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Post-Treatment Care

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Post-treatment refers to the first two years after completion of treatment.1Logemann 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. Side effects can still occur, and to optimize outcomes, many patients will need rehabilitation, especially for speaking and/or swallowing.

Post-treatment care: swallowing deficits

Researchers evaluated deficits in swallowing for patients who received radiation therapy at baseline and post-treatment. Most had swallowing impairments at baseline, likely due to cancer complications; 83 percent had a decreased ability to retract the tongue, 42 percent had delayed swallowing and 67 percent had decreased tongue strength.1Logemann 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.

Researchers found that some swallowing functions improved a year after radiation therapy in head and neck cancer patients. One year post-radiation therapy, 83 percent had a decreased ability to retract the tongue, 33 percent had delayed swallowing and 50 percent had decreased tongue strength.

Over the first months to a year post-treatment, there was little change in the swallowing impairments.1Logemann 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.

Researchers evaluated deficits in swallowing for chemoradiation therapy patients at baseline and post-treatment. Most people who were going to receive chemoradiation therapy had swallowing deficits at baseline: 61 percent had a decreased ability to retract the tongue, 39 percent had delayed swallowing and 46 percent had decreased tongue strength.1Logemann 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.

One year post-chemoradiation therapy, a higher proportion of patients had swallowing deficits. One year post-chemoradiation therapy, 86 percent had a decreased ability to retract the tongue, 44 percent had delayed swallowing and 60 percent had decreased tongue strength.1Logemann 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.

Patients who were administered chemoradiation therapy also exhibit swallow impairments at baseline, such as a decreased ability to retract the tongue, decreased tongue strength or delayed swallowing. However, in the first three months post-chemoradiation therapy, more patients developed problems with tongue retractions, decreased tongue strength and decreased swallowing.

Researchers found that people treated with surgery also exhibit swallowing impairments post-treatment. One of the main factors that impacted swallowing was the amount and type of tissue removed. For example, if surgeons removed one-fourth of the tongue, swallowing was profoundly affected.2Pauloski BR. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am. 2008 Nov;19(4):889-928.

There are measures a patient can take to manage the occurrence of swallowing deficits after radiation or chemoradiation therapy. Researchers found that people who did swallowing therapy before receiving radiation or chemoradiation therapy did better than people who did this therapy only after receiving radiation or chemoradiation therapy.3, Kulbersh BD, Rosenthal EL, McGrew BM, et al. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope. 2006 Jun;116(6):883-6.4Carroll WR, Locher JL, Canon CL, Bohannon IA, McColloch NL, Magnuson JS. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008 Jan;118(1):39-43.

People with swallowing deficits after treatment, however, should receive rehabilitation, which includes specific swallowing and strengthening exercises.

Post-treatment care: speech therapy

If your loved one experiences continued difficulty speaking due to surgery or side effects of head and neck cancer treatments, he or she may continue to see a speech therapist for some time after cancer treatment is completed.

Post-treatment care: nutritional needs

Radiation therapy post-treatment side effects include decreased salivation among 60 to 92 percent5, Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet 2008; 371:1695-1709.6Epstein JB, Emerton S, Kolbinson DA, et al. Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck. 1999 Jan;21(1):1-11. of patients and inflammation in the skin lining the mouth (mucositis) among 97 percent of the patients.2Pauloski BR. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am. 2008 Nov;19(4):889-928.

Chemoradiation therapy side effects post-treatment also include decreased salivation, with mucositis among 90 percent of the patients.2Pauloski BR. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am. 2008 Nov;19(4):889-928.

In addition, chemoradiation often leads to a worsening in swallowing deficits after treatment; one year after chemoradiation therapy, only 44 percent of people who received this therapy had a normal diet.1Logemann 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.

Decreased salivation and mucositis can negatively affect eating. In particular, severe mucositis often presents as pain in the mouth.2Pauloski BR. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am. 2008 Nov;19(4):889-928. If mouth pain is combined with swallowing deficits, patients may not meet their nutritional needs.

If the patient has problems with swallowing, mucositis or decreased salivation and it affects eating, talk to a registered nutritionist. The nutritionist may decide that your loved one needs to temporarily obtain nutrients through a feeding tube or an IV.7Referenced 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.

If the patient has the following symptoms, then encourage him or her to follow these recommendations to obtain adequate nutrition:

  • If the patient has mucositis, he or she should avoid spicy foods.2Pauloski BR. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am. 2008 Nov;19(4):889-928.
  • If decreased salivation is disrupting the ability to eat, consult with a physician; a clinician can prescribe a medication called pilocarpine or a similar medication to stimulate salivary production.5Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet 2008; 371:1695-1709.

Post-treatment care: addressing addiction

If your loved one struggles with one or more addictions to cancer-causing substances such as tobacco or excessive alcohol, encourage him or her to seek assistance in quitting. Quitting using these substances will help to prevent recurrence or a new cancer developing.

Post-treatment care: follow-up visits and testing

All head and neck cancer survivors need to have follow-up visits with their doctors to evaluate ongoing needs for rehabilitation and to test for recurrent disease. When treatment is completed, your loved one should receive a follow-up schedule from the care team (if not, request one). Remind and encourage the survivor to keep these appointments; they are important to prevent and detect cancer recurrence.

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Realize there are a lot of people helping you, caring for you.Gordon O. (laryngeal cancer survivor)

References

1 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.

2 Pauloski BR. Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am. 2008 Nov;19(4):889-928.

3 Kulbersh BD, Rosenthal EL, McGrew BM, et al. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope. 2006 Jun;116(6):883-6.

4 Carroll WR, Locher JL, Canon CL, Bohannon IA, McColloch NL, Magnuson JS. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008 Jan;118(1):39-43.

5 Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet 2008; 371:1695-1709.

6 Epstein JB, Emerton S, Kolbinson DA, et al. Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck. 1999 Jan;21(1):1-11.

7 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.