Managing the Unique Needs of Survivors of Head and Neck Cancer

Bridgett Harr, CNP

Bridgett Harr, CNP

Bridgett Harr, CNP, considers survivorship care to be very important. This is especially true when it comes to patients with head and neck cancer. There are vastly different needs when it comes to different tumor types. For survivorship care, nurses should be aware of the different therapies that can be offered as we well as the barriers that can occur. Harr, a CNP at the Cleveland Clinic Cancer Center, sat down with Oncology Nursing News to discuss the unique issues that survivors of head and neck cancer might face as they move into aftercare.

What are some of the gaps in knowledge for survivorship caregiving, and what can we do to lessen those gaps?

Research is a relatively limited field for survivorship right now. We know that survivorship care is beneficial for patients, but there's not that research to show us that it is. So we need to really work and get that research base to show that it is good and also look at the efficacy and utility of the care plans, as well as survivorship visits.

When it comes to survivorship and recommending it, what is important for the oncology nurse to know?

It's all about education. We need to think about cancer survivorship as part of the continuum of cancer care. It needs to be just as routine to us in ending treatment, you just go right to survivorship care. It's just another part of treatment.

For head and neck cancer patients, how can survivorship differ from other tumor types?

For head and neck cancer patients, we specifically gear survivorship more toward healthy behaviors, stopping smoking. We also speak with them more about dryness and taste changes and how they can overcome those, as well as appetite changes. We work with them for speech, fatigue, and fibrosis that happens in their mouth and neck.

Are there any integrative therapies that you recommend?

We use physical therapy a lot for some of the trismus and neck and mouth fibrosis. We also recommend massage sometimes, because that can really help people. We also use acupuncture. The Cleveland Clinic Cancer Center has an integrative medicine that is connected with us, that allows people to get acupuncture in a group setting, so it's cheaper and more accessible in that setting. They typically use that for taste changes, sometimes fatigue, dryness in the mouth, and pain. It really touches on most of the symptoms from head and neck cancer.

Is speech therapy common?

It depends on where the primary is for the head and neck cancer. If it's more of an oral/tongue, they'll use speech therapy for learning how to speak again and learning different ways to help enunciate. If it's more of an oropharyngeal cancer, they will focus more on the swallowing, what techniques we can use to help people swallow, and how they need to re-evaluate and rework their swallowing.

What are some of the barriers to access that patients can experience?

It just depends on their financial means. Most insurance covers physical therapy and speech therapy. Acupuncture, most insurances don't cover, which is why the group setting may be so important for them to actually get access to it. It's also that these patients are done with treatment. They're not coming back every day and it's taking time out of their work days to come back to do it. It's about making those appointments available later and seeing what we can do to help.

Are patients generally aware of all the different therapies that can be offered?

They definitely are made aware of it. Sometimes, it's just about if they're able to come or available to come with their schedule, and how many times insurance is going to pay for it.