head and neck cancer is called head and neck malignant tumors, including oral cancer, nasopharyngeal cancer , laryngeal cancer and other malignant tumor diseases. According to statistics from China Anti-Cancer Association , in 2021, there were about 148,000 newly confirmed head and neck cancer patients in China, and nearly 78,000 deaths from head and neck cancer, and there are a growing trend.
Currently, 70% to 80% of head and neck cancer patients are already locally advanced or advanced when diagnosed. After traditional comprehensive treatment, they are still prone to recurrence and metastasis, and are prone to complications such as language disorders, swallowing disorders and . Therefore, how can reduce head and neck cancer complications and enable patients to obtain a higher quality of life has been a hot topic in clinical research in the field of head and neck cancer in the past two years. This article shares a guideline consensus titled " head and neck cancer survivors " published on JAMA for clinical reference.
References
1. Consultation on smoking cessation and alcohol cessation (Evidence Level: IA)
In recent years, although the epidemiology of squamous cell carcinoma in head and neck cancer has changed, more than 70% of squamous cell carcinoma cases are associated with human papillomavirus , while squamous cell carcinoma associated with tobacco and alcohol are relatively reduced. At the same time, there is evidence that smoking in is a risk factor in increasing the mortality rate of head and neck cancer patients even in the case of antiviral treatment controlling human papillomavirus. However, according to clinical statistics, more than 50% of head and neck cancer patients are smokers and continue to smoke after diagnosis.
In addition, it should be noted that 1/3 of patients drink more than 3 cups of alcohol a day, which can easily increase the risk of head and neck cancer recurrence, depression and resistance to other drugs .
Therefore, the guideline points out that head and neck cancer patients must undergo consultation on smoking cessation and alcohol cessation, and evaluate withdrawal plans, and cooperate with doctors to quit smoking and quit drinking.
2. Regularly use effective examination methods to evaluate depression and/or anxiety disorders (Evidence Level: IA)
in the diagnosis, treatment and prognosis process. Some studies have shown that the mental stress of head and neck cancer patients is greater than that of other cancer patients, and the suicide rate of is twice that of other cancer patients, and the trend is on the rise.
In addition, due to cancer pain, patients are forced to rely on opioid pain-relieving drugs for a long time, which leads to a significant decline in quality of life. In addition, the patient has symptoms such as dysphagia, tooth loss, and local lymph node enlargement, which may also have a negative impact on his quality of life and self-image.
In view of this, this guide strongly recommends that use NCCN psychological pain thermometer, patient health questionnaire and other examination methods to regularly evaluate the mental status of head and neck cancer patients and whether there are depression and anxiety disorders . At the same time, patients are recommended to combine speech therapy, oral therapy, and physical therapy, and closely follow-up (the evidence levels are IIA, IB and IIA, respectively).
3. Evaluate thyroid function every 6 to 12 months, especially patients with a previous history of neck radiotherapy (evidence level: IIA)
is essential for treatment of head and neck cancer. However, due to adverse reactions, 1/3 to 1/2 of patients with radiotherapy will experience symptoms of hypothyroidism. Therefore, recommends regular examination of thyroid stimulating hormones and thyroid hormones to evaluate thyroid function , and timely supplement thyroid hormones to prevent or control the occurrence of hypothyroidism.
In addition, patients with head and neck cancer who have undergone extensive neck surgery and are at risk of hypothyroidism should also be screened.
IV. Patients with a history of smoking need to undergo regular chest CT examinations (Evidence Level: IIA)
An American lung cancer screening study results show that the incidence of lung cancer among severe smokers with a history of head and neck cancer is significantly higher than that of smokers without a history of head and neck cancer (2080vs.09, with an absolute risk reduction rate of 2.54, 95%CI95%CI809, with a decrease in absolute risk rate of 2.54, 95%CI8 1.63~3.95). At the same time, smoking in head and neck cancer patients will also increase the risk of primary lung cancer before and after treatment.
Therefore, in addition to actively quitting smoking, should also undergo regular chest CT examinations in order to observe whether nodules, tumors and other diseases in the lungs are present, and surgical resection is performed early, so as to reduce the risk of metastatic lung cancer or primary lung cancer in head and neck cancer.
5. Summary
. Consultation on smoking cessation and alcohol cessation (evidence level: IA).
. Regularly use effective examination methods to evaluate depression and/or anxiety disorders (level of evidence: IA).
. Thyroid function is evaluated every 6 to 12 months, especially in patients with a previous history of neck radiotherapy (evidence level: IIA).
. Patients with a history of smoking need to undergo regular chest CT examinations (evidence level: IIA).
References
[1]Samuel Auger, Andrew Davis, Ari J. Rosenberg.Recommendations for Care of Survivors of Head and Neck Cancer[J].JAMA, 2022.
[2] China Anti-Cancer Association. "China Malignant Oncology Discipline Development Report (2021)" - Research Progress in Head and Neck Tumors [EB/OL] http://www.caca.org.cn/system/2022/08/05/030019815.shtml, 2022-8-15
Translation: Feng Xiwen
