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Follow-Up Care

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Long-term side effects from the initial treatment plan can develop and emerge years later. For this reason, follow-up evaluations are essential. A health care professional should give your loved one a schedule of follow-up visits and outline what evaluations he or she should have done based on his or her cancer type, stage and treatments.

Factors that influence follow-up care

The type of therapy received during the treatment of head and neck cancer will determine the type of follow-up assessments performed.

If radiation therapy was administered to the neck region, then there is an increased likelihood of developing impaired thyroid gland functioning.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 2, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. One in four patients who were administered surgery and radiation therapy combinations develop hypothyroidism, or an underactive thyroid gland, post-treatment.2Alexander MV, Zajtchuk JT, Henderson RL. Hypothyroidism and wound healing: occurrence after head and neck radiation and surgery. Arch Otolaryngol. 1982 May;108(5):289-91. Hypothyroidism can result in a variety of symptoms that negatively impact quality of life such as weight gain, fatigue, weakness, hair loss, pain or depression.Because of this increased risk of developing hypothyroidism, if the patient received irradiation to the neck region, then he or she will need to undergo periodic assessments of thyroid gland function.

If your loved one received chemoradiation therapy, then the cancer care team will recommend frequent speech and swallowing evaluations. Researchers found that one year after chemoradiation therapy, 44 percent of patients did not have a normal diet, while 22 percent did not have a functional swallow.3Logemann JA, Pauloski BR, Rademaker AW, et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck. 2008 Feb;30(2):148-58.

The health care professionals should suggest how frequently your loved one should have follow-up evaluations. Your loved one may need to undergo the following evaluations, depending on the type of therapy administered and any emergent symptoms that may develop:

  • History and physical1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 2, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Imaging to evaluate for the presence of new or recurrent cancer1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 2, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Thyroid-stimulating hormone levels (to assess thyroid functioning if your loved one’s neck was irradiated during treatment)
  • Nutrition, hearing, speech and swallowing evaluations1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 2, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Dental evaluation, especially if the oral cavity was irradiated1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 2, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Surveillance for symptoms of depressions1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 2, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Potential monitoring for Epstein-Barr virus and routine annual imaging (for nasopharyngeal cancer patients)

Your loved one should take steps to decrease the likelihood of developing cancer again.

Smoking and excessive alcohol consumption are known risk factors for various types of head and neck cancer.4American Cancer Society (ACS). Cancer Facts and Figures 2012. Atlanta, GA: American Cancer Society, Inc. 2012. If your loved one has a history of smoking, chest imaging may be recommended during follow-up. If your loved one needs help to stop smoking or drinking excessive amounts of alcohol, you may want to request counseling for your loved one with an addiction specialist.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 2, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

http://vimeo.com/64108652
The nurses and therapists were terrific at working with me and giving me exercises to learn how to swallow and speak again. Barry W. (palatomaxillary and low grade adenocarcinoma of minor salivary gland cancer survivor)

References

1 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 2, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

2 Alexander MV, Zajtchuk JT, Henderson RL. Hypothyroidism and wound healing: occurrence after head and neck radiation and surgery. Arch Otolaryngol. 1982 May;108(5):289-91.

3 Logemann JA, Pauloski BR, Rademaker AW, et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck. 2008 Feb;30(2):148-58.

4 American Cancer Society (ACS). Cancer Facts and Figures 2012. Atlanta, GA: American Cancer Society, Inc. 2012.