ACS Releases Long-term Care Guideline for Survivors of Head and Neck Cancer
Article date: March 22, 2016
By Stacy Simon
The American Cancer Society has released a new Head and Neck Survivorship Care Guideline to help survivors of head and neck cancer and their primary care providers better manage their long-term care. The guideline addresses cancers of the oral cavity, tongue, lip, pharynx (throat), and larynx (voice box). Recommendations in the guideline may also apply to cancers of the salivary glands, nasal and paranasal sinuses, and nasopharynx. But it does not address cancers of the brain, thyroid, or esophagus because they are very different in terms of symptoms and treatment.
The guideline was published March 22, 2016 in CA: A Cancer Journal for Clinicians, a journal of the American Cancer Society. It provides detailed recommendations for how and when to test for new or returning cancers, managing side effects, making healthy lifestyle changes, and coordinating care among primary care providers and specialists.
An estimated 436,060 survivors of head and neck cancer are living today in the United States, and that number is growing. Long-term survival is becoming increasingly common; therefore, it is important that long-term survivorship care is managed in coordination with health problems associated with aging.
Tobacco use and alcohol consumption account for about 75% of head and neck cancer cases. Another important risk factor is human papillomavirus (HPV) infection. As many as 70% of cancers of the oropharynx (the part of the throat behind the mouth) are linked to high-risk strains of HPV.
The guideline was developed by the National Cancer Survivorship Resource Center, a collaboration between the American Cancer Society, The George Washington University Cancer Institute, and the Centers for Disease Control and Prevention.
Checking for new or returning cancer
After treatment, the new guidelines recommend that survivors get regular follow-up tests and physical exams as part of a coordinated after-treatment care program. They should also learn about and report any new symptoms that might be related to their cancer. Symptoms that should be reported to the doctor include:
- Swelling or lumps
- Red or white patch in the mouth
- Sore throat that doesn’t go away
- Bad breath that isn’t helped by good dental habits
- Nasal congestion that doesn’t get better
- Frequent nose bleeds
- Trouble breathing
- Double vision
- Numbness or weakness
- Ear or jaw pain
- Difficulty chewing, swallowing or moving the tongue or jaw
- Blood in saliva or phlegm
- Loose teeth or dentures that don’t fit right
- Losing weight without trying
Survivors should also follow the American Cancer Society’s early detection guidelines to check for other cancers by following the same testing schedule for their age and gender as the general population. Survivors who have a history of smoking should talk to their doctors about whether to have annual lung cancer screening. They should also talk to their doctor about testing for other head and neck cancers and for esophageal cancer, as they may be at higher risk than the general population.
Managing side effects
Depending on the cancer site, surgery, radiation, and chemotherapy for head and neck cancers can cause pain and functional problems in the neck, shoulder, mouth, throat, eyes, and ears. Treatment can also cause sleep problems, weight loss, eating and digestion problems, lymphedema (severe swelling in the arm), fatigue, hearing loss, vertigo (feeling like the room is spinning), speech problems, nerve damage (peripheral neuropathy), tooth and gum problems, and thyroid problems. It’s important to discuss these side effects and any others with a medical provider so they can be evaluated and treated when possible.
It is not unusual for people who’ve had head and neck cancers to experience anxiety or depression. Feelings of sadness or distress should be discussed with a doctor, who can evaluate whether they are signs of clinical depression. Clinical depression can lower quality of life, and also make people less able to take care of their own health. There are many ways to treat clinical depression, including medicine, counseling, or a combination of the two.
Encouraging healthy behaviors
The guideline recommends that primary care doctors talk to survivors of head and neck cancers about their lifestyle habits and give them advice on how to make changes, if needed. A healthy lifestyle after a head and neck cancer diagnosis can reduce symptoms and improve quality of life, and may help lower the risk of some cancers. Healthy behaviors include:
- Getting to and staying at a healthy weight. For those overweight, this can mean limiting high-calorie foods and beverages, and getting more physical activity.
- Eating a diet rich in vegetables, fruits, and whole grains, and low in saturated fats. Survivors who have eating problems or face any other challenges to good nutrition should talk to their doctor or ask for a referral to a registered dietician.
- Regardless of current weight, aiming for at least 150 minutes of physical activity every week, with a doctor’s approval. This should include strength training at least 2 days a week.
- Avoiding tobacco. If you smoke and want to quit, read our Guide to Quitting Smoking or call us at 1-800-227-2345 and we’ll help you get started. Research shows that getting help increases your chances of success.
- Avoiding alcohol, including mouthwash containing alcohol.
- Maintaining oral health by taking good care of teeth and dentures and visiting the dentist regularly.
Coordinating medical care
When cancer treatment ends, patients should ask their oncologist for a written follow-up care plan that they can share with their primary care doctor and other doctors. It should include an explanation of which provider – oncologist, primary care doctor, or other specialist – should be in charge of cancer-related and other medical care.
- New Head and Neck Survivorship Care Guideline addresses cancers of the oral cavity, tongue, lip, pharynx (throat), and larynx (voice box).
- After treatment, the new guidelines recommend that survivors get regular follow-up tests and physical exams to report any new symptoms.
- Survivors who have a history of smoking should talk to their doctors about whether to have annual lung cancer screening.
- It is not unusual for people who’ve had head and neck cancers to experience anxiety or depression. Feelings of sadness or distress should be discussed with a doctor.
- The guideline recommends that primary care doctors talk to survivors of head and neck cancers about their lifestyle habits and give them advice on how to make changes, if needed.
Citation: American Cancer Society Head and Neck Cancer Survivorship Care Guideline. Published March 22, 2016 in CA: A Cancer Journal for Clinicians. First author Ezra E. W. Cohen, MD, University of California at San Diego, La Jolla, Calif.
Reviewed by: Members of the ACS Medical Content Staff
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