Aim of the head and neck cancer case study
This case study aims aim to facilitate the development of competencies that reflect the role of the Specialist Cancer Nurse (SCN) in ensuring a coordinated approach to care planning, implementation and evaluation across the cancer journey for people affected by head and neck cancer.
The incidence of head and neck cancers is relatively low. However, people affected by these cancers often receive intense medical, nursing and allied health support during their cancer journey due to the complexity of the disease, multimodal treatments, and disruptive side effects and symptoms.3
This complexity requires that the person's care be well coordinated.
There are many points along the cancer journey when the SCN can improve outcomes for people at risk of or affected by this disease. These include:
Section 1: Reduce risk
Factors identified as increasing risks for the development of head and neck cancer include:3-5
- heavy alcohol and/or tobacco use
- a poor or imbalanced diet
- exposure to carcinogens and co-carcinogens
- possible vulnerabilities caused by genetic factors or the human papilloma virus.
The SCN can play an important role in public health efforts that promote understanding of these risks.
Section 2: Find the condition early
There are no definitive screening processes that can detect head and neck cancers early.6
People who present early with few symptoms and localised disease are likely to require less invasive treatment and thus achieve better outcomes, including cosmetic results.3, 6 Symptoms may include:6
- localised pain
- hoarse voice
- difficulty swallowing
- mouth ulcers
- leukoplakia of oral mucosa
- bad breath.
Targeted public health initiatives to raise awareness of the importance of these symptoms within high risk groups may improve rates of early detection.
Section 3: Have the best treatment and support during active treatment
Treatment for head and neck cancers may include a combination of surgery, antineoplastic agents, radiotherapy and biotherapies.7 A coordinated approach to care planning, delivery and follow up is required to ensure continuity of care.
Treatment effects and symptoms have the potential to significantly impact many areas of a person's life, such as:3, 7, 8
- body image
- nutrition and hydration
- capacity to work and socialise.
SCNs, in collaboration with members of the multidisciplinary (MDT) team, have a major role in minimising the impact of these treatments and coordinating the range of services and care providers involved in the person's treatment program.
Section 4: Have the best treatment and support between and after active treatment
The physical, psychological, practical and informational needs related to head and neck cancer require intervention from the MDT.3
A range of supportive care needs may be experienced by people affected by head and neck cancer including:3
- altered communication
- altered nutrition and swallowing
- oral and respiratory effects and symptoms
- pain and other discomforts
- psychological distress related to body image
- altered social relationships.
The SCN is well placed to play a key role in coordinating multiple health services in response to the needs of people who have received treatment for head and neck cancer, assisting them to resume activities of daily living, occupation, and social interaction.9
Section 5: Have the best care at the end of life
Advanced cancer impacts on the quality of life of the individual and their family or caregivers in many ways, as it can be associated with:10
- distressing physical symptoms
- deterioration of physical functioning
- increasing psychological distress
- increasing disruption to social activities
- challenges to existential and spiritual wellbeing.
The SCN, as part of the MDT, provides individualised, evidence-based supportive care to respond to these needs.