Advanced Head & Neck Cancer: Care Beyond Cure

Abstract

Head and neck cancer patients have some premorbid features which make them a more challenging group compared to those with cancers in other anatomic regions. They have a tendency to abuse or have abused alcohol, tobacco or both; they may be less meticulous in personal habits, especially oral care, tend towards poor nutrition and have a higher incidence of personality and character disorders. They are also less successful socio-economic group. Most of those who succumb to head and neck cancer have uncontrolled local disease irrespective of the presence of metastasis. Distant metastasis arises in lung, liver and bone in a small number of patients particularly if there is involvement of multiple lymph nodes. The recent cancer estimates show that out of 10 million new cancer cases diagnosed annually 0.675 million patients suffer from head and neck cancer and 60% of all head and neck cancer occur in less developed countries 1. The 5-year survival rates of multimodal chemoradiotherapy is below 20%, with a median survival of 12 months or less 2,3,4. According to WHO (2002) 'Palliative Care' is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical ,psychosocial and spiritual .Palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life such as chemo therapy or radiation therapy and includes those investigations needed to understand better and manage distressing clinical complications. It is usually apparent that palliative treatment may differ from curative treatment but in certain situations the borderline between the two may be blurred and a clear-cut distinction may not always be possible in many T3 and T4 primary lesions in recurrent disease. Accompanying the great expansion of ablative and reparative cure in head and neck cancer over the past three decades, the scope for palliation has also improved substantially and perhaps over a broader field than curative therapy. These are the following symptoms from which Head & Neck cancer (HNC) patient suffers.