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Head and neck cancer (HNC) constitutes approximately 3% of all cancers in the UK, with in excess of 8500 new cases annually. Management of HNC depends on site, extent, histology, previous medical history and patient choice. A multidisciplinary approach is required to optimize patient wellbeing, owing to the significant functional and psychosocial implications that can impact on quality of life. Members of the dental team, to include the general dental practitioner, have a key role in patient care; therefore the dental team should be knowledgeable in the short-term and longer-term implications and how this impacts on quality of life.
Clinical Relevance: This article offers the dental team with an overview of how HNC and the various treatments, such as surgery, radiotherapy and chemotherapy, impact upon quality of life, both in the short term and longer term.
Article
Patients with HNC not only live with the potential of their illness being life-threatening, but with the consequences of the disease or treatment itself, such as disfigurement, impaired speech and swallowing, as well as problems concerning finances, socializing and family worries. This affects patients' quality of life (QOL) and impacts not only on them but also their families. QOL is difficult to define as it is a perceived subjective outcome. It is also a broad multi-dimensional concept which permeates many aspects of an individual's life to include well-being, life satisfaction and spiritual beliefs. The World Health Organization defined QOL as ‘individuals’ perception of their position in life, in the context of their culture and value systems in their life in relation to their goals, expectations, standards and concern’.1 Length of survival is of paramount importance and remains the key primary endpoint of treatment, but measured alone it is an unsatisfactory measure of treatment success; therefore, functional status and quality of survival also needs to be assessed. This is especially apparent for patients with HNC because social interactions and emotional expression depends, to a great extent, on the functional and structural integrity of the head and neck region. Furthermore, there can be considerable individual variation on the priority a patient places on cure and level of post-treatment dysfunction that is deemed acceptable. What is technically possible might not be acceptable to some patients, thus it is key to have a good insight into the patient's goals and value system. QOL differs between individuals at similar stages of disease, with some reporting unacceptably poor QOL, which may be equated to general coping styles and personality.2
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