[Head and neck neoplasms and palliative care, symptoms and quality of life: literature review]

Abstract

Head-neck neoplasms are the fifth most common cancer. Head-neck patients are particularly exposed to quality of life impairment due to the central anatomical-functional role of this region in primary functions such as breathing, swallowing and phonation. Many patients are already at an advanced stage of the disease at the time of diagnosis and their prognosis remains unfavourable despite new treatment options. They face daily with multiple and simultaneous symptoms. In 20% of cases the average survival is only 5 months, making it appropriate to take charge early for the important need of palliative care. The aim of this review is to deepen the knowledge concerning the neoplasms of the head-neck district, with particular reference to the symptoms and quality of life of people in advanced stage and in palliative care. The literature review was performed through CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, Scopus and Web of Science. The research identified 9 studies that met the inclusion criteria. The results of the studies showed the prevalent symptoms of dyspnea, fatigue, nutrition and oral problems, pain, insomnia, anxiety and depression. Oral nutrition could be compromised, producing weight loss and malnutrition. In such a condition, the enteral route could be necessary. The impact of the symptoms was greater for those who could not maintain adequate nutrition and was a predictor of reduced food intake, weight loss and survival. Malnutrition influenced the performance status and quality of life which seemed to remain unchanged as the end of life approached. Mucositis, dysphagia and xerostomia had a strong association. Dysphagia was related to dysphonia. A worsening of emotional distress was shown in relation to the female gender and the tumor site. Head-neck cancer had a strong impact on the quality of life. Patients considere dyspnea, dysphonia, mobility problems, anger and weakness as the most important issues. Earlier interventions could allow a partial and temporary improvement of quality of life compatible with the patient's conditions. Nursing care involves multidimensional assessment and an early individualized, symptom-driven and needs-oriented approach.