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Post-Treatment Care

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Deficits in functioning (e.g., swallowing) for patients who received radiation therapy were evaluated at baseline and post-treatment. Most patients exhibited swallowing impairments at baseline, such as a decreased ability to retract the tongue, delayed swallowing or decreased tongue strength. During the first months to one year post-treatment, there was little change in the swallowing impairments for most patients.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.

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Patients who were administered chemoradiation therapy also exhibit swallow impairments at baseline, such as decreased tongue strength or delayed swallowing. However, in the first three months post-chemoradiation therapy, patients worsened. Moreover, fewer patients were able to intake their nutrients orally and fewer had a normal diet.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. Notably, it appears that fewer patients who undergo chemoradiation will be able to swallow effectively post-treatment.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.

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

However, the impact of surgery on swallowing varies greatly depending on the extent of the cancer removal (ablation) and the type and sophistication of the reconstruction surgery performed.

All patients with swallowing deficits, however, should receive rehabilitation, which includes specific swallowing and strengthening exercises.

Post-treatment care: nutritional needs

Radiation therapy post-treatment side effects include decreased salivation among 60 to 92 percentof patients and inflammation in the skin lining the mouth (mucositis) among 97 percent of the patients.

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

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

The following may be useful if you have impaired swallowing and/or mucositis and decreased salivation post-treatment:

  • Avoid spicy foods, especially if you have mucositis.2 Pauloski 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 your ability to eat, consult your physician to see if you can use a medication called pilocarpine or a similar medication to stimulate salivary production.3 Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371:1695-1709.
  • It is possible that you may need to obtain nutrients through a feeding tube or an IV.5Referenced 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.
We would go for a walk so I could feel the sun on my face. That was really important; it was our connection.Jason S. (tonsil 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 Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371:1695-1709.

4 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.

5 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.

6 Gritz ER, Carmack CL, de Moor C, et al. First year after head and neck cancer: quality of life. J Clin Oncol.1999 Jan;17(1):352-60.

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

8 Chen HC, Evans KFK, Salgado CJ, Mardini S. Methods of voice reconstruction. Seminars in Plastic Surgery. 2010;227-232.

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

10 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.

11 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.

12 Semple CJ, Dunwoody L, Sullivan K, Kernohan WG. Patients with head and neck cancer prefer individualized cognitive behavioural therapy. Eur J Cancer Care (Engl). 2006 Jul;15(3):220-7.

13 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.

14 American Cancer Society (ACS). Cancer Facts and figures 2012. Atlanta, GA: American Cancer Society, Inc. 2012.