Palliative and supportive care in head and neck cancer: United Kingdom National Multidisciplinary Guidelines

Abstract

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the assessments and interventions for this group of patients receiving palliative and supportive care.Recommendations• Palliative and supportive care must be multidisciplinary. (G)• All core team members should have training in advanced communication skills. (G)• Palliative surgery should be considered in selected cases. (R)• Hypofractionated or short course radiotherapy should be considered for local pain control and for painful bony metastases. (R)• All palliative patients should have a functional endoscopic evaluation of swallowing (FEES) assessment of swallow to assess for risk of aspiration. (G)• Pain relief should be based on the World Health Organization pain ladder. (R)• Specialist pain management service involvement should be considered early for those with refractory pain. (G)• Constipation should be avoided by the judicious use of prophylactic laxatives and the correction of systemic causes such as dehydration, hypercalcaemia and hypothyroidism. (G)• Organic causes of confusion should be identified and corrected where appropriate, failing this, treatment with benzodiazepines or antipsychotics should be considered. (G)• Patients with symptoms suggestive of spinal metastases or metastatic cord compression must be managed in accordance with the National Institute for Health and Care Excellence guidance. (R)• Cardiopulmonary resuscitation is inappropriate in the palliative dying patient. (R)• ‘Do not attempt cardiopulmonary resuscitation’ orders should be completed and discussed with the patient and/or the family unless good reasons exist not to do so where appropriate. This is absolutely necessary when a patient's care is to be managed at home. (G)

Head and neck cancer: improving outcomes with a multidisciplinary approach

“…Recent data focus on the role of supportive care in reducing acute and late toxicities; early evaluation of pretreatment conditions, swallowing impairment, and new side-effect onset improves outcomes and quality of life (QoL). 8 For recurrent/metastatic (R/M) disease, CT remains the standard therapeutic option. After platinum progression, no second lines that significantly improve prognosis are available.…”

Non-curative treatment of patients with oral tongue squamous-cell carcinoma

“…Recently, more research has also been aimed at further developing palliative care. Development has also been made in symptom management of advanced disease, as the impact of various aspects of palliative care is better recognized [ 1 – 4 ].…”

“…Palliative care modalities, which also include radiotherapy and surgical interventions, play a critical role in improving quality of life of the patient by alleviating tumour-related symptoms. Still, the functional deficits and symptomology caused by HNCs, due to the distinctive profile of the cancer itself in combination with the organs and tissues affected, remain a challenge even for experienced multidisciplinary centres [ 4 , 5 ].…”

Ethics of crisis sedation: questions of performance and consent

“…In addition, we have reviewed official guidelines from two UK Healthcare Trusts detailing the proper use of crisis sedation as a response to ‘major hemorrhage’ and ‘carotid blowout’ that are otherwise untreatable. iii We have also located a number of major statements, such as ‘Palliative and supportive care in head and neck cancer: United Kingdom National Multidisciplinary Guidelines’,8 the ‘European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care’9 and ‘Care of Dying Adults in the Last Days of Life’ published by the UK’s National Institute for Health and Care Excellence10 that mentions the topic, although in passing. iv We have found no reason to demur from the conclusions drawn in a systematic review of the management of terminal haemorrhage literature published in 2009: the existing literature on the topic is primarily based on expert opinion, the weakest evidence base for medical care and interventions 11…”