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Long-Term Planning

There are steps that you can take to manage certain side effects before treatment, some of which may minimize long-term complications that can be caused by treatment-associated side effects. You should first discuss the side effects with your physician, along with their recommendations for management of side effects.

The following precautions and plans may apply to you, depending on the type of treatments that you are likely to receive as part of your treatment plan:

  • Dental evaluation: See a dentist for an evaluation and pretreatment dental work prior to starting radiation
  • Prophylactic fluoride teeth treatment: If you are likely to receive radiation therapy, you are at higher risk for developing cavities; this side effect has been attributed to decreased salivation.6 Vissink A, Burlage FR, Spjkervet FKL, Jansma J, Coppes RP. Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14(3):213-225. Prophylactic fluoride treatment is recommended to protect your teeth during and after treatment, and decrease the long-term risk of developing cavities.2, Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368.15, Horiot JC, Schraub S, Bone MC, et 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):77-82.16 Zlotolow IM. Clinical manifestations of head and neck irradiation. Compend Contin Educ Dent. 1997;18(2 Spec No):51-6.
  • Consult a registered nutritionist and speech pathologist: Many of the treatment-associated side effects can impair the desire to eat, such as severe mucositis or nausea and vomiting. In addition, some of the treatments can cause function loss and impair swallowing. Therefore, prior to the treatment, the nutritionist should provide recommendations specific to the treatment, such as food to avoid, in addition to strategies to implement in case there are problems obtaining adequate nutrition.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.Strategies as to how to eat if eating becomes difficult can also be provided. You can also learn swallowing exercises to do daily during and after your treatment, which should help you maintain the ability to swallow.4 Gaziano JE. Evaluation and management of oropharyngeal dysphagia in head and neck cancer. Cancer Control. 2002 Sep-Oct;9(5):400-9.
  • Begin an exercise program: Most patients will experience cancer-related fatigue during and after their treatment, and it may be so extreme that they will not be able to do their normal activities.9, Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993 Aug;68(2):220-4.10, Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol. 1997 Jul;34(3 Suppl 2):4-12.11, Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008 Jul;16(7):791-801.12 Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12 Suppl 1:4-10. Because exercise has been found to decrease cancer-related fatigue, patients may want to consider implementing an exercise program prior to the initiation of therapy, which may help them after treatment.17, Dimeo F, Rumberger BG, Keul J. Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc. 1998 Apr;30(4):475-8.18, Dimeo F, Schwartz S, Wesel N, Voigt A, Theil E. Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol. 2008;19(8):1495-1499.19, Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560.20 Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012 Jul-Aug;62(4):243-74.
  • Find a support group: Patients report experiencing stress and anxiety. Moreover, one in three patients experiences moderate depression even 10 years after receiving radiation therapy.21 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.Participating in patient support groups has been associated with improved quality of life.22 Ashbury FD, Cameron C, Mercer SL, Fitch M, Nielsen E. One-on-one peer support and quality of life for breast cancer patients. Patient Educ Couns. 1998 Oct;35(2):89-100. You may want to consider identifying and participating in a support group.
The loss of speech and the ability to eat solid food is the most emotionally and physically challenging part. Once you have a routine down, you can deal with it. 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.2.2014. © 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 Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368.

3 Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck. 2004 Sep;26(9):759-69.

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

5 Lichter AS, Lawrence TS. Recent advances in radiation oncology. N Engl J Med. 1995;332(6):371-9.

6 Vissink A, Burlage FR, Spjkervet FKL, Jansma J, Coppes RP. Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14(3):213-225.

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

8 Forastiere A, Koch W, Trotti A, Sidransky D. Head and Neck Cancer. N Engl J Med. 2001;345(26):1890-1900.

9 Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993 Aug;68(2):220-4.

10 Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol. 1997 Jul;34(3 Suppl 2):4-12.

11 Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008 Jul;16(7):791-801.

12 Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12 Suppl 1:4-10.

13 Wendt TG, Grabenbauer GG, Rödel CM, et al. Simultaneous radiochemotherapy versus radiotherapy alone in advanced head and neck cancer: a randomized multicenter study. J Clin Oncol. 1998 Apr;16(4):1318-24.

14 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.

15 Horiot JC, Schraub S, Bone MC, et 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.

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

17 Dimeo F, Rumberger BG, Keul J. Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc. 1998 Apr;30(4):475-8.

18 Dimeo F, Schwartz S, Wesel N, Voigt A, Theil E. Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol. 2008;19(8):1495-1499.

19 Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560.

20 Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012 Jul-Aug;62(4):243-74.

21 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.

22 Ashbury FD, Cameron C, Mercer SL, Fitch M, Nielsen E. One-on-one peer support and quality of life for breast cancer patients. Patient Educ Couns. 1998 Oct;35(2):89-100.