Changes and challenges following treatment for head and neck cancer


Receiving a diagnosis of cancer is one of the most challenging life events an individual and their family and friends can face. The treatment and consequences of head and neck cancer (H&NC) in particular can be devastating. Treatment generally involves surgery, radiotherapy and chemotherapy and their consequences have profound effects, not least having a changed appearance and the possibility of cancer recurrence. Impacts include physical, social and psychological difficulties and changed lifestyles (Semple et al. 2008, pp. 85–93). There is a body of evidence that has investigated the change in quality of life (QoL) as a result of H&NC and international standardized instruments for assessment are available (Rogers et al. 2007). Difficulties encountered include changes in appearance, speech, swallowing, saliva, chewing, taste, pain, shoulder movement, mood and anxiety (Rogers et al. 2008). Most studies that have investigated changes in QoL as a consequence of H&NC have been quantitative using these standardized instruments. Less research has investigated life changes as a consequence of H&NC and treatment using qualitative methods. Consequently, the study by Semple et al. (2008) in this issue of JAN is novel and contributes to the emerging body of evidence on this subject. They argue that understanding life changes following treatment would allow professionals to address information and support needs for patients and develop appropriate interventions.

Changes to the body, whether through age or illness, can cause stigma. Care of people with a fractured body or incontinence, for example, or care of a dying person, pose challenges to doctors, nurses and carers. Learning to adapt and live with a changed or altered body due to loss of limbs or a damaged body following war, terrorism, accident or cancer is particularly challenging and alters people’s lives. The consequences of ageing, bodies and society are the focus of a re-launched study group in the UK (The British Sociological Association 2008) and the whole subject area merits further research and understanding. The findings of Semple et al. contribute to this and illustrate the consequences of H&NC and its treatment in terms of physical changes. Cancer concerns, living with uncertainty and fear of recurrence were experienced by the majority of people interviewed and coping strategies to deal with this are required. Nurses and members of the multidisciplinary team can assist with developing helpful strategies for social functioning and coping, as the findings from this study illustrate. Some people reported closer inter-personal relationships while some did not. A potential issue faced by people who have experienced H&NC and its treatment could relate to intimacy, body contact and kissing, although these issues were not reported in this particular study but are important considerations.

Work and day-to-day tasks were also affected with some people reporting changing their perceptions and lifestyle, placing less value on career goals and more focus on family and enjoyment. It behoves us all to regularly evaluate our lives, values, goals and achievements and not to wait for a diagnosis or illness. Of particular note was the finding of people being most vulnerable in the posttreatment phase. When faced with the onslaught of treatment, coping and dealing with that is a priority, but once it is completed daily schedules alter and is important for family, friends and professionals to appreciate. A helpful strategy suggested was to have access to an ‘expert’ patient who has been through the cancer journey. People with H&NC traded off the lifestyle changes and challenges following treatment with survival. More research of these issues is required and the role of nurses and other healthcare professionals, family and friends can play posttreatment, in relation to lifestyle and adaptation, is vital particularly once the delivery of intensive treatment is over.