Jan B. Vermorken, Volker Budach, C. René Leemans, Jean-Pascal Machiels, Piero Nicolai and Brian O’Sullivan (eds.)Critical Issues in Head and Neck Oncology10.1007/978-3-319-42909-0_19

19. Symptoms at End-of-Life of Head and Neck Cancer Patients

Dirk Schrijvers¹

(1)

Department of Medical Oncology, Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium

Dirk Schrijvers

Email: Dirk.Schrijvers@zna.be

Introduction

Patients with recurrent/metastatic head and neck cancer will eventually develop a disease stage that is not amendable anymore for cancer-directed treatment with surgery, anticancer medication, and/or radiotherapy. These patients should receive optimal symptom control by means of palliative care.

Palliative care is an approach that improves the quality of life (QoL) of patients and their families facing the problem associated with a life-threatening illness. This aim is realized through the prevention and relief of suffering by means of early identification, assessment, and treatment of physical, psychological, social, and spiritual problems [1]. Palliative care should be given by a multidisciplinary team that addresses all these problems.

Epidemiology of Symptoms at the End-of-Life

During the last weeks of the life, head and neck cancer patients experience problems at many levels.

Severe physical problems, defined as a score >4 on the Edmonton Symptom Assessment Scale (ESAS), which are most commonly experienced during this phase are weight loss, pain (±30–85 %), dyspnea (±20), nausea (±15 %), lack of appetite (±37 %), asthenia (±58 %), drowsiness (±30 %), dysphagia, feeding problems (62 %), respiratory (43 %), and communication difficulties [2–4].
Emotional problems, such as anxiety (±30 %) and depression (±25 %), are also commonly observed in head and neck cancer patient at the end-of-life [3].
Social problems are prevalent. The stress level of the nonprofessional caregiver determines if a patient can stay at home during the last phase of his/her life. This depends on the support, that is provided to help the caregiver to perform his/her tasks at home. In case of insufficient support, the patient will be institutionalized because of burn-out or unbearable stress of the caregiver [5].
Spiritual problems at the end-of-life have not well been studied in patients with head and neck cancer [6], but in cancer patients at the end-of-life, it seems that they are discussed in only around 20 % of patients [7].

All these problems should be addressed, and by using of a standardized approach they may be adequately discussed and handled, resulting in a better QoL [3].

Treatment of Selected Physical Problems

Physical problems should be addressed, but the situation of the patient should be taken into account before deciding on the adequate approach. Several problems (e.g., nutrition issues) may be important in the perception of the patient and the family, but may be not considered to be essential by the professional caregiver. However, the perception of these problems by the patient and the family should be addressed adequately by the professional caregiver to avoid miscommunication and inadequate behavior by both parties.

Problems should only be addressed by an aggressive treatment approach if it will improve/stabilize the QoL of the patient. Otherwhile, the professional caregiver should explain the benefits and harms of any intervention, in order not to persist or start with a meaningless treatment and adhere to therapeutic obstinacy.

Gastro-Intestinal Problems

Many patients with head and neck cancer experience gastro-intestinal problems at the end-of-life such as foul breath, trismus, xerostomia, sticky saliva, swallowing difficulties, dysphagia, or insufficient calorie intake, partly due to the disease but also due to previously administered treatments.

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