Supportive care for pharyngeal cancer

Supportive care helps people meet the physical, practical, emotional and spiritual challenges of pharyngeal cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.

Your recovery after treatment for pharyngeal cancer will be looked after by the cancer specialists, head and neck surgeon, nurses, dieticians, dentists, physical therapists, speech therapists, social workers and your family doctor.

Recovering from pharyngeal cancer and adjusting to life after treatment is different for each person, depending on the stage of the cancer, the tissues removed during surgery, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A person who has been treated for pharyngeal cancer may have the following concerns.

How a person feels about themselves is called self-esteem. Body image is how a person sees their own body. Pharyngeal cancer and its treatments can affect a person’s self-esteem and body image. Often this is because cancer or cancer treatments may result in body changes, such as:

• scars
• skin changes
• changes to the shape of the face or neck
• having to use a prosthesis
• changes in body weight
• difficulty chewing, swallowing or speaking
• having an ostomy, such as a tracheostomy or gastrostomy

Some of these changes can be temporary. Others will last for a long time or be permanent.

For many people, body image and how they think other people see them is closely linked to self-esteem. It may be a real concern for them and can cause considerable distress. They may be afraid to go out, afraid others will reject them, or feel angry or upset, even if the effects of treatment may not show on the outside of the body.

Find out more about how to cope with problems of self-esteem and body image.

Many people will have a dry mouth (xerostomia) during and after treatment for pharyngeal cancer. Dry mouth may be worse with chemoradiation than with radiation alone. Chemoradiation combines radiation therapy with chemotherapy. The 2 treatments are given during the same time period.

Dry mouth can make it hard to chew, swallow and talk. When it is very serious, it can affect your nutrition. The healthcare team takes steps to check for, prevent and manage dry mouth. A registered dietitian can also give suggestions on how to have good nutrition when dry mouth affects your ability to eat.

Find out more about dry mouth.

Sore mouth is also called stomatitis or oral mucositis. Chemotherapy drugs and radiation therapy to the head and neck area can damage the cells that line the mouth, throat (pharynx) and esophagus and cause you to have a sore mouth. When these treatments are given together as chemoradiation, soreness may be worse than with radiation therapy or chemotherapy alone.

Find out more about sore mouth.

Sometimes structures such as the tongue and jaw bones need to be removed during surgery for pharyngeal cancer. Removing these structures can cause chewing problems. Reconstructive surgery and rehabilitation can help you manage if you have difficulty chewing.

If large parts of the tongue, jawbones, voice box (larynx), pharynx or palate are removed during surgery, you may have difficulty swallowing and speaking. Reconstructive surgery helps reduce problems with speaking and swallowing. A prosthesis can be used to replace lost tissue and improve speaking but it is often difficult to fully restore normal speech and swallowing abilities.

A speech therapist (speech-language pathologist) can help you deal with changes in your voice and learning to speak again. They can also help you with swallowing problems.

Find out more about difficulty swallowing and how speech therapy can help with speech and swallowing problems.

Radiation therapy to the head, neck or mouth may damage the salivary glands and taste buds, which can affect the way some foods taste. Chemotherapy drugs can also affect the taste buds.

Taste changes are often temporary. Taste usually returns to normal a few weeks or more after treatment is finished.

Find out more about taste changes.

Tooth decay (also called dental cavities or dental caries) is a late side effect of radiation therapy to the head and neck. Radiation therapy can damage the salivary glands so they can’t produce as much saliva. Saliva helps to clean the teeth and gums, so when less saliva is made, there is a higher risk of cavities and gum disease.

A dental checkup is often done before treatment starts. Good mouth care is very important to prevent problems during and after treatment. Regular visits to the dentist after treatment are often recommended.

Trismus makes it hard to open the jaw. It occurs when scar tissue forms in the jaw muscles or joint. Trismus can be caused by surgery or radiation therapy for pharyngeal cancer. If a person receives both surgery and radiation therapy, the risk of developing trismus is higher.

Find out more about trismus.

Difficulty chewing and swallowing, as well as taste changes, may lead to poor nutrition and weight loss. You can take steps to help increase your appetite and have good nutrition. A registered dietitian can help you deal with loss of appetite. Your healthcare team may also recommend nutritional supplements.

You may have a gastrostomy tube to make sure you have good nutrition during treatment because some treatments can make it difficult to eat or drink. A gastrostomy tube lets food and liquids pass directly into your stomach.

Find out more about loss of appetite, tube feeding and nutrition for people with cancer.

You may have earaches or difficulty hearing if either ear is in the area being treated with radiation therapy. These problems develop when radiation hardens earwax or irritates or damages the middle or inner ear.

Tell your radiation therapy team if you have trouble hearing. You may have eardrops to soften the earwax, treat infection or relieve pain. You may need to have a tube placed in one or both ears to drain fluid and air from the middle ear. These tubes are removed when radiation therapy is finished. Hearing problems from radiation therapy for pharyngeal cancer usually go away 1 to 2 weeks after radiation treatment ends.

Radiation to the neck and some surgeries for pharyngeal cancer can cause decreased thyroid function (called hypothyroidism). The thyroid makes hormones that are important in the breakdown of certain nutrients, normal bone formation, regulating the nervous system and maintaining normal body temperature. Hypothyroidism means that the thyroid is not making enough hormones for your body.

Symptoms of hypothyroidism include:

• fatigue or feeling sluggish
• dry skin and hair
• weight gain or difficulty losing weight
• being more sensitive to cold temperatures
• feeling sad or depressed

Follow-up tests for people who have treatment for pharyngeal cancer will include a blood test to check thyroid function. Treatment for hypothyroidism includes daily medicine to regulate the thyroid gland.

Osteoradionecrosis is the death of bone caused by radiation. People who have had radiation therapy to the head and neck are at risk of developing osteoradionecrosis in the lower jaw.

Find out more about osteoradionecrosis.

Feeling anxious about or unhappy with your body can affect your sex drive and make you feel worried, angry, upset or depressed. People often worry about how they look to a partner after treatment for pharyngeal cancer. They may be afraid that body changes from the cancer or its treatment will make them less attractive or close to their partner. It may take some time for their partner to adjust to big changes in appearance, but many people continue to have strong, supportive relationships and a satisfying sex life after pharyngeal cancer.

Talk to your healthcare team if you have any concerns about sexuality. You may also want to talk to a counsellor if changes to your body image affect your intimate relationships.

Find out more about sexuality and cancer.

People with head and neck cancers such as pharyngeal cancer often experience emotional distress. The cancer and its treatment may cause a change in appearance, interrupt their daily activities and lifestyle and prevent them from taking part in their usual interests. This can lead to delays in rehabilitation, which can cause more distress. Symptoms of emotional distress include worry, anxiety, fatigue, depression and changes in mood.

It is important to tell your doctor about your feelings. You may be given medicines and get to see a counsellor who will help you work through your feelings. Talking to someone who has had the same cancer and treatments may also be helpful.

To make decisions that are right for you, ask your healthcare team questions about supportive care.