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Strategies for Success

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The National Comprehensive Cancer Network (NCCN®) Clinical Practice Guidelines In Oncology (NCCN Guidelines®) are written by a panel of experts who, after evaluating the best evidence available (such as clinical reviews, expert opinion and randomized clinical trials) provided recommendations on the treatment of each type of cancer. The NCCN Guidelines® for Head and Neck Cancers include steps that should be taken before the beginning of treatment.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 November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. Here are some of those recommendations and other steps you and your loved one should consider before the start of treatment to optimize outcomes.

Evaluation by a speech or swallowing therapist

The NCCN Guidelines® for Head and Neck Cancers recommend that some patients may need to have their ability to speak and swallow assessed pre-treatment (baseline).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 November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

Many people with head and neck cancer have a compromised ability to speak and/or swallow even before the start of treatment. For example, researchers evaluated the ability of patients with oropharyngeal cancer to swallow at baseline and found that most patients had some form of swallowing disorder: 67 percent were not able to completely retract their tongues, and 40 percent had delayed swallowing.2Logemann 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. Approximately 20 percent of the people with oropharyngeal cancer could not eat a normal diet at baseline.2Logemann 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.

A speech/swallowing therapist is often an integral member of the head and neck cancer care team and may provide essential recommendations at various times during your loved one’s cancer journey.

A speech/swallowing therapist may evaluate the patient’s ability to speak and swallow prior to, during and after treatment.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 November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. The speech/swallowing therapist can also provide your friend or family member with recommendations of best practices to preserve the ability to swallow, such as best oral hygiene practices.3Gaziano JE. Evaluation and management of oropharyngeal Dysphagia in head and neck cancer. Cancer Control. 2002 Sep-Oct;9(5):400-9. In addition, the speech therapist will recommend swallowing exercises, which can be practiced throughout treatment to best maintain and improve the ability to swallow.

It is likely that you and your patient will work frequently with the speech/swallowing therapist during the cancer journey.

Assessment by a registered nutritionist

The NCCN Guidelines for Head and Neck Cancers recommend that a registered nutritionist may need to assess whether a patient’s nutritional needs are being met at baseline and periodically throughout the course of the cancer journey.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 November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

The nutritionist can provide you and your loved one with strategies for treatment-associated side effects that may disrupt eating through the course of treatment. If the nutritionist determines that your loved one is not getting adequate nutrition at any time, then it may be necessary to receive nourishment intravenously or through a feeding tube.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 November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

Find a support group

You may consider attending a support group with your loved one. Many people with cancer benefit from advice on navigating their journey from people who have had similar experiences.4, Ziebland S, Chapple A, Dumelow C, Evans J, Prinjha S, Rozmovits L. How the internet affects patients' experience of cancer: a qualitative study. BMJ. 2004 Mar 6;328(7439):564.5Meier A, Lyons EJ, Frydman G, Forlenza M, Rimer BK. How cancer survivors provide support on cancer-related Internet mailing lists. J Med Internet Res. 2007 May 14;9(2):e12.

Find counseling services or a psychologist

During the cancer journey, you or your loved one may experience emotional distress. Researchers evaluated the psychological well-being of people with cancer and their caregivers and found that 30 percent of the people with cancer and 40 percent of caregivers experienced anxiety.6Janda M, Steginga S, Langbecker D, Dunn J, Walker D, Eakin E. Quality of life among patients with a brain tumor and their carers. J Psychosom Res. 2007;63:617-623. Even over just a few weeks, counseling services can decrease the level of anxiety among people with cancer and their caregivers.7, Badger T, Segrin C, Dorros SM, Meek P, Lopez AM. Depression and anxiety in women with breast cancer and their partners. Nurs Res. 2007 Jan-Feb;56(1):44-53. 8Northouse LL, Mood DW, Schafenacker A, et al. Randomized clinical trial of a family intervention for prostate cancer patients and their spouses. Cancer. 2007 Dec 15;110(12):2809-18. To get the best results from counseling, researchers recommend that the patient and caregiver be treated together.Therefore, it is helpful to identify a counselor or therapist early in the cancer journey, selecting a person with whom you and your loved one feel comfortable. Counseling services do not need to be limited to dealing with feelings of emotional discomfort. For example, counseling can teach you active coping and problem-solving skills that help with caregiving.8Northouse LL, Mood DW, Schafenacker A, et al. Randomized clinical trial of a family intervention for prostate cancer patients and their spouses. Cancer. 2007 Dec 15;110(12):2809-18.

http://vimeo.com/64108655
The support of friends and family was wonderful and emotionally overwhelming in a positive way. Barry J. (tongue 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 November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

2 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.

3 Gaziano JE. Evaluation and management of oropharyngeal Dysphagia in head and neck cancer. Cancer Control. 2002 Sep-Oct;9(5):400-9.

4 Ziebland S, Chapple A, Dumelow C, Evans J, Prinjha S, Rozmovits L. How the internet affects patients' experience of cancer: a qualitative study. BMJ. 2004 Mar 6;328(7439):564.

5 Meier A, Lyons EJ, Frydman G, Forlenza M, Rimer BK. How cancer survivors provide support on cancer-related Internet mailing lists. J Med Internet Res. 2007 May 14;9(2):e12.

6 Janda M, Steginga S, Langbecker D, Dunn J, Walker D, Eakin E. Quality of life among patients with a brain tumor and their carers. J Psychosom Res. 2007;63:617-623.

7 Badger T, Segrin C, Dorros SM, Meek P, Lopez AM. Depression and anxiety in women with breast cancer and their partners. Nurs Res. 2007 Jan-Feb;56(1):44-53.

8 Northouse LL, Mood DW, Schafenacker A, et al. Randomized clinical trial of a family intervention for prostate cancer patients and their spouses. Cancer. 2007 Dec 15;110(12):2809-18.