Your AI-Trained Oncology Knowledge Connection!
Ms. Clarke provides an excellent overview of the rehabilitation process for the head and neck cancer patient. She highlights pretreatment and posttreatment rehabilitation issues and details the nature of each multidisciplinary intervention. I concur with the rehabilitation process that she describes and second the importance of multidisciplinary interventions beginning prior to treatment.
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 today’s 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.
As the economics of health care increasingly dictate the parameters of patient care delivery, the role of rehabilitation has taken on new meaning with regard to positive patient outcomes. This is particularly true for the head and neck cancer patient coping with devastating physical and functional changes. With treatment advances leading to increased survival, health-care providers must therefore focus on restoring function and assisting the patient to achieve an acceptable quality of life. For the head and neck cancer patient with multiple rehabilitation needs, this can best be accomplished through a comprehensive, coordinated approach, utilizing interdisciplinary clinical and community resources aimed at facilitating the rehabilitation process and ultimately achieving individualized rehabilitation goals.
In the past, head and neck cancers were felt to be primarily a locoregional control challenge. Distant metastases were not thought to occur frequently. However, the popularity of combined-modality programs emphasizing regional treatment with surgery and radiation in the 1960s enhanced the ability to control the disease at the primary site and within the regional cervical lymphatics. Nevertheless, survival was not improved because treatment failure at distant sites occurred frequently. Apparently, prior treatment programs that did not provide locoregional control masked the ability of this disease to spread to distant sites. Patients died of uncontrolled locoregional disease before they could experience distant metastases.
In 1970, Ansfield and colleagues published the results of a randomized trial in head and neck cancer, which showed that giving fluorouracil (5-FU) concomitantly with radiation decreased regional recurrences and improved overall survival over radiation alone.[1] Publication of these results came 6 years before those of an Italian trial showing similar findings with adjuvant cyclophosphamide, methotrexate, and 5-FU (CMF) in breast cancer.[2] Yet, while adjuvant chemotherapy has rapidly become the norm in the management of early breast cancer, concomitant chemotherapy is still considered undefined in the treatment of head and neck cancer. This situation is elegantly described by Dr. Karen Fu, one of the most respected investigators in this area.
Chemotherapy, when combined with radiotherapy and/or surgery in the treatment of patients with head and neck cancer, appears to be most efficacious if it is given concurrently with radiotherapy. Concurrent chemotherapy and
SAN FRANCISCO-Not all clinicians are satisfied with the current TNM staging system for head and neck cancers. The problem is that the TNM system is based on a morphologic description of the tumor.
This study compared the activity and toxicity of fluorouracil (5-FU)/cisplatin with the combination tegafur and uracil (UFT)/cisplatin in the neoadjuvant treatment of locally advanced-stage III or IV (M0)-head and neck
Squamous cell carcinoma of the head and neck is a potentially curable neoplasm. Historically, the standard approach to treatment has been either surgery or radiation therapy, or a combination of the two. Over the past
The treatment of head and neck cancer has traditionally consisted of surgery with postoperative radiation therapy. Chemotherapy has been reserved for palliation.
DENVER--Novel agents have been designed to exploit molecular markers as therapeutic targets in head and neck cancer. Two studies presented at the American Society of Clinical Oncology meeting involved agents targeting the p53 gene, either by eradication of p53-altered tumor cells or restoration of normal gene function. The third study involved a monoclonal antibody targeted at tumor cells with an abnormality of the EGF receptor.
The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
The Society of Surgical Oncology surgical practice guidelines focus on the signs and symptoms of primary cancer, timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and role of the surgeon in
Benign and malignant tumors can arise from any of the structures contained within the parapharyngeal space. Such tumors are very rare, however. Also, malignant tumors from adjacent areas (eg, the pharynx) can extend into the parapharyngeal space by direct growth, or distant tumors may metastasize to the lymphatics within the space. Although the history and physical examination can provide clues to the site of origin and nature of a parapharyngeal space tumor, imaging studies are more useful for defining the site of origin and extent of the mass, as well as its vascularity and relationship to the great vessels of the neck and other neurovascular structures. Surgery is the mainstay of treatment. The surgical approach chosen should facilitate complete tumor extirpation with minimal morbidity. Irradiation is administered as primary therapy in patients with unresectable tumors, poor surgical candidates, and selected other patients. Radiation therapy is also used after surgery for high-grade malignancies or when wide surgical margins cannot be achieved. [ONCOLOGY 11(5):633-640, 1997]
Head and neck cancer and its treatment frequently cause changes in both speech and swallowing, which affect the patient's quality of life and ability to function in society. The exact nature and severity of the post-treatment changes depend on the location of the tumor, the choice of treatment, and the availability and use of speech and swallowing therapy during the first 3 months after treatment. This paper reviews the literature on speech and swallowing problems in various types of treated head and neck cancer patients. Effective swallowing rehabilitation depends on the inclusion of a video-fluorographic assessment of the patient's oropharyngeal swallow in the post-treatment evaluation. Pilot data support the use of range of motion (ROM) exercises for the jaw, tongue, lips, and larynx in the first 3 months after oral or oropharyngeal ablative surgical procedures, as patients who perform ROM exercises on a regular basis exhibit significantly greater improvement in global measures of both speech and swallowing, as compared with patients who do not do these exercises. [ONCOLOGY 11(5):651-659, 1997]
This paper is an excellent overview of speech and swallowing rehabilitation in head and neck cancer patients. Dr. Logemann and co-workers are clearly leaders in this field and, as such, are eminently qualified to summarize the topic. This subject is of great importance, as the effects of head and neck cancer and its treatment can be economically, psychologically, and socially devastating to patients. Quality-of-life issues continue to be critical in this patient population.
Logemann and colleagues highlight an aspect of the treatment of patients with head and neck cancer that is frequently ignored; ie, the importance of rehabilitation efforts and evaluations of post-therapy quality of life. As oncologists, whether surgical, radiation, or medical, our studies and publications have traditionally focused on overall survival, disease-free survival, and, particularly in the management of head and neck cancer, local control of disease. More recently, investigators have begun to address quality of life when constructing studies for patients with all kinds of malignancies, and newer performance outcome instruments have been designed specifically for patients with head and neck cancer.[1]
The article by Moore provides an example of much needed research evaluating clinical outcomes in head and neck oncology. Measuring the quality of life (QOL) of patients with head and neck cancer presents some unique challenges. First, head and neck cancer profoundly influences some of the most fundamental functions of life, including breathing, eating, and communication. Second, treatment of head and neck cancer does not always improve these functional deficits, and in many instances, the treatment itself results in further deterioration of these functions. Finally, "traditional" outcome measures (disease-free survival, overall survival, local and regional control, response rates) do not adequately assess the global impact of this disease and/or its treatment on patients' perception of life satisfaction.
Quality-of-life (QOL) research in patients treated for head and neck cancer is in its infancy. Early research focused on psychosocial issues related to extensive surgical resection and its consequences. Many advances
Using a new molecular test, investigators at The Johns Hopkins University School of Medicine have detected genetic mutations specific to cancer in blood samples of six patients with head and neck cancer. Their findings are reported in the September issue of Nature Medicine.
At the 4th International Conference of Head and Neck Cancer held in Toronto, Canada, Robert H. Maisel, md, an otolaryngologist at the University of Minnesota Cancer Center, advocated performing tracheoesophageal puncture (TEP) at the time of surgical removal of the voice box due to cancer. While the voice-rehabilitating surgical procedure has been part of the cancer operation since 1985, it has traditionally been performed several months after removal of the larynx.
NIJMEGEN, The Netherlands--With 12,000 new cases of esophageal cancer diagnosed every year in the United States, and 5-year postoperative survival rates still hovering under 20%, the need to develop more effective multimodality treatment strategies remains crucial, said David Ilson, MD, of Memorial Sloan-Kettering Cancer Center.
We investigated the incidence of micrometastases from squamous cell carcinomas of the head and neck in neck dissection specimens originally staged as pN0. A total of 76 dissection specimens from 60 patients were
