Managing hidden late complications in irradiated head and neck cancer patients using a practical integrative approach: a narrative review

Abstract

: Radiation techniques have evolved in the last twenty years towards ubiquitous use of intensity modulated radiation therapy (IMRT), which has decreased late complications from radiation to the head and neck area. Despite this, devastating sequelae still impair the long-term functioning of head and neck patients. There are the well-known sequelae of trismus, osteoradionecrosis and xerostomia. However, inadequately addressed sequalae such as dysphagia, odynophagia, hypoguesia, internal lymphedema and cognitive impairment do significant hidden damage to patients’ quality of life (QOL). Research has demonstrated that QOL can continue to decline even 10 years post radiation treatment, when many clinicians have long since ended follow-ups. Patients often underreport these symptoms and physicians are not trained to specifically ask about these symptoms long-term. This paper will use an evidence-based approach to look at the hidden sequelae of radiation to the head and neck area, review the current data regarding integrative approaches, and provide a practical integrative system for the practicing clinician. A practical system would include exercise, psychosocial techniques for the mind and emotions, meditation and early referral to a registered dietitian nutritionist (RDN) to educate and support the patients’ nutritional needs. Integrative techniques have been shown in the literature to provide an increased QOL and also in some studies, a direct improvement in patients’ recurrence rates and mortality. If more providers were to understand and put more emphasis on early integrative interventions, it could improve long-term head and neck cancer QOL and mortality outcomes after radiation.