NEW YORK (Reuters Health) - New guidelines from the American Cancer Society (ACS) cover all aspects of medical care for head and neck cancer survivors, with a special emphasis on care coordination.
"The key message is, of course, that these patients require a multidisciplinary approach even after they are cured of their cancer," Dr. Ezra E.W. Cohen from the University of California at San Diego, La Jolla, told Reuters Health by email.
"The top recommendations, however, are that surveillance for second primary cancers is critical especially in tobacco-related head and neck cancers; swallowing disorders are common, can dramatically affect health and quality of life, and need to be proactively addressed; that dental disease is multifactorial and, if addressed early, severe problems can be averted; and that psychosocial distress is quite common and can have dramatic effects on function if not recognized and treated," Dr. Cohen said.
Head and neck cancer (HNC) survivors account for 3% of all cancer survivors, and their long-term medical care often depends on primary care clinicians and other health practitioners.
For these clinicians, Dr. Cohen and colleagues in the ACS multidisciplinary expert workgroup reviewed the literature and assembled dozens of recommendations covering surveillance for HNC recurrence; screening for second primary cancers; assessment and management of physical and psychosocial long-term and late effects of HNC and treatment; health promotion; and care coordination and practical implications.
HNC survivors should undergo a detailed cancer-related history and physical examination every one to three months for the first year after primary treatment, every two to six months in the second year, every four to eight months in years 3-5, and annually after five years, according to the guideline.
Clinicians should counsel HNC survivors about signs and symptoms of local recurrence and refer them to specialists if these signs and symptoms arise.
The guideline contains several recommendations for the assessment and management of long-term and late effects of HNC and its treatment, along with recommendations for lifestyle practices to support long-term health.
For the best care, the guideline recommends development of a multidisciplinary survivorship care plan, ongoing communications between primary care providers and the oncology team, and inclusion of caregivers in the care and support of HNC survivors.
Detailed recommendations appear in the March 22 CA: A Cancer Journal for Clinicians.
"We attempted as much as possible to provide guidance on when to involve specialists and what symptoms to specifically look for," Dr. Cohen said. "Of course, we could not cover all possible scenarios. Moreover, as we were investigating the literature, it became clear that high-level evidence to support some of the recommendations was simply not available. There is a great deal of research that needs to be advanced in this area."
"The number of head and neck cancer survivors is rising rapidly in this country and around the world," Dr. Cohen concluded. "These patients will continue to have symptoms from their original cancer and treatment for many years but many of these effects can be ameliorated with appropriate management. The primary care provider is in the perfect position to provide oversight around the multifaceted care these patients require, and we hope these guidelines will assist them in delivering the best care possible."
The Centers for Disease Control and Prevention supported this research. A number of coauthors reported disclosures.
CA Cancer J Clin 2016.