Practical palliative care for the patient with terminal head and neck cancer

Head and neck cancer patients who develop incurable recurrent tumors present the surgical team with unique problems dissimilar to patients with cancer of other areas. When the structures of the head and neck are violated by tumor, the dying process is slow, lingering, and painful; and the anatomic areas involved tend to be visible, difficult to shield from those in attendance, and of course, are very obvious to the patient. This review offers some practical guidelines for the management of head and neck cancer pain, nutrition, anorexia, odor control, mental confusion, and local control of visible tumor. Our approach includes the palliative use of surgery, radiotherapy, and chemotherapy, and the participation of members of a palliative team by which therapeutic decisions and timing can be individualized for each patient. This system of palliation offers significant advantages to the patient and to the surgeon, and is a new concept applicable to head and neck cancer patients for whom previously little could be offered.