End Stage Palliative Care of Head and Neck Cancer: a Case Study

Abstract

<b>Background:</b> Locally advanced head and neck cancer is generally incurable and has a short survival rate. Thisstudy aimed to evaluate symptom relief, disease response, and acute toxicity after palliative hypo-fractionatedradiotherapy and long-term survival in affected patients. Materials and <br/><b>Methods</b>: Between January 2011 toDecember 2011, 80 patients who were histopathologically diagnosed as having stage III or stage IV head andneck squamous cell carcinoma based on Eastern Cooperative Oncology Group (ECOG) performance status 1-3,were offered palliative radiotherapy (20 Gy/5Fr/5 Days). Later these patients were evaluated on 30th day aftercompletion of treatment for disease response based on World Health Organisation (WHO) criteria and palliationof symptoms using symptomatic response grading and acute toxicities by the Radiation Therapy Oncology Group(RTOG). Many patients were given post radiation therapy (RT) palliative chemotherapy for appropriate palliativecare and a few patients were selected for further curative RT. The overall survival was also evaluated amongthis group of patients with last follow up date of 1st May, 2014. <br/><b>Results</b>: The most common presenting complaintwas pain followed by dysphagia. Most patients (60-70%) had appreciable relief in their presenting symptoms. Agood response was observed in the majority following palliative RT; a few patients had progressive disease andsome had stable and regressed disease. None of the patients experienced radiation toxicity that required hospitaladmission. Almost all showed grade one and two acute skin and mucosal toxicity one month after completion oftreatment. The mean survival days for patients given only hypofractionated palliative RT was 307 days, thosewith post palliative RT and palliative chemotherapy was 390 days and patients who went on to receive furtherpalliative RT and curative RT dose had significantly overall survival of 582 days. <br/><b>Conclusions</b>: Advanced headand neck cancer should be identified for suitable palliative hypofractionated radiotherapy to achieve acceptablesymptom relief in a great proportion of patients and should be followed by palliative chemotherapy or curativeRT in suitable cases for long-term symptom-free survival.