Head and Neck Cancer Supportive Care and Survivorship

At Harold C. Simmons Comprehensive Cancer Center, our support services for head and neck cancer focus on rehabilitation, psychology, and survivorship to help patients and their families through the cancer journey.

Survivorship

Head and neck cancer survivors need special follow-up care from a team that monitors their progress and helps reduce long-term complications. UT Southwestern provides quality survivorship care, in accordance with American Cancer Society guidelines.

Surveillance for recurrence

All head and neck cancer survivors are at risk for recurrence, but the risk level differs depending on the tumor’s stage and other disease characteristics.

Patients should pay attention to new or different symptoms and report them to their doctor. These include:

• Coughing or spitting up
• New swelling or masses
• New pain or pain that gets worse
• New areas that do not heal
• New or different fatigue or weakness
• Persistent headache
• Speech changes
• Swallowing difficulties and/or appetite loss
• Unexplained weight loss
• Worsening cough or shortness of breath

Patients should follow these guidelines for subsequent exams and evaluations:

• Follow-up visits:
  • Year 1: Every one to three months
  • Year 2: Every two to six months
  • Year 3-5: Every four to eight months
  • Year 6 and beyond: Every 12 months
• Imaging: We may order a computed tomography (CT) scan, magnetic resonance imaging (MRI), or positron-emission tomography (PET)/CT scan eight to 12 weeks after treatment. However, depending on a patient’s situation, we might decide to do this more frequently.
• Thyroid function: Patients who received radiation therapy should be evaluated for thyroid function every six to 12 months for six years after treatment.
• Vaccinations:
  • Influenza: Every 12 months
  • Shingles: Every five years
  • Pneumococcal: Once, then revaccination as appropriate

Screening for second primary cancers

Head and neck cancer survivors are at a higher risk for developing new head and neck, lung, or esophageal cancers. This risk depends on several factors, including:

• Treatment received for the head and neck cancer
• Age
• Genetics

Screening for second primary cancers is critical for these patients.

Based on a patient’s history of smoking, we may decide to screen for lung cancer with an annual low-dose computed tomography (CT) scan.

All other cancer screenings should follow general guidelines.

Managing physical and psychosocial harms of tumors and treatment

Head and neck cancer can cause late long-term side effects that affect the body or mind. Some effects can occur in any head and neck cancer survivor, such as:

• Acid reflux
• Anxiety
• Body or self-image concerns
• Difficulty swallowing
• Difficulty speaking
• Distress
• Depression
• Sexual health and intimacy issues
• Sleep apnea or sleep disturbance
• Spiritual needs
• Shortness of breath
• Swelling in the arm and/or leg from lymphatic system blockage (lymphedema)
• Trismus (lockjaw)
• Weakness and/or fatigue

Others are specific to a particular treatment. For example, survivors who have had surgery may experience:

• Decreased neck, arm, or shoulder mobility
• Neck, arm, or shoulder discomfort
• General pain

Patients who received radiation therapy may notice:

• Altered or loss of taste
• Dry mouth
• General pain
• Involuntary muscle contractions in the neck (cervical dystonia)
• New dental issues
• Red, peeling, or swelling skin (radiation dermatitis), a common side effect of radiation therapy

Survivors who received taxanes- or platinum-based chemotherapy may have:

• Hearing loss (ototoxicity)
• Infertility
• Kidney problems (nephrotoxicity)
• Neuropathy (numbness/tingling in feet, legs, and hands)

Patients who experience any of these effects should tell their doctor, who can manage the condition or provide a referral.

Healthy behaviors

Healthy habits and lifestyle changes can help reduce the risk of cancer complications or recurrence. We recommend survivors focus on:

• Maintaining a healthy weight: Diets should emphasize vegetables, fruits, and whole grains. If patients have a problem with food intake or with feeding tubes or IV support, they should let their doctor know so they can be referred to a registered dietitian.
• Being physically active: Being active includes exercise and strength training (ideally, at least 150 minutes per week), as tolerated. It’s important that patients consult their doctor before beginning an exercise program.
• Avoiding tobacco: We offer tobacco cessation counseling and referrals for those who currently use tobacco.
• Practicing proper dental care: Yearly dentist visits and daily dental care, including self-examination for any lesions, are recommended.
• Limiting alcohol use
• Using SPF 30 (or higher) sunscreen daily
• Sharing a family history of cancer: Survivors should notify their doctor if there is a history of cancer in the family, especially if the diagnosis was before age 50. Genetic counseling may be available.

Coordination of cancer care

We recommend survivors continue to:

• Visit their oncologist for all issues related to their cancer or cancer treatment
• See their primary care physician for all general health care, including management of other illnesses and medication management
• See their dentist for oral and dental exams, especially if they received radiation

Embrace Survivorship

Our goal is to help survivors maintain their overall health and well-being during their cancer treatment. EMBRACE Survivorship is a series of workshops designed to assist patients and their families with physical, emotional, and practical issues that can arise during the cancer journey.