Home and Inpatient Hospice Care of Terminal Head and Neck Cancer Patients

Abstract

The objective is to evaluate and compare data on a cohort of terminal head and neck cancer (HNC) patients from both home and hospital-based hospice programs and to define the particular problems and needs of those patients. The setting was a tertiary academic referral centre in Tel Hashomer, Israel. We carried out a retrospective survey of patient charts based on hospice databases and death certificates of the hospital tumor registry. Charts of 102 HNC patients admitted to the hospice between 1988 and 1994 and 24 charts of HNC patients cared for by the home hospice program between 1990 and 1994 were studied. Pain, airway problems, and dysphagia were the common problems reported. A comparison of the two programs showed home hospice patients to be younger and with lower pain levels, less weight loss, and less oral candidiasis. There were fewer oral cavity tumor patients in the home hospice group. The incidence of distant metastases was in the 50% range in both groups. Judging by chart entries relating to pain, airway care, and food intake, treatment protocols were effective in both programs in the alleviation of pain and other symptoms. Both programs appeared to provide adequate care for terminal HNC patients. The main differences in care between the two groups stemmed from the decisions of referring physicians and not from a predetermined level of care. The incidence of distant metastases was higher than that reported in earlier clinical series.

Salivary flow and its relation with oral symptoms in terminally ill patients

“…This is not surprising and correlates with the reported prevalence of oral candidiasis incurred in up to 85% 3 with the rate of incidence most likely approaching 90% as the patient with cancer nears death 14. Previous retrospective chart studies by our group on a cohort of terminal head and neck carcinoma patients reported that oral candidiasis was seen and treated in 10–14% of inpatients and 2% of home care patients 15, 16. Because patients with head and neck carcinoma are more prone to oral complications due to the basic nature of their disease and treatment, we believe that this lower incidence rate arose from inadequate diagnosis with regard to oral symptoms recorded in the patient charts that were analyzed retrospectively.…”

Salivary flow and its relation with oral symptoms in terminally ill patients

“…12 Terminally ill patients possess local and systemic predisposing factors to oral candidal infection. 15,16 Because patients with head and neck carcinoma are more prone to oral complications due to the basic nature of their disease and treatment, we believe that this lower incidence rate arose from inadequate diagnosis with regard to oral symptoms recorded in the patient charts that were analyzed retrospectively. 13 The majority of the patients included in this study had oral candidiasis (94%).…”

End‐of‐Life Care among Head and Neck Cancer Patients

“…8 The importance of palliative care teams and the utilization of hospice services cannot be overstated. 9,10 Given the poor prognosis of many advanced tumors, initial treatments, even those with seemingly curative intent, might be considered by some to be palliative. 11 Timon and Reilly 12 estimate that 20% of patients would qualify for palliative care at the time of initial diagnosis, with an average survival of 5 months within this cohort.…”