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Strategies for Success

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The NCCN Guidelines® for Head and Neck Cancers recommend that your ability to speak and swallow be assessed pretreatment (baseline):1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

  • Evaluation by a speech pathologist: You may experience a change in your voice or ability to speak during the course of treatment or even after the completion of treatment.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc. Therefore, many head and neck cancer patients are advised to see speech pathologists. For example, 34 to 70 percent of patients who received radiation therapy developed a speech impairment post-treatment.2 Chen H-C, Evans KFK, Salgado CJ, Mardini S. Methods of voice reconstruction. Seminars in Plastic Surgery. 2010:227-232.

A speech pathologist is often an integral person in your cancer care team and may provide essential recommendations at various times during your cancer journey.

Evaluation by a speech pathologist may be done prior to treatment, especially to obtain baseline measurements of your ability to speak and swallow as well as to assess the likelihood of your experiencing side-effects in your voice or ability to speak as a result of your treatment.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc. The speech pathologist can also provide you with recommendations to preserve your ability to swallow, which may include changes in your oral hygiene routine. In addition, you can learn swallowing exercises and practice them during therapy to maintain your ability to swallow.3 Gaziano JE. Evaluation and management of oropharyngeal Dysphagia in head and neck cancer. Cancer Control. 2002 Sep-Oct;9(5):400-9.

It is likely that you will work with your speech pathologist frequently during your cancer journey; speech pathologists also often work with patients during rehabilitation.

  • Evaluation by a registered nutritionist: Patients with head and neck cancer are often undernourished before initiating treatment,which may be due to complications associated with the tumor.4 Doyle C, Kushi LH,Byers T, et al.2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee; American Cancer Society.Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin.2006;56:323-353. Many patients with head and neck cancer may experience weight loss during the course of the disease.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

Therefore, a registered nutritionist may assess your nutritional needs at your baseline and periodically throughout the course of your cancer journey.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc. The registered nutritionist can provide you with strategies for treatment-associated side effects that may disrupt eating through the course of treatment.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc. If your nutritionist determines that you are currently not getting adequate nutrition at any time during the course of your disease, you may temporarily 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.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

  • Evaluation by a Dentist: Radiation therapy has been associated with an increase in cavities and bone loss.5 Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008; 371:1695-1709.

Prior to treatment, you should have a dental evaluation.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc. If you are likely to receive radiation therapy, then prophylactic fluoride treatment should be done to protect your teeth during treatment and for the rest of your life, which can decrease the likelihood of developing cavities.6, Horiot JC, Schraub S, Bone MC, Bet al. Dental preservation in patients irradiated for head and neck tumours: A 10-year experience with topical fluoride and a randomized trial between two fluoridation methods. Radiother Oncol. 1983 Aug;1(1):77-82. 7, Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995; 45: 352-368.8 Zlotolow IM. Clinical manifestations of head and neck irradiation. Compend Contin Educ Dent. 1997;18(2 Spec No):51-6.

  • Find a support group: You may consider identifying a support group for you and/or your family members. Patients diagnosed with head and neck cancer have been found to suffer from depression; approximately one in five patients had depression after completing radiation therapy for head and neck cancerand one in three patients had depression many years after the completion of treatment.9, Katz MR, Kopek N, Waldron J, Devins GM, Tomlinson G. Screening for depression in head and neck cancer. Psycho-Oncology. 2004 Apr;13(4):269-80.10 Terrell JE, Fisher SG, Wolf GT. Long-term quality of life after treatment of laryngeal cancer. The Veterans Affairs Laryngeal Cancer Study Group. Arch Otolaryngol Head Neck Surg. 1998 Sep;124(9):964-71. Many patients also benefit from learning how to navigate their cancer journey or other skills, such as how to communicate with health care professionals, from people who have done the same before.11, 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):564.12 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.
Bring a book and a pen. Write everything down, no matter what it is. The informed patient is the best patient.Debra R. (mucoepidermoid carcinoma of the palate survivor)

References

1 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

2 Chen H-C, Evans KFK, Salgado CJ, Mardini S. Methods of voice reconstruction. Seminars in Plastic Surgery. 2010:227-232.

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

4 Doyle C, Kushi LH,Byers T, et al.2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee; American Cancer Society.Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin.2006;56:323-353.

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

6 Horiot JC, Schraub S, Bone MC, Bet al. Dental preservation in patients irradiated for head and neck tumours: A 10-year experience with topical fluoride and a randomized trial between two fluoridation methods. Radiother Oncol. 1983 Aug;1(1):77-82.

7 Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995; 45: 352-368.

8 Zlotolow IM. Clinical manifestations of head and neck irradiation. Compend Contin Educ Dent. 1997;18(2 Spec No):51-6.

9 Katz MR, Kopek N, Waldron J, Devins GM, Tomlinson G. Screening for depression in head and neck cancer. Psycho-Oncology. 2004 Apr;13(4):269-80.

10 Terrell JE, Fisher SG, Wolf GT. Long-term quality of life after treatment of laryngeal cancer. The Veterans Affairs Laryngeal Cancer Study Group. Arch Otolaryngol Head Neck Surg. 1998 Sep;124(9):964-71.

11 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.

12 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.

13 National Cancer Institute (NCI) Website. Accessed at http://www.cancer.gov/ on February 19, 2013.