Case Series: Palliative Care Challenges in Head and Neck Cancer Patients
Author: Mohamad Zulfadhli Abdullah
Mohamad Zulfadhli Abdullah, MBBS, Nor Amalina Abd Latif, MBBS, Siti Khairizan Rahim, MRCP
Head and neck cancer cases are increasing and there were 4870 new cases reported by Malaysian National Cancer Registry in year 2020. Most of the cases are aggressive and diagnosed in the advanced stage. In Pusat Perubatan Universiti Sains Malaysia, Bertam (PPUSMB), the commonest head and neck cancer cases referred to palliative care team are lip and oral cavity cancer, followed by maxillary squamous cell carcinoma. We reviewed 10 cases of head and neck cancer and analysed the challenges in managing pain, wound and nutrition.
We have selected 10 cases of head and neck cancer referred to palliative care team between year 2019 to 2022. The patients were aged between 38 to 77 years old and in the advanced stage of cancer. The cases selected consists of six cases of tongue cancer, two cases of maxillary squamous cell cancer and two cases of lip cancer.
The most challenging pain symptom was during brachytherapy, radiotherapy session and pain from the wound. The highest cumulative dose of opioids (oral morphine milligram equivalent) required was 660 mg morphine in 24 hours for a patient with tongue cancer.
Most of the wounds developed was due to the cancer progression and after radiotherapy. Caretakers and nurses handling the wounds faced challenges to find suitable types of dressings as most of the cases have non-healing wounds with excessive discharge and tendencies to bleed.
Most of the patient had difficulties to feed orally and percutaneous gastrostomy tube feeding was the best option to maintain nutritional support in this population.
Palliative care is an approach to improve the quality of life of these patients and their caretakers. They manifest a diverse range of physical symptoms but pain control, wound care and nutritional support are the most challenging parts encountered by both caretakers and the palliative care team.
Keywords: Head and neck cancer, palliative care, pain, wound care, nutrition.
1Pusat Perubatan Universiti Sains Malaysia, Bertam, Pulau Pinang
2Internal Medicine, Pusat Perubatan Universiti Sains Malaysia, Bertam, Pulau Pinang
Correspondence to: Mohamad Zulfadhli Abdullah, Medical Officer, Pusat Perubatan Universiti Sains Malaysia Bertam, Pulau Pinang, Malaysia, [email protected]