Head and Neck Insights
This section is a resource designed to provide insight on head and neck topics. Each weekly section will pose a question, topic description and links to related publications.
This week's topics are shown as listed.
- Head and Neck Cancer Survivorship
•Hepatitis C and Head and Neck Cancer
•Head and Neck Cancers
•Salivary Gland Tumors
•Chemotherapy Use in Head and Neck Cancer
•Head and Neck Cancer Treatment
•Oral Cavity Cancer
•Human Papilloma Virus Vaccination (HPV)
•Management of Papillary Thyroid Cancer
•HIV and Head and Neck Cancer
•Functional Outcomes after Head and Neck Cancer Treatment
•Surgical Technique in the Treatment of Head and Neck Cancer
•Airway Management for Head and Neck Free Flap Patients
•Merkel Cell Carcinoma
•Lymphedema of the Head and Neck
•Management Head and Neck Cancer in the Elderly
•Head and Neck Cancer Surgical Complications
•Diagnosis of Oral Cancer
•Antibiotic Use in Head and Neck Cancer Surgery
•Nutritional Status During Head and Neck Cancer Treatment
•Unknown Primary Squamous Cell Carcinoma of the Head and Neck
•Targeted Agent Therapy for Melanoma
•Chemotherapy for Head and Neck Cancer
Vlad C. Sandulache, M.D., Ph.D.
May 20 - May 24, 2019
Specific question: What is the role of survivorship care for head and neck patients?
Survivorship care generally refers to longitudinal follow-up that provides life-long management of cancer patient clinical care. Most of the existing literature would support a transition period to survivorship care at 5 years from treatment completion. This transition point is supported by a decreased risk of recurrence and an increase in the ratio of non-cancer related mortality to cancer related mortality. Increased non-cancer mortality in 5 year+ survivors is multifactorial but appears to be largely driven by cardiovascular disease (i.e. exacerbation of hypertension, increased stroke and myocardial infarction risk). In addition to a higher rate of medical problems, head and neck cancer survivors have also been shown to demonstrate a higher (>2fold) and apparently increasing risk of suicide compared to other disease sites.
Although deceptively simple from a cancer surveillance perspective survivorship care is in fact incredibly complex. Meeting the needs of a head and neck cancer survivor requires a robust understanding of the underlying cancer pathophysiology, the chronic sequelae of relevant treatment modalities and the interaction between cancer, cancer treatment and patient comorbidities. This naturally raises the question of who should provide survivorship care. Existing data support an approach which generates treatment teams and algorithms designed to maximize care delivered while minimizing burdens on the patients for multiple clinic visits and extensive traveling. Multiple studies have demonstrated a role for registered nurses in survivorship care. Data from other tumor types also support the involvement of advanced practice providers in survivorship care. In part due to these types of data, survivorship care is often transitioned to nurses or midlevel providers at multiple centers throughout the US. In lieu of organized survivorship care plans, primary care providers will become de facto survivorship care providers. However, there is significant patient data which indicates that patients prefer specialist led care. In part this represents a recognition on the part of patients that oncologists familiar with the patient, they cancer and their treatment regimen are better equipped to understand late sequelae of the disease and associated treatment. Ideally, survivorship care would be provided by teams consisting of nurses, mid-level providers and oncologists, working in close coordination with the patients’ primary care provider.
Osazuwa-Peters N, Simpson MC, Zhao L, Boakye EA, Olomukoro SI, Deshields T, Loux TM, Varvares MA, Schootman M. Suicide risk among cancer survivors: Head and neck versus other cancers. Cancer. 2018 Oct 15;124(20):4072-4079. PMID: 30335190.
Monterosso L, Platt V, Bulsara M, Berg M. Systematic review and meta-analysis of patient reported outcomes for nurse-led models of survivorship care for adult cancer patients. Cancer Treat Rev. 2019 Feb;73:62-72. PMID: 30639801.
Mayer EL, Gropper AB, Neville BA, Partridge AH, Cameron DB, Winer EP, Earle CC. Breast cancer survivors' perceptions of survivorship care options. J Clin Oncol. 2012 Jan 10;30(2):158-63. PMID: 22162585.