Quality-of-life considerations in treatment of unresectable, recurrent head and neck cancer

Abstract

Recurrent, unresectable head and neck squamous cancer is a complex problem. Evidence for the efficacy of treatment is scant in this area and given the large number of patient and tumor variables involved in the recurrent tumor, several factors play a role in deciding the choice of management. The results of treatment are very poor and associated with significant toxicity. Thus, the quality of life outcome following treatment should play a major role in the choice of treatment. Unfortunately, generation of quality-of-life data is hampered by several factors, not least of which are the ethical issues raised by end of life care. This article reviews the relevant literature, summarizes existing evidence and draws conclusions, identifies gaps in the knowledge and offers guidance for further research.

Increased sMICA and TGFβ 1 levels in HNSCC patients impair NKG2D-dependent functionality of activated NK cells

“…3 The toxicity and morbidity proscribed by current therapies can severely impair quality of life, such that the prognosis for these patients remains poor. 4,5 HNSCC patients have a high risk of impaired immune response due to (i) decreased leukocyte numbers, (ii) impaired leukocyte proliferative capacity, and (iii) increased numbers of CD4 C CD25 C Foxp3 C regulatory T cells (T regs ), which are able to suppress all functions of T cells, natural killer (NK) cells and NK-T cells. 6 Innate immune cells, such as NK cells, have stimulatory effects on the host defense by rapid activating the recognition of, migration towards and efficient elimination of tumor-or otherwise "stressed" cells.…”

Clinical ethics consultation in patients with head and neck cancer

“…In head and neck cancer, fundamental decisions regarding the relative risks and benefits of treatment require patient‐centric input, and rarely fit into a neat algorithm . When faced with patients with incurable disease, these choices become even more difficult, and the impact upon quality of life metrics is even more important . In head and neck cancer, in the words of an experienced surgeon, “the mistake that many make is to believe that anything less than everything is, in fact, nothing at all.” The fallacy that foregoing further cancer‐directed therapy is “doing nothing” should rather be reframed into the focus upon “doing everything” to treat symptoms effectively.…”

Using PROMs to guide patients and practitioners through the head and neck cancer journey

“…Thus, projected HRQOL as reported on PROMs should be prioritized in the choice of treatment. 71 HRQOL of patients receiving platinum-based chemotherapy plus cetuximab first line for recurrent and/or metastatic HNC has been shown to be acceptable. 72 However, of interest is the effect of administration of immune checkpoint inhibitors on HRQOL, such as nivolumab, in patients with platinum-refractory, recurrent HNC.…”