After Head and Neck Cancer: The Need For Rehabilitation

To raise awareness of head and neck cancer and its consequences, the International Federation of Head and Neck Oncologic Societies has declared July 27th to be World Head and Neck Cancer Day.

Head and neck cancer is the seventh most common form of cancer worldwide. Like other cancers, it may be treated with chemotherapy, radiotherapy and surgical intervention. All of these treatments are invasive and stressful, and so it is not surprising that survivors of this cancer often face severe long-term consequences – resulting both from the disease itself and from its treatment – that may persist long after treatment has finished. But it’s important to remember that many of these problems can be helped by rehabilitation. For many people, function can be restored and quality of life can be improved with access to a comprehensive team of cancer rehabilitation professionals – physiotherapists, lymphoedema therapists, occupational therapists, speech and language therapists, dietitians, psychologists and psychotherapists, and specialist nurses.

Some of the common issues faced by people living with or beyond a diagnosis of head and neck cancer include:

  • Fatigue
  • Lymphoedema of the neck, face and head
  • Chemotherapy induced peripheral neuropathy (CIPN)
  • Speech and swallow problems
  • Shoulder and neck problems
  • Jaw pain and movement problems  
  • Mental health difficulties

Lymphoedema

The lymphatic system plays an important role in regulating the body’s fluid balance and immune system. The role of the lymphatic system is to gather fluid from tissue space and return it to the circulatory system. If the lymphatic system is not working properly, a build-up of lymph fluid occurs leading to swelling in the affected area. Lymphoedema is the term used to describe this swelling. It is a life-long condition that requires ongoing and consistent care.

People living beyond a head and neck cancer diagnosis and treatment are at high risk of developing lymphoedema – one study found that 75.3% of patients had some form of the condition following their cancer treatment.

Lymphoedema in the head and neck region can result in swelling of the lips or eyelids and the face can be visibly disfigured. This can cause discomfort, but it is also often emotionally difficult due to changes in body image and the visibility of swelling.

Lymphoedema can’t be cured, but lymphoedema therapy from a specialist physiotherapist can help to alleviate some of the effects. Initiating therapy as early as possible is advised. Treatment involves extensive education on long term management, hygiene and skin care, manual lymphatic drainage, massage, exercise, the use of compression multilayer bandaging and compression garments.  Psychological support can be helpful in managing the emotional aspects of the condition.

Fatigue

Cancer-related fatigue is common both during and after treatment of head and neck cancer. In fact, up to 90+% of people will experience fatigue at some point of their care. Cancer-related fatigue is different to everyday tiredness and can be an overwhelming experience. Generally, it is not relieved by rest and it interferes with daily functioning. It can last from months to years, continuing after treatment ends, and it can make everyday tasks seem like enormous challenges.

Rehabilitation for cancer-related fatigue is likely to focus on the amount of exercise and physical activity the patient gets. Too little exercise can increase the level of fatigue experienced, as a lack of movement can lead to muscle weakening causing general body deconditioning. Mild to moderate exercise is helpful for fatigue and provides a boost to quality of life; however, too much physical exertion can cause additional fatigue by using up stores of energy. An individualised prescribed exercise programme, supervised by a cancer rehabilitation physiotherapist, can help patients to restore their function and quality of life. Cognitive behaviour therapy also has an important role in the management of cancer-related fatigue. Occupational therapists play an important role in helping patients manage their activities and energy expenditure.   

Chemotheraphy-induced peripheral neuropathy (CIPN)

Neuropathy means ‘damage to the nerves’. Neuropathy often occurs as a side effect of chemotherapy. It commonly presents as a numb or tingling sensation in the hands and feet, often coupled with a loss of feeling in these areas. Many patients who go through chemotherapy for head and neck cancer may experience some form of peripheral neuropathy. For some patients, this neuropathy will go away quickly following the end of chemotherapy. But for others, it may last much longer.

Physiotherapy, prescribed exercise and occupational therapy can restore function in extremities following chemotherapy-induced peripheral neuropathy, as well as helping with balance, strength, safety and falls prevention.

Mental health challenges

Head and neck cancer may significantly alter physical appearance and bodily functioning and therefore directly impacts body image. This can lead to difficulties with self-esteem, confidence, mood and relationships. Depression and anxiety are common in people living beyond a diagnosis of head and neck cancer. Mental health challenges can result from adjustment to diagnosis, altered body image and, particularly after head and neck cancer, from a loss of physical function. Mental health practitioners (psychotherapists, psychosexual therapists and psychologists) play an important role as part of a comprehensive cancer rehabilitation team and can help with the psychological difficulties faced by people after a cancer diagnosis.

Other common symptoms

The long-term consequences of head and neck cancer and its treatment are wide-ranging. After treatment of head and neck cancer, many people may experience spinal accessory nerve palsy, which is damage to a major nerve that controls movement of muscles in the neck and shoulder. Patients with this condition might experience pain in the neck and shoulder, difficulty lifting their arm, and a loss of arm strength.

Another frequent side effect, in particular after neck radiotherapy, is cervical contracture, or shortening of the neck, leading to stiffness. Radiotherapy can result in scarring and muscle weakness in the neck. This can lead to problems moving the neck and head as well as pain in the head, neck, upper back or shoulder. Physiotherapy can help to strengthen these areas and help improve function such as turning the head to the side.

Disorder of the temporomandibular joints (the joint in the upper part of the jaw) and difficulty swallowing are some examples of further difficulties that may be faced by survivors of head and neck cancer. Many of these difficulties can be remedied, in whole or in part, with input from a rehabilitation team such as physiotherapists, speech therapists and dietitians.

How Strive Clinic Can Help

The Cancer Rehabilitation and Survivorship Programme at Strive Clinic is a comprehensive, interdisciplinary and evidence-based programme of care for people living with or beyond cancer. If you would like to speak to one of our therapists to find out more about the services we offer, and how we can help you in your recovery, please fill out the contact form below.  

 

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