A Multidisciplinary Approach For Head & Neck Cancer
The Pueblo River Walk I do not intend to discuss an off-label use of a product during this activity I have not had any relevant financial relations during the past 12 months to disclose Treatment of head and neck cancer poses unique challenges. Adequate supportive measures are required to minimize the acute and long term affects of this intensive treatment protocol. 1
Head and neck cancers comprise approximately 5% of all cancers 1. (Lenhard,Osteen,&Gansler,2001,p.300) The majority of patients have surgery followed by concurrent chemotherapy and radiation. This presents a challenging course for the patient. These acute and long term side effects can greatly impact the patient s quality of life long after the surgery has healed and the chemotherapy and radiation have ended. The acute physical side effects include Dry Mouth Excess Mucous Change in Taste Mouth Sores Difficulty Swallowing Unwanted Weight Loss Skin Reactions Emotional Side Effects 2
Long term side effects include Difficulty Opening the Mouth Oral Infections Fatigue Lymphedema Difficulty Swallowing Malnutrition Loss of Neck Mobility Osteonecrosis Other long term issues may include Financial Issues Job Loss Unable to Work at Previous Occupation Survivorship Concerns Concurrent use of chemotherapy and radiation intensifies many of the physical and emotional symptoms, but especially loss of appetite, difficulty swallowing, mucositis (mouth sores), fatigue, depression, social isolation and limited neck and shoulder mobility. 3
Patients treated for head and neck cancers have extensive quality of life issues, and far reaching long term health issues and a higher post treatment suicide rate then patients with other types of cancer 2. (Improving Functional Outcomes in Head and Neck Cancer 2009, p.13). In order to address these problems our cancer center began to develop a program in collaboration with the Radiation Oncologist. The result was our CARES TEAM C ancer A ssessment R esearch/ resource E ducation S urvivorship The Vision To ensure that people affected by head and neck cancer live well through top quality care and survivorship excellence. That they are supported through their journey with the resources, knowledge and compassion they deserve. 4
The initial objective was to provide all the specialty services that our patients would require in one location. This created an opportunity for collaboration among the health care professionals and ultimately better care to the patients. OUR TEAM CARES Team Radiation Oncologist Dental Hygienist Physical Therapist Dietician Radiation Therapists Clinical Coordinator Nursing Staff Oncology Counselor Speech Therapist Dosimetrist Clinical Trials Nurse Survivorship Nurse 5
How Our Team Approach Works Initial Dental Assessment before treatment starts Team Pre-Assessment Weekly teaching and treatment sessions Patient Binders used for education Team Post-Assessment (6wks-4months-1year) Survivorship Care Plan Clinical Research What positive impact the team has had Identifying immediate concerns earlier in the journey Surgical complications Need for dental extractions/shielding Overall poor oral status Poor nutritional status Difficulty swallowing Decreased mobility Social problems 6
Current Outcomes Decrease time from initial consultation to start of radiation because of dental delays Decreased weight loss during treatment Improved swallowing during and after treatment Improved mobility of the neck and shoulders a year out How the Team fills the gaps Complete dental clinic in the cancer center Stress scale to help identify coping abilities Weight and wellness check one week after treatment ends Quality of life studies Clinical Trials (screened weekly) Weekly summaries to the doctors Weekly rounds in the morning Treatment summaries Moving Forward Collecting feedback from our patients and their families Updating the patient binder yearly Increasing the number of patients to participate in clinical trials Developing long term clinical research studies 7
The Team and Our Community State Fair Events Annual free oral screening Annual Head and Neck Symposium Tobacco Cessation classes CancerFit Exercise Program Thank You for Attention Questions??? References 1. Improving Functional Outcomes in Head and Neck Cancer. (2009, March/April 7(1)). The Journal of Supportive Oncology, pp. 10-15: Retrieved from http://www.supportiveoncology.net 2. Lenhard, R.E. Jr, Osteen, R.T.,& Gansler,T. (2001). The American Cancer Society s Clinical Oncology. Atlanta, GA: Blackwell Publishing, Inc. 8
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