14.11 (14.5) Palliative issues in the care of patients with head and neck cancers Flashcards
Where do head and neck cancers arise from?
List FOUR locations in the head and neck
From epithelial lining of the upper aerodigestive tract & affects oral cavity including:
◆ lips
◆ pharynx
◆ larynx
◆ paranasal sinuses
◆ nasal cavity
◆ salivary glands
◆ middle ear
What type of cancer are most head and neck cancers?
List FIVE risk factors for head and neck cancer
Majority are squamous cell carcinoma.
Risk factors:
◆ inc age*
◆ male sex*
◆ low socioeconomic status*
◆ tobacco*
◆ high EtOH intake*
◆ chewing tobacco or betal quid/paan (arica nut)
◆ viral infection with HPV, EBV
◆ premalig lesions (leucoplaia, erythoplakia, lichen planus)
Risk factor not listed in 6th:
◆ mucosal irritation by ill fitting dentures or roughened dental edges
Box 14.11.1
What are the four domains of health that contribute to QOL
Physical
Emotional
functional
social
PE FS
Head and neck cancers impact two vital functions
swallowing and vocalization
List 5 signs or symptoms that may indicate swallowing dysfunction and should trigger an SLP assessment
-inability to control food, liquids, saliva in oral cavity
-pocketing of food in cheek*
-excessive chewing*
-drooling*
-nasal regurgitation*
-cough, choking or throat clearing during swallowing*
-abnormal vocal quality after swallowing
(wet or gurgled voice)
-build up or congestion after meal
-complaint of difficulty swallowing
-weight loss
List two investigations for assessing oropharyngeal swallowing
modified barium swallow
fibreoptic endoscopic evaluation of swallowing - gold standard
List three ways that adjuvant xrt contributes to swallowing issues in patients with head and neck cancer
mucositis
tissue edema
xerostomia
hyperviscous secretions
What are three disorders of vocalization that can occur in a patient with head and neck cancer
disordered speech (structural changes in lips, tongue, teeth and hard palate)
disordered resonance
disordered voice
List 6 specific symptom control issues that may arise in someone with head and neck cancer
Most pertinent as per 6th:
◆ pain*
◆ oral care & mucositis*
◆ sialorrhoea & secretion mgmt
◆ wound care & major bleeds (“carotid blowout”)*
◆ airway obs & trach mgmt*
◆ nutrition & diff swallow*
◆ psych distress & social isolation*
Prev listed other answers:
auditory function
taste alteration
xerostomia
fistula
hypothyroidism
dermatitis
lymphedema
anemia
mood/anxiety disorders
neurocognitive impairment
list 3 interventions for lymphedema in patients with head and neck cancer
- manual lymphatic drainage
- compression garments
- education re postural techniques, identification and prevention of infection, exercises to maintain neck and shoulder mobility
List four contributors to poor nutrition in patients with head and neck cancer
Cancer related:
- decreased oral intake due to pain
- difficulty swallowing/dex tongue mobility
- mechanical obs by tumor
Treatment related:
- neurological dysfunction
- radiation induced xerostomia/fibrosis
- dental extractions
- lymphedema
FS
Odynophagia
Dysphagia
Obstruction
Treatment related
List four ways to reduce risk of osteoradionecrosis (ORN) in patients with head and neck cancer
ORN - ischemic necrosis of bone in a previously irradiated area with associated soft tissue necrosis
—-
stop smoking*
stop EtOH*
use fluoride before bedtime to reduce dental carries*
minimize trauma and exposure to local irritants*
diseased teeth maintained through endodontic tx
for unrestorable teeth retention of roots is preferable to extraction
What is the primary tx for ORN
hyperbaric O2
Loss of which type of taste is most correlated to poor QOL
umami taste - due to role in triggering interest in eating and enjoyment
What is the most frequent symptom complaint of people receiving XRT for head and neck cancers
xerostomia
