affected by these closures. The postoperative patient with a head and neck tumor not only has less time in the hospital to recover and learn how to provide self-care but also may receive care and instruction from nurses or allied health personnel unfamiliar with the specialized needs of this patient population.
The head and neck surgical patient may be placed in an intensive care unit for a few days after surgery when the acute-care needs of airway management and incision care are the most important. Following this acute phase, much of the care required is related to rehabilitation and preparing the patient and family to assume the care that will be needed on an ongoing basis.[1-3] Nurses from a general medical surgical or oncology unit may not have been trained in the specialized needs of these patients.
Ms. Clarke briefly reviews the nursing care necessary for the postoperative head and neck surgical patient. She discusses in general terms care of the tracheostomy tube and airway and the oral cavity and incisional care required for the routine patient, as well as the patient with complications or a free flap. She mentions the importance of a feeding tube for nutritional support.
The scope of this article is limited to the rehabilitation of the patient after head and neck surgery. Therefore, the reader should realize that additional resources will be necessary to fully understand the complex care required by this group of patients.
Ms. Clarke mentions Dropkins research on patients' readiness for self-care. Patients must be prepared to look in the mirror and acknowledge the changes that the tumor and surgery have made before they will be able to comprehend the instruction provided by the nurse. Most of the time, nurses do not have the luxury of allowing patients to adapt to the changes in appearance before they begin teaching self-care. With the push for early discharge, nurses must use every available moment to instruct and reinforce self-care with patients and their families or significant others. Additional research about self-care and patient readiness to learn will be needed to adapt instructions to the decreased hospital stay.
The hospital staff must work with the office/clinic staff and the home health nurses in providing continuity of care and instruction. Because the patient will not be in the hospital for an indefinite time, teaching must start in the office prior to surgery and continue in the home after discharge. Reinforcement of instruction and procedures, referrals to support groups and rehabilitation services, and constant patient follow-up by telephone and in person may replace some of the supervision that previously took place in the hospital.
All verbal instructions should be supplemented with written guidelines so that the patient and family have a resource if problems arise. The staff may also find it useful to develop an instructional videotape to enhance verbal instructions and provide demonstrations of rehabilitation procedures. One must remember that these teaching tools are only aids and serve to enhance direct-patient teaching; they are not intended to replace the personal teaching provided by the nurse.
Ms. Clarkes discussion of a rehabilitation team working with this group of patients is an excellent way to guarantee that they will be offered services that will enhance their rehabilitation. The use of clinical pathways is another means by which both the experienced and the inexperienced nurse can ensure that patients receive the coordinated rehabilitative services that are needed.
Educational resources for the nurse who will be providing care to the head and neck surgical patient are mentioned in the article. The American Cancer Society and the Society of OtorhinolaryngologyHead and Neck Nurses are resources available to nurses. The Lost Chord Club and SPOHNC (Support for People with Oral and Head and Neck Cancer, PO Box 53, Locust Valley, NY 11560-0053) are support groups for the patient and family/significant others. Part of the rehabilitation can come from people who have been there and found ways to overcome some of the problems.
We all realize that the health care we provide must be cost-effective. At the same time, we must also provide care to patients that will allow them to return to an acceptable quality of life.
1. Baker C: A functional status scale for measuring quality of life outcomes in head and neck cancer patients. Cancer Nurs 18(6):452-457, 1995.
2. Deleyiannis FWB, Weymuller EA: Quality of life in patients with head and neck cancer, in Myers EN, Suen JY (eds): Cancer of the Head and Neck, pp 904-916. Philadelphia, WB Saunders, 1996.
3. Sigler BA, Edwards AT, Wilkerson J: Nursing care, in Myers EN, Suen JY (eds): Cancer of the Head and Neck, pp 818-839. Philadelphia, WB Saunders, 1996.
4. Dropkin MJ: Coping with disfigurement/dysfunction and length of hospital stay after head and neck surgery. Oral Head Neck Nurs 15(1):22-27, 1997.
5. SPOHNC: Support group available for patients with head and neck cancer. Oral Head Neck Nurs 14(4):14, 1996.