Monitoring and Evaluation of Late Functional Outcome in Post-treatment Follow-Up in Clinical Routine Setting

Abstract

Patients treated for head and neck cancer (HNC) often suffer from severe and visible loss of function as the cancer itself and the side effects of aggressive treatments have the potential to severely affect quality of life. Therefore, the aim of follow-up is not only the early detection of potentially curable recurrences and second primary tumors but also the diagnosis and rehabilitation of functional impairments. Clear guidelines determining the frequency of follow-up visits are missing, and the impact of follow-up visits on patient's prognosis is unclear. An intensive post-treatment follow-up is needed to detect functional impairments and to initiate their treatment. The aim is an optimal rehabilitation of the patients. This article focusses on goals of aftercare treatment and describes the spectrum of long-term sequelae, and the impact of Patient Reported Outcome (PRO) instruments of which three will be introduced.

Identification and management of late dysfunction in survivors of head and neck cancer: Implementation and outcomes of an interdisciplinary quality of life (IQOL) clinic

“…Since dysphagia (i.e., swallowing dysfunction) is the most commonly reported dysfunction after HNC treatment, 1,3 and roughly half of patients with radiation‐associated dysphagia experience sensory neuropathy in their pharynx and/or larynx leading to silent aspiration, 2‐3 instrumental swallowing evaluation was judged to be a critical element of this clinic. Fiberoptic endoscopic evaluation of swallowing (FEES) was selected for use in this clinic as it is an instrumental swallowing assessment that is well‐tolerated and easily performed in the clinic setting.…”

“…Due to the increase in HPV‐mediated oropharynx cancer that is more treatment‐responsive and more commonly diagnosed in younger patients, there is an increased expectation of long‐term survival 2 . Determining how best to deliver care that meets the complex needs of these cancer survivors is an oncologic imperative 3‐10 …”

“…2 Determining how best to deliver care that meets the complex needs of these cancer survivors is an oncologic imperative. [3][4][5][6][7][8][9][10] The Institute of Medicine characterizes four essential elements of survivorship care: (a) prevention and (b) surveillance of recurrence, new cancers and other late effects, (c) intervention for the effects of cancer, and (d) coordination between specialist and primary care. 11 Survivorship clinics are typically physician, nurse, or advanced practice provider (APP) led.…”