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"I Would Like a Quick Return to a Normal Lifestyle"

Nathan E. Goldstein, MD; Eric Genden, MD; R. Sean Morrison, MD

JAMA. 2008;299(15):1818-1825.

Head and neck cancers constitute a diverse group of diseases including malignancies of the oral cavity, oropharynx, larynx, sinuses, and skull base. Treatment of these cancers includes a combination of surgical resection, chemotherapy, and radiation. Due to both the patterns of disease recurrence and the adverse effects of treatments, patients with head and neck cancer often have a complex and prolonged course of illness that is marked by periods of freedom from disease and symptoms interspersed with bouts of serious illness, debility, and numerous physical and psychological symptoms including pain, dysphagia, weight loss, disfigurement, depression, and xerostomia. Thus, management of this disease is best provided by an interdisciplinary team that includes individuals from the disciplines of otolaryngology, palliative care, radiation oncology, oncology, nutrition, speech, and physical and occupational therapy. Using the case of Mr K, we describe the symptoms encountered by patients with head and neck cancer and suggest options for management. We discuss the psychological aspects that affect these patients, including issues such as changes in body image, quality of life, anxiety, and guilt. Finally, we discuss the importance of the interdisciplinary team in the care of these patients and outline the roles of each team member. By providing comprehensive care to patients with malignancies of the head and neck, clinicians can increase the likelihood that patients and their families will be able to obtain the best possible outcomes and quality of life.

Author Affiliations: Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Adult Development (Drs Goldstein and Morrison) and Department of Otolaryngology (Dr Genden), Mount Sinai School of Medicine, New York, and the James J. Peters VA Medical Center, Bronx, New York (Drs Goldstein and Morrison).

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