, For many patients, the signs of head and neck cancer cannot be concealed. Facial disfigurement: the last bastion of discrimination. Proactive nursing follow-up is critical with home-based therapy. 39. These limitations might include limited sight and limited manual dexterity in handling pills. Oral Health, Cancer Care, and You. Gamba A, Romano M, Grosso IM, et al. This can include the mechanism of action, early and late side effects that may be experienced, and reasons to call his or her doctor or nurse. 7, 8 Mucosal injury to normal oral cavity tissue is stimulated by toxicity that correlates with radiation treatment or a chemotherapy dose. Severe mucositis can delay treatment and so limit the effectiveness of the child's cancer therapy. 74. If side effects are left unreported, necessary dose adjustments may not be made, and serious consequences can occur that can impact their life and further therapy. A study of utility and validity. The assessment data collected provides guidance for the nurse to develop an individualized plan of care with implementation of evidence-based interventions. Fiegenbaum W. A social training program for clients with facial disfigurements: a contribution to the rehabilitation of cancer patients. Increasing numbers of patients are receiving oral chemotherapy at home, and with this move to oral self-administration, there has been a critical shift in responsibility of management from the provider to patient. Only by examining the relationships between these variables and quality of life can we begin to develop a greater understanding of factors associated with quality of life for patients with head and neck cancer. One must evaluate whether or not a patient is able to swallow pills and whether there is adequate gut function and absorption. Purpose: To assess the effectiveness of a symptom-focused home care program in patients with cancer who were receiving oral chemotherapy in relation to toxicity levels, anxiety, depression, quality of life, and service utilization. 1999; 67(3):320-331. Psychol Med. Head and neck cancer-specific quality of life: instrument validation. Feber T. Head and Neck Oncology Nursing . There is therefore a need for prospective studies in this area encompassing representative samples with appropriate statistical power. The most common head and neck cancers, squamous cell carcinomas, have a different pathology from the rarer salivary gland neoplasms, whose origin is largely unknown. One certainly worries about that mentality in any situation. A last consideration in patient selection is simply the patient’s ability to tolerate an oral medication. In cancer care, poor quality of life has been explained as the gap that exists between one’s actual status and one’s ideal standard. Oral chemotherapy is an attractive option in the treatment of patients with cancer because of its convenience and ease of administration. Arch Otolaryngol Head Neck Surg. Disadvantages mainly include the facts that (1) adverse effects are common; (2) cure is uncommon, especially for large tumors; and (3) subsequent surgery is more difficult and hazardous and survival is reduced further. This article examines risk factors, diagnosis, management and the clinical nurse specialist’s role in providing care to and supporting patients with this challenging disease. The International Association for the Study of Pain describes pain as an unpleasant sensory and emotional experience with actual or potential tissue damage. Strategy tools for the patient and provider will need to be developed to ensure optimal compliance and safety. Likewise, neoplasms affecting the brain are categorized separately.  Five-year survival rates are dependant on stage and site of tumor, with stage I and II survival rates ranging from 40% to 95% and stage III and IV survival rates ranging from 0% to 50%.  Furthermore, logistic regression analyses indicated that the presence of pain had an adverse effect on life satisfaction at 1 ( P = .04) and 2 years ( P = .01) after treatment. 1995;77:404-408. PrepU - Chapter 46: Management of Patients With Oral and Esophageal Disorders questionA client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer.  For example, Andre et al quantified that head and neck cancer is 34 times more likely to occur in a person who drinks more than 1.5 L of wine a day than in a nondrinker. Within the realm of cancer management, it is no longer satisfactory just to measure the effectiveness of treatment on survival alone, as cancer and its subsequent treatment may cause physical, emotional, and psychological difficulties for individuals. reported on a prospective, randomized controlled trial comparing the quality of life of 156 patients with cancer (various cancer sites except cerebral tumor and nonmelanoma skin tumors) receiving psychotherapy based on the premise of CBT to patients receiving no therapy. Calman KC. Hence, the next logical step is to examine variables, such as coping styles, personality, and social support, that may influence the quality of life of patients with head and neck cancer. Edelman S, Bell DR, Kidman AD. Psycho-Oncology . As disease progresses, deterioration in symptoms particularly those involving fatigue, muscular weakness and dysphagia can make eating more difficult, and this can impact patients not only physically but also psychologically. Koster META, Bergsma J. With oral chemotherapy, the patient-to some degree-is responsible for making dose adjustments in his or her own therapy; eg, the patient must decide whether to continue taking medication in the face of mild to moderate side effects. Oral mucositis is among the most distressing of these and develops on a continuum, from inflammatory changes to ulcerative lesions. In other words, it is not only quantity of life that is important but also quality of life. Watson D, Friend R. Management of social-evaluative anxiety. Head Neck . Am Cancer Soc. Young PE, Beasley NJ, Houghton DJ, et al. [7,8] Herzon and Boshier observed that patients placed immense importance on reentering society in a meaningful way and that this often precedes even fear of reoccurrence. Comprehensive advice regarding management of a compromised oral cavity is available from the UK Oral Mucositis in Cancer Group. An educational intervention for newly-diagnosed cancer patients undergoing radiotherapy. [doctoral thesis]. 52. Chemotherapy alters the integrity of the mucosa, the normal microbial flora of the oral cavity, salivary quantity and composition, as well as epithelial maturation. 38. Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients. Abstract. 8. Quality of life, including psychiatric morbidity, was measured longitudinally for 1 year and compared with that of a control group. 3. An anxiolytic agent, such as lorazepam (Ativan), may be very effective in these patients, and may also provide some antiemetic effect. Oral cancer: diagnosis, management and nursing care Oral cancer: diagnosis, management and nursing care Hewett , Julie 2009-12-04 00:00:00 Oral cancer is estimated to be the ninth most common cancer worldwide. Otto, S. Oncology Nursing . 44.  There is a concern that the incidence is increasing, particularly in younger patients and in women. Recent studies, within the head and neck cancer field, on quality of life have predominantly provided information on the evaluation and validation of disease-specific head and neck cancer instruments and how different treatment modalities affect quality of life. All rights reserved. Clin Child Psychol Psychiatry . Andre E, Schraub S, Mercier M, Bontemps P. Role of tobacco and alcohol in the aetiology of head and neck cancer: a case control study in the Doubs region of France. Notes. Belfast, Northern, Ireland: DHSSPS;2003. J Natl Cancer Inst. J Med Ethics . Fawzy alluded to the quest for interventions to help individual patients with cancer to cope with this life crisis. Farberow NL, Ganzler S, Cutter F, Reynolds D. An eight-year survey of hospital suicides. 61. The resultant aberrant cell behavior leads to expansive masses of abnormal cells that destroy surrounding normal tissue and can spread to vital organs resulting in disseminated disease, commonly a harbinger of Imminent patient death. 11. 1995;18:452-457. Oncology nurses who are involved with patients taking oral chemotherapy must understand what factors affect compliance and how identification of these factors can aid in the development of educational strategies that will help assure patient compliance. Oral regimens pose new challenges in patient selection and education. 23.  Thirty-one patients who were assessed to be at high risk with high levels of distress were randomly assigned to three 1-hour information sessions about radiation therapy, cancer, coping strategies, and communication skills, or to a standard no intervention control group. Generally, under the quality of life umbrella, most of the following domains or constructs are found, namely, life satisfaction, physical functioning, psychological functioning, social relationships, occupational performance, and adverse effects of treatment. An increasing number of oral chemotherapy agents are being developed and used in clinical practice. [53(p551)] The WHOQoL acknowledges the primacy of subjective perceptions and also the role of objective or contextual factors. Measures were taken at baseline and 1 and 3 months later. J Consult Clin Psychol. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), lips or palate (roof of the mouth). Patients may have real and compounding problems in the social and family setting, which are often directly related to the change in many basic functions such as eating, speaking, and breathing. Unfortunately, although the side-effect profiles of many oral chemotherapy agents are relatively favorable, serious systemic side effects can still occur, making early recognition with prompt intervention critical. Mc Grouther DA. Oral or mouth cancer most commonly involves the tongue. These and other factors are outlined in Table 1. Also, older patients are more likely to be taking multiple oral medications, and the addition of oral chemotherapy to this patient’s regimen may not be feasible, either due to the increased complexity or potential drug interactions.  Moreover, the team did not have any training in diagnosing or treating depression or other related psychological problems. Pain. 59 Smell and taste changes during chemotherapy can have a significant impact on a patient’s ability to eat, which may ultimately lead to weight loss and malnutrition. 1999; 4(2):127-142. Survival from head and neck cancer in Mumbai (Bombay), India. 41. These roles are of vital importance in the management of ambulatory oral chemotherapy. This article examines risk factors, diagnosis, management and the clinical nurse specialist’s role in providing care to and supporting patients with this challenging disease. That is a different concern than patients who do not come back. 1996;122:482-487. Much of the earlier work on factors associated with psychosocial dysfunction in patients with head and neck cancer was based on qualitative information. Nursing Care Plans. 1 Molassiotis A, Brearley S, Saunders M, Craven O, Wardley A, Farrell C, Swindell R, Todd C and Luker K (2009) Effectiveness of a home care nursing program in the symptom management of patients with colorectal and breast cancer receiving oral chemotherapy: a randomized, controlled trial J Clin Oncol 27 6191–8 PMID: 19917849 10.1200/JCO.2008.20.6755 ), pain control, promoting nutrition, and emotional support. Prevention and Management of Oral Mucositis in Patients With Cancer. These problems can become so severe that the cancer therapy has to be altered, delayed or interrupted — which may affect treatment outcomes.  A possible explanation for this discrepancy is that it feels intuitively inappropriate to discuss health in patients diagnosed with a potentially fatal illness. Schwartz S, Patrick DL, Yeuh B. Quality-of-life outcomes in the evaluation of head and neck cancer treatments. 59. J Laryngol Otol. At 1-year follow-up, the intervention group had improved in most areas as compared to the control group ( N = 34). First and foremost, patients need to know the correct dose and administration schedule. where are we going? Arch Otolaryngol Head Neck Surg. At the outset, patients have to assimilate important information about their condition and treatment options, and many embark on treatment regimens, all of which can threaten their physical and psychological well-being. Mills ME, Sullivan K. The importance of information giving for patients newly diagnosed with cancer: a review of the literature. Not only is the mouth vital for eating, drinking, taste, breathing, verbal and non-verbal communication, saliva also has antibacterial properties and is part of the body’s defence against infection.Poor oral hygiene is well known to be associated with painful, unpleasant diseases such as gingivitis (Fig 1), dental caries, halitosis and xerostomia an… Head Neck . 2002;128:268-274. There is a concern that the incidence is increasing, particularly in younger patients and in women. Quality of life studies have particular importance in many clinical trials, especially where there are 2 treatment options and neither provides any clear survival advantage. Cameron C: Patient compliance: Recognition of factorsinvolved and suggestions for promoting compliance with therapeutic regimens. Most oral cancers … A patient’s support system-including family, friends, or home care nurses-also greatly influences the likelihood of compliance with therapeutic regimens. 1999;31(B):301-309. 1989;14: 101-114. 49. As a result, the child receiving chemotherapy may experience pain, dysphagia, alteration in nutritional status, and risk of infection. A dose reduction does not necessarily lessen the chance of antitumor effects. 7. Head Neck . The male/female ratio is less than 2:1, and this gap is closing steadily.  In conjunction with the reporting of problems in social functioning, head and neck cancer has been identified as an actual and potential source of considerable emotional distress. . Kurtulmaz SY, Erkal HS, Serin M, Elhan AH, Cakmak A. Squamous cell carcinoma of the head and neck: descriptive analysis of 1293 cases. 2000;89:437-444. The complexity of the regimen will also affect the patient’s ability to comply. Increasing numbers of patients are receiving oral chemotherapy at home, and with this move to oral self-, ABSTRACT: Oncology nurses play a pivotal role in educating the cancer patient who is about to commence oral chemotherapy. 1984;10:124-127. Despite the difficultly in finding a universal definition of quality of life, most authors agree that it is, at its most fundamental level, subjective, multidimensional, and dynamic as it changes over time and situations. Eur J Cancer . Aaronson NK, Ahmedzia S, Bergman B, et al. Conversely, an increased amount of evidence is available on psychosocial interventions for the generic cancer population, such as education, emotional support, or psychotherapy. 1969;33:448-457. Today, many global and disease-specific research instruments have already been developed and validated for use with patients diagnosed with head and neck cancer, and these provide a timely opportunity for further research. Clarke designed a social rehabilitation program to promote coping in patients with head and neck cancer. Clin Otolaryngol. A group-cognitive behaviour therapy programme with metastatic breast cancer patients. 1990;2:112-118. New York: Guildford Press; 1990. 2. Yeole BB, Sankaranarayanan R, Sunny L, Swaminathan R, Parkin DM. 40. 2000;504:497-512. A functional status scale for measuring quality of life outcomes in head and neck cancer. 5. Author links open ... use of multiple types of evidence in developing a structured plan of care facilitates improved patient outcomes and the ... Rita Million RN, BSN: Graduate Assistant, University of Nebraska Medical Center, College of Nursing, Omaha, NE. [ONCOLOGY 15(Suppl 2):37-40, 2001].  Frequently, many of these patients cannot conceal the effects of treatment because of the very visible nature of their condition and obvious functional difficulties. Toothbrushing instructions include using a soft or extra-soft toothbrush; a flavored dentifrice may not be tolerated, but fluoride is essential. Terrell JE, Nanavati K, Esclamado RM, Bishop JK, Bradford CR, Wolf GT. However, while researchers and clinicians are beginning to find out more about the problems encountered by patients with head and neck cancer, many factors influencing their quality of life still remain poorly understood. However, at 3-year follow-up, participants of both groups had high levels of depression and treatment-related side effects were also prevalent in both groups. Herzon F, Boshier M. Head and neck cancer-emotional management. Psychosocial considerations of the post-treatment of head and neck cancer patients. 1994;33(8):879-885. 2. More recently, Davidson has suggested that CBT is emerging as the most therapeutic and cost-effective approach for adult patients with cancer with psychological morbidity. Quality of life in cancer patients: a hypothesis. Because this client has 2nd ed. Quality of life in treated head and neck cancer patients: a preliminary report. Eur J Cancer Oral Oncol. Despite significant investment in research to investigate different treatment regimens for head and neck cancer, limited improvement in patient survival has been achieved in the last 30 years in many countries. Eakin R. Head and neck cancer. The primary responsibilities of the oncology nurse are to facilitate patient education, communication, and follow-up. These can affect not only how the patient follows his or her drug schedule, but also what he or she is willing to report or discuss regarding complications and side effects. Spence RAJ, Johnston PG. I think we have to put the same burden on intravenous treatments-that people do not always give optimal therapy. With these standardized tools, researchers are beginning to find out more about the difficulties experienced by patients with head and neck cancer, but far less is known about the management of such problems. 12. The information must be perceived correctly, and to that effect, educational materials must be at an appropriate level of understanding for patient comprehension. Similar strategies in nonresearch settings, such as patients on home oral therapy, may also be useful in dose verification. Spielberger CD, Sarason IG. 67. The patient’s immunity will be compromised and there is a potential for oral side effects associated with cancer therapy. Gilikich RE, Goldsmith TA, Funk GF. Objectives: To present a clinical update of evidence that applies to the development of a nursing plan of care for the prevention and treatment of oral mucositis related to cytotoxic therapy. However, such patients require careful monitoring and oncology nurses will continue to play a significant role in the safe and effective management of these patients.  Measures of psychological well-being using standardized scales were taken prior to a workshop and at 6 weeks and 6 months follow-up. Paulo Hoff, MD: What you need are a television, a VCR, and a tape with instructions. Oral cancer is estimated to be the ninth most common cancer worldwide. Psychol Health Med. A sense of increased flexibility and autonomy can be an emotional boost for patients.  As a consequence of these difficulties, patients can experience depression, social anxiety, reduced self-esteem, sexual difficulties, and a generalized sense of reduced quality of life. They must also embrace the reality of profound changes in relation to their speech, ability to swallow, taste, as well as noticeable alterations in appearance. 53. 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Oral agent is common for patients ’ health and well-being for a variety of.! That of a series on managing and preventing Meeting the information needs of cancer patients in Sweden included! Identified several specific factors involved in promoting compliance with therapeutic regimens is increasingly being used with a brief interruption therapy! 42 ] However, Partridge concluded that there has also been minimal research effective! Hads was studied in both groups could not return to normal eating after curative treatment for oral cancer like... And functional status scale for head and neck oncology clarke A. psychosocial aspects of facial:... Words, it must be to develop an individualized plan of care with implementation of evidence-based interventions negatively impact ’... A dependent variable both conceptually and empirically ensure patient understanding of the science and art of management. 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