The palliative care needs and experiences of people with advanced head and neck cancer: A scoping review

Abstract

Background: The palliative care needs of people with advanced head and neck cancer pose unique complexities due to the impact the illness has on eating, speaking, appearance and breathing. Examining these needs would help provide guidance about developing relevant models of care and identify gaps in research knowledge. Aim: To identify and map out the palliative care needs and experiences for people with advanced head and neck cancer. Design: A scoping literature review following the methods described by the Joanna Briggs Institute. Data sources: An electronic search of the literature was undertaken in MEDLINE (Ovid), EMBASE and CINAHL covering the years January 1996 to January 2019. Results: People with advanced head and neck cancer often had palliative care needs but there was variability in the timing and access to relevant services. A high prevalence of interventions, for example hospital admissions were needed even during the last month of life. This was not necessarily negated with early engagement of palliative care. Dissonance between patients and family carers about information needs and decision-making was an additional complexity. Studies tended to be descriptive in nature, and often involved a single centre. Conclusion: This scoping review demonstrates the complexity of care for people with advanced head and neck cancer and the issues related to the current healthcare systems. Focus on appropriate referral criteria, increased integration and coordination of care and robust evaluation of specific care components seems key. Linkage between research and service design delivery across teams, disciplines and care settings seems pertinent.

Patient-Reported Outcomes Assessing the Impact of Palliative Radiotherapy on Quality of Life and Symptom Burden in Head and Neck Cancer Patients: A Systematic Review

“…Even in the era of immune checkpoint-inhibitors the median overall survival is still roughly one year, for example in recurrent or metastatic cases (3,4). In addition, severe symptoms may have a marked negative impact on a patient's health-related quality of life (5). Palliative radiotherapy can be an option to improve or stabilize health-related quality of life and symptoms.…”

Palliative Care and End-of-Life Issues in Elderly Cancer Patients With Head and Neck Cancer

“…Patients with advanced head and neck cancer in palliative care setting report a diverse range of physical symptoms ranging from pain, fatigue or lack of energy, difficulty eating or swallowing, dry mouth, incontinence, bleeding, dyspnoea, fungating lesions, change in appetite, cough, communication difficulties, constipation, retained mucus, soft tissue oedema, and insomnia (5,6).…”

“…Fatigue or lack of energy is frequently reported in elderly patients with cancer and prevalences range from 77% to 81% (5).…”

“…In elderly patients, integration of geriatric medicine and palliative care is still a problem and specific attention should be given as to geriatric palliative care. Geriatric palliative care is a field of inter-specialty collaboration unifying competences from geriatric medicine, oncology and palliative care to respond to the socio-demographic changes and challenges of older adults with severe and life-limiting conditions (5,6).…”

Head and neck cancer end of life care: complex challenges

“…Head and neck cancer (HNC) is the collective term for a wide range of cancers arising from the lining of the oral cavity and surrounding areas including, but not limited to, the nasal cavity, the pharynx, larynx and salivary glands. The prognosis in HNC is variable, depending on type and stage at diagnosis, but an average 5-year survival in the region of 40%–65% 1. Patients with advanced HNC face unique challenges due to the site of the tumour impacting on vital functions such as breathing, eating/drinking and communicating 1.…”