Palliative issues in the care of patients with cancer of the head and neck

By convention, head and neck cancer (HNC) refers to tumours arising from the epithelial lining of the upper aero-digestive tract. This includes patients with tumours of the oral cavity, larynx, pharynx, paranasal sinuses, and salivary glands. There are approximately 50 000 cases of HNC diagnosed annually within the USA⁽¹⁾. The vast majority of tumours (>90 per cent) are squamous cell carcinomas. Due to the higher rate of smoking and heavy drinking in males, this type of cancer affects men disproportionately. Patients with HNC experience a wide array of palliative problems. Symptoms may be related to the tumour, acute toxicities of treatment, or the long-term sequelae of therapy. Although some symptoms are common to all cancers, HNC patients experience a host of unique problems which require special consideration. In addition, palliation is a major issue throughout the disease trajectory. Symptoms are usually present at the time of diagnosis and remain problematic through the terminal phase. For those patients who are cured, long-term biopsychosocial sequellae may persist for years. Thus, assessment and treatment of palliative issues is an intrinsic and vital component of care for the HNC patient. This chapter will address the palliative issues unique to this cohort of patients. It has been divided into four sections: (1) a review of presenting symptoms, initial evaluation, and contemporary treatment; (2) quality of life (QOL) and psychosocial issues; (3) functional deficits (speech and voice); and (4) symptom-control issues specific to HNC. The reader is referred to other chapters in this text to address general symptom-control problems.