Source: www.ajmc.com
Author: Surabhi Dangi-Garimella, PhD

With an increasing population of head and neck cancer survivors in the United States, the American Cancer Society identified the need to develop survivorship guidelines that can lend support to primary care clinicians and other health practitioners as they care for survivors.

With an increasing population of head and neck cancer (HNC) survivors in the United States, the American Cancer Society (ACS) identified the need to develop survivorship guidelines that can lend support to primary care clinicians and other health practitioners as they care for survivors. The guideline emphasizes monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination.

According to ACS estimates, nearly 3% (436,060) of cancer survivors in the United States have survived a bout of HNC. With these numbers in mind, ACS convened an expert panel that included members with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech language pathology, physical medicine and rehabilitation, nursing, and a HNC survivor who provided a patient perspective. The panel reviewed existing guidelines and research evidence through April 2015, and created recommendations, which the committee has stressed “should be viewed as consensus-management strategies” to assist survivors. While 2081 articles were identified from a preliminary search, only 184 were finally included as evidence base.

Published online in CA: A Cancer Journal for Clinicians, the following are some of the key recommendations provided by the guideline for primary care physicians:

  1. Surveillance for HNC recurrence
    a. History and physical. Primary care clinicians should
    i. individualize clinical follow-up care provided to HNC survivors based on age, specific diagnosis, and treatment protocol as recommended by the treating oncology team
    ii. conduct a detailed cancer-related history and physical examination every 1-3 months for the first year after primary treatment, every 2-6 months in the second year, every 4-8 months in years 3-5, and annually after 5 years
    iii. confirm continued follow-up with otolaryngologist or HNC specialist for HN-focused examination
    b. Education. Primary care clinicians should educate survivors on signs of local recurrence and refer them to an HNC specialist is symptoms of recurrence are observed.
  2. Screening and detection of second primary cancers. HNC survivors should be screened similar to the general population for early detection of primary cancers, including lung cancer and another head and neck and esophageal cancer (as if at increased risk).
  3.  Physical and psychosocial support. Long term and late effects of HNC should be regularly assessed at each follow-up visit.
  4. Guideline recommends assessing for spinal accessory nerve palsy, cervical dystonia/muscle spasms/neuropathies, shoulder dysfunction, trismus, dysphagia, gastroesophageal reflux disease, and lymphedema
  5. Additional recommendations are for monitoring fatigue, altered of loss of taste, hearing loss, vertigo, vestibular neuropathy, sleep apnea, speech disturbance, hypothyroidism, oral and dental caries, periodontitis, xerostomia, osteonecrosis, and oral infections.
  6. Body and self-image. If HNC survivors have body or self-image concerns, they should be referred to psychosocial care.
  7. Distress or anxiety. Following regular assessment, primary care clinicians should either provide in-office counseling, provide pharmacotherapy, and/or refer HNC survivors to appropriate psycho-oncology and mental health resources or social workers per their need.
  8. Health promotion. These recommendations include educating HNC survivors on their treatment and its side effects, maintaining a healthy weight, encouraging physical activity, adequate nutrition, tobacco cessation, and the importance of personal and oral hygiene.
  9. Care coordination and practice implications. Clinicians should obtain the survivor’s treatment summary and survivorship care plan from the oncology team, maintain a continued dialogue with the oncology team, and should include caregivers, spouses, or partners in the process or care and support.

Reference
Cohen EE, LaMonte SJ, Erb NL, et al. American Cancer Society head and neck cancer survivorship care guideline. CA Cancer J Clin. 2016;66(1):43-73. doi:10.3322/caac.21343.