Symptom control issues and supportive care of patients with head and neck cancers

Combined-modality treatment of head and neck cancers, though linked to improved outcomes over earlier treatment methods, can be associated with acute and late adverse effects. These toxicities may lead to significant morbidity, increased mortality, and decreased quality of life. It is necessary to provide patients with adequate supportive-care measures in order to lessen suffering while maintaining the ability to deliver necessary doses of anticancer agents. The current review describes the pathology, assessment, and treatment options for cases of mucositis, impaired swallowing, nutritional and metabolic changes, xerostomia, radiation dermatitis, lymphedema, taste alterations, and pain, all of which may be associated with treatment of patients with head and neck cancers. Additionally, the pretreatment and during-treatment evaluation of dental health, as well as posttreatment dental care, are described.     

Endovascular carotid reconstruction in palliative head and neck cancer patients with threatened carotid blowout presents a beneficial supportive care measure

ABSTRACT Carotid blowout is a devastating complication in patients with head and neck malignancy. The traditional surgical treatment for carotid blowout is often technically difficult and is associated with an unacceptably high morbidity and mortality. Recently, endovascular therapy has been proposed for head and neck surgical patients. Preliminary reports showed a better outcome with less morbidity and mortality compared to the previous treatment modalities. The use of such techniques in cases of impending or acute carotid blowout syndrome has been previously described to be beneficial for palliative head and neck cancer patients as well. We introduce a case of a head and neck cancer patient receiving palliative care, presenting with threatened carotid blowout, who was managed with endovascular placement of a covered stent under elective conditions in order to prevent an inevitable carotid rupture. In the present case endovascular carotid stenting allowed preservation of the vessel, prevented the dramatic situation of carotid rupture, and facilitated a rapid hospital discharge without any neurologic or stenting sequelae.     

End-of-life care for terminal head and neck cancer patients

The objective of this study was to describe end-stage disease in patients suffering from advanced head and neck cancer (hnc). It is one of the most unpleasant and agonizing way a person may die and is a challenging problem for all involved with its treatment. Until today, only few detailed information about the final phase of life of hnc patients in a hospice setting are available. The design of this study was a cohort sample. The course of disease until death was thoroughly analyzed. In addition, hospice staff was interviewed. The study was conducted in a hospice setting (University Hospital). The charts of 16 patients suffering from end-stage hnc were evaluated. The median survival time in the hospice was 19.5 days. There, a more or less rapid deterioration of disease was evident. Several nurses sometimes felt extremely distressed after confrontation with the advanced disease stages. Partially, the situations for the nursing staff were unbearable because of visible, odorous, and fungating tumors or metastasis. The final days were characterized by restlessness followed by somnolence and resulting in an irreversible coma. The goal of palliative treatment of terminal hnc patients is offering the most convenient way to "live" the final days of their lives in dignity. The short survival time in hospice indicates that incurable patients may be referred to terminal care institutions too late in their dying trajectory. Physicians should be encouraged to talk to their terminally ill patients about the status and incurability of the disease as early as possible to facilitate patient and family decision making on how to prepare for the impending end of life.     

难治性头颈部癌热放化三联综合治疗的临床护理

头颈部癌是常见恶性肿瘤之一,约占全身肿瘤的6%,5年生存率在50%左右,其治疗失败的主要原因是局部复发,约占70%。其次是远处转移,因头部集中了重要器官,空间狭小手术治疗难以根治,对手术不能切除的头颈部癌采用常规很难治愈。临床采用对头颈部癌热放化三联综合治疗,并配合以心理护理,热疗、放疗、化疗反应的跟踪护理,取得满意的效果。现将其介绍如下。1资料与方法1.1临床资料选取我院1998年2月—2003年12月,头颈部癌病人60例,分为热放化组,放化组和单放组,每组20例。入组标准:不能手术或不能切除的头颈部癌,术后和或放疗复发癌,颈部巨大淋巴…     

难治性头颈部癌热放化三联综合治疗的临床护理

头颈部癌是常见恶性肿瘤之一，约占全身肿瘤的6％，5年生存率在50％左右，其治疗失败的主要原因是局部复发，约占70％。其次是远处转移，因头部集中了重要器官，空间狭小手术治疗难以根治，对手术不能切除的头颈部癌采用常规很难治愈。临床采用对头颈部癌热放化三联综合治疗，并配合以心理护理，热疗、放疗、化疗反应的跟踪护理，取得满意的效果。现将其介绍如下。[第一段]     

Advances in supportive care of patients with cancer and bone metastases: nursing implications of zoledronic acid

The knowledge and training of nursing staff is essential for the safety and comfort of patients receiving i.v. therapies. The use of i.v. bisphosphonates as an adjunct to standard antineoplastic therapies in patients with advanced cancer is becoming widespread. Zoledronic acid and pamidronate (Zometa and Aredia, Novartis Pharmaceuticals Corporation, East Hanover, NJ) are nitrogen-containing bisphosphonates. Pamidronate has been the standard of care for patients with osteolytic bone lesions from breast cancer or multiple myeloma. However, zoledronic acid, which has demonstrated increased potency and a broad clinical utility, is emerging as the new standard of care. In addition to treating hypercalcemia of malignancy, zoledronic acid is approved for treating patients with bone metastases (osteolytic or osteoblastic) from a wide range of solid tumors, including breast, prostate, and lung cancers, or osteolytic bone lesions from multiple myeloma. Zoledronic acid (4 mg via a 15-minute infusion) has a safety profile comparable with pamidronate (90 mg via a two-hour infusion) and has demonstrated comparable or superior efficacy to that of pamidronate in every patient population tested. The shorter infusion time of zoledronic acid compared with that of pamidronate may provide added convenience, but safety guidelines should be followed for all i.v. bisphosphonate therapies. These guidelines and nursing care of patients receiving i.v. bisphosphonates are reviewed.     

A dietitian-led clinic for patients receiving (chemo)radiotherapy for head and neck cancer

Purpose

Malnutrition is prevalent in head and neck cancer patients and is associated with poorer outcomes and increased health care costs. This study aimed to evaluate the acceptability, organisational efficiency and clinical outcomes of a dietitian-led head and neck cancer clinic.

Methods

Two consecutive, independent, patient cohorts were studied with a pre–post-test design of 98 patients prior to the introduction of a dietitian-led clinic (DLC) and the subsequent 100 patients who attended the newly formulated DLC. The two groups were compared for frequency of dietitian intervention, weight loss, enteral feeding, hospital admissions and post-treatment medical follow-up requirements.

Results

Nutritional management in a DLC was associated with reduced nutrition-related admissions from 12% to 4.5% (p?=?0.0029), unplanned nasogastric tube insertions from 75% to 39% (p?=?0.02), improved transition to oral diet post-radiotherapy from 68.3% to 76.7% (p?=?0.10) and reduced radiation oncologist review at 2?weeks post-radiotherapy from 32% to 15% patients (p?=?0.009) compared to the cohort prior to the DLC.

Conclusions

A dietitian-led head and neck cancer clinic is associated with improved efficiency and nutritional management of head and neck cancer patients and offers a feasible model of care.     

立体聚焦支持护理在头颈部肿瘤放疗患者中的应用

目的 观察立体聚焦支持护理在头颈部肿瘤放疗患者中的应用效果.方法 将2016年1月至2016年6月收治于本院的头颈部放疗患者112例作为研究对象,随机分为对照组与试验组各56例,对照组接受常规放疗护理,试验组接受立体聚焦支持护理,比较干预后两组头颈部肿瘤放疗病例在各相关观察指标方面的差异.结果 试验组头颈部肿瘤放疗病例干预后的生活质量评分和护理满意度评分均显著高于对照组同类病例,差异有统计学意义(P<0.05).结论 采用立体聚焦支持护理对头颈部肿瘤放疗患者实施干预,在提升该类病例生活质量及护理满意度方面均具备积极效应.     

Developing a free supportive care program for cancer patients within an integrative medicine clinic

The cancer patient's journey not only includes a threat to one's life, but the need to face many medical and emotional challenges. The free Cancer Supportive Care Program (CSCP) within the Center for Integrative Medicine Clinic at Stanford University Hospital and Clinics has been identified as a successful model for helping patients to deal with these challenges. Its programs include informational lectures, support groups, chair massages, exercise, alternative modality classes, a Life Tapes Project, an informational website, and a bimonthly newsletter available free to anybody touched by cancer. Now in its third year, this program benefits from a blending of leadership resources, availability of space, institutional agreement on patient need and funds from private and corporate donations. By presenting the basic premises of the Cancer Supportive Care program and outlining specifics about the program, institutions in various national and international demographic regions may implement similar programs according to their resources and the needs of patients. It is our hope that the CSCP can become a model for the development of similar programs in various parts of the United States and abroad.     

Periodontal care in patients undergoing radiotherapy for head and neck cancer

Purpose

The aim of this study was to evaluate periodontal changes after periodontal treatment and control in patients with malignant tumors of the upper aerodigestive tract who were submitted to radiotherapy with or without chemotherapy.

Methods

We included all patients attending the Oncology Clinic of the Federal University of Minas Gerais, School of Dentistry. Clinical periodontal parameters obtained by a single calibrated examiner were evaluated at baseline, 10 days after radiotherapy, and 180 days after radiotherapy. Patients were grouped into healthy or periodontally diseased individuals. All patients received oral hygiene instructions, and the diseased patients received periodontal therapy at baseline. Comparisons between the groups were performed via the McNemar and Wilcoxon tests using SPSS v. 17.0.

Results

A total of 28 patients were examined at baseline, of which 27 were examined 10 days after radiotherapy and 25 were examined 180 days after radiotherapy. The prevalence of periodontal disease at baseline was 67.9 % and did not decrease over time (p?=?1.0). There was a significant reduction in probing depth (PD), plaque index (PI), and bleeding on probing between baseline and follow-up, which was not observed in the attachment level (AL).

Conclusions

Periodontal therapy was effective in reducing PI and improving periodontal status, as evidenced by the decreases in PD and the maintenance of AL.     

食管癌术后早期营养支持100例护理体会

目的:探讨食管癌患者术后早期实施营养支持的护理方法。方法:选择100例食管癌术后患者,随机分为全胃肠外营养组(TPN组)55例和肠内营养组(EN组)45例,分别检测营养指标和免疫指标。结果:TPN组和EN组术后第8天血清前白蛋白、转铁蛋白以及IgA、CD4 和CD4 /CD8 水平比较无显著差异(P>0.05);EN组并发症发生率低于TPN组,两组比较有显著性差异(P<0.05);EN组术后肛门排气时间、平均住院天数比TPN组明显减少,两组比较有显著性差异(P<0.05)。结论:食管癌术后早期营养支持可有效改善患者的营养状况,促进患者康复,肠内营养对患者更经济有效。     

Nurse-led follow-up care for head and neck cancer patients: a quasi-experimental prospective trial

Purpose

The aim of this study was to compare conventional medical follow-up with follow-up containing additional nursing consultations regarding the psychosocial adjustment and health-related quality of life (HRQOL) of head and neck cancer patients.

Methods

Using a quasi-experimental design, patients were enrolled consecutively into two groups. Experimental care covered six 30-min bimonthly nursing follow-up consultations during the first year posttreatment. Data were collected at posttreatment months 1 (baseline), 6, and 12 for both groups.

Results

The intervention group was significantly worse at baseline, based on two of the seven adjustment scales and on the majority of HRQOL scales. However, their outcome at 6 and 12 months was consistent with that of the group which received conventional follow-up. Thus, the intervention group had a larger improvement in scores, and this was significant for one of the seven adjustment scales and 19 of the 33 HRQOL scales at 6 and 12 months, respectively. Most of the differences in HRQOL scales were clinically relevant at 6 months.

Conclusion

These results suggest that nurse-led consultations for patients with head and neck cancer have a positive effect, primarily with respect to HRQOL. Nurse-led follow-up leads to a similar psychosocial adjustment as conventional follow-up, even among patients who showed worse performance at the start of follow-up. Thus, nurse-led follow-up may be a cost-effective way to improve follow-up care for this patient group.     

宫颈癌患者支持性照顾需求的调查

目的调查宫颈癌患者治疗期间支持性照顾需求及影响因素。方法采用癌症患者支持性照顾需求调查问卷对正在接受治疗的200例宫颈癌患者进行调查。结果宫颈癌患者支持性照顾需求各维度得分由高到低依次是心理需求、健康信息需求、支持和照顾需求、生理和日常生活需求、性需求。年龄、民族、是否知晓诊断、文化程度和发病情况是宫颈癌患者支持性照顾需求的影响因素(P0.01)。结论医护人员在临床工作中要注意宫颈癌患者文化程度、年龄和民族等差异,重视患者的需求,为患者提供针对性护理服务。     

Competent gastrostomy for patients with head and neck cancer

This study was performed to evaluate the efficiency and patient satisfaction with a modified Janeway gastrostomy for patients with head and neck cancer and cancer of the upper GI tract and involved 24 consecutive patients with serious malnutrition caused by advanced cancer of these sites. All underwent surgery during which a tube was constructed from the anterior gastric wall with the aid of GIA-75 automatic stapler. The operation was performed under local anaesthesia, with a senior anaesthesiologist, who sedated the patients, in attendance. The operation was successful in all cases. No postoperative mortality could be attributed to the operation. The complications were minor. The patient's close relatives were able to feed them intermittently with home-made formula made according to the instructions of our dietician. No late complications were recorded. Overall, the patients were satisfied with this technique for managing their feeding problem. The modified Janeway gastrostomy is an easy and safe operative procedure; it is an effective way of managing patients with malnutrition as a result of cancer of the head and neck or of the upper GI tract.