Understanding Your Treatment Plan

Your health care team will likely recommend a treatment course based on 1) your specific type of head and neck cancer; 2) disease stage; and 3) clinical guidelines that are based on the best evidence to date from research. These are not the only factors used to select the best treatment options, so you should ask for as much information as possible to understand the benefits, risks and side effects associated with your treatment plan.

There are predominantly three types of therapy for head and neck cancer, which include the following: surgery, radiation therapy or chemotherapy, or a combination of these therapies.

Treatment type: Surgery

If surgery is used for early stage head and neck cancer, it may be the only treatment modality needed and can be curative. Surgery can also be combined with other therapies; for example, surgery can be performed first, followed by radiation therapy.

The treatment goals associated with surgery include removing the entire tumour and keeping the nearby anatomic structures intact. A complication associated with extensive head and neck surgery is that it may be necessary to remove bones, such as part of the jaw, or even entire structures, such as the external ear. Your doctor is required to clearly state what will happen during your surgery, so you will know what to expect. A concern that many patients have is whether a surgical procedure will impact their appearance or ability to eat or speak. Your health care team will use many strategies to retain both form and function, but it may require rehabilitation several months after treatment.

Treatment type: Radiation Therapy

If radiation therapy is used for early stage head and neck cancer, it may be the only treatment needed and can often be curative. Radiation therapy may also be used sequentially (e.g., after surgery) or concurrently with chemotherapy (chemoradiation).

Radiation therapy uses high-energy rays that disrupt the DNA of targeted cells and induce cell death, which then decreases the size of the tumour. To optimally deliver the high-energy rays to the site of the tumour yet protect surrounding tissues, radiation planning is performed before the radiation procedure; basically, imaging of the tumour site is mapped while the patient is positioned in the same manner as the upcoming treatment. Then, during radiation therapy treatment, the patient is carefully positioned in the same place and the beams deliver radiation therapy to the tumour.

Radiation therapy can have the following side effects:

  • Inflammation of the membranes lining the mouth (mucositis); approximately 50 percent of patients who are administered radiation therapy develop this symptom at the time of treatment, and it can cause pain and interfere with eating and/or swallowing
  • Alteration in taste
  • Decreased salivation (xerostomia)
  • Changes in voice (e.g., hoarse voice)
  • Difficulty opening the mouth (trismus)
  • Cavities, which are likely due to decreased salivation
  • Fatigue, experienced by 70 to 80 percent of patients
  • Airway obstructions

Treatment type: chemoradiation therapy

Chemoradiation therapy may need to be used following surgery. Alternatively, it may be used as the initial treatment for patients with more advanced head and neck cancer.

Chemoradiation therapy can have the following side effects:

  • Inflammation of the membranes lining the mouth, or mucositis; this symptom interferes with eating or swallowing
  • Decreased salivation
  • Fatigue, reported by 70 to 80 percent of patients
  • Nausea and/or vomiting

Staying on Top of Your Treatment Plan

Before you receive your treatment plan, you may want to discuss with your health care professionals what you can do to manage side effects. In addition, you can ask them if there are specific side effects to discuss with them either immediately or later point.

While receiving your medications, you may want to keep worksheets in a binder that include the following:

  • A list of typical treatment-associated side effects (e.g., vomiting, fatigue)
  • A way to rate the intensity of each side effect from none, mild, moderate, to severe
  • Any directions that you were given to manage the side effect, which may include taking a medication or notifying a health care professional

For example, if you are receiving chemoradiation therapy, you may want to create a worksheet as follows:

 

Symptom Symptom Severity Steps You Took to Manage the Symptom
Vomiting None
Mild
Moderate
Severe
Lemonade

Anti-vomiting medication

Fatigue None
Mild
Moderate
Severe
Hot milk 30 minutes before bed

Natural sleep remedies

Mild sleep medication

Mucositis None
Mild
Moderate
Severe
Mucosoothe