Page 209 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

DISCUSSION
‘’My life was saved by the specialists, 15 years ago. An experimental approach rigorously removed the tumor in my base of tongue. Sure, there was ‘collateral damage’: the right side of the tongue has been paralyzed since then because the nerve was removed too. One of the consequences is that the larynx is no longer closed properly when swallowing before food or liquid is pushed into the esophagus. Result: liquid in particular always leaks a little into the trachea, which then leads to moderate or severe choking. Or, even more serious, if it only leaks a little bit and the ‘choke invoking sensor’ at the back of the throat does not notice it will cause the occasional scenario of an aspiration pneumonia.
The doctors told me that it can’t go on like this. I was strongly advised to accept a feeding tube and start taking all my food intake with it. During the doctor’s visit where I was advised to go for the feeding tube, an alternative was, which was suggested almost casually and with a calm, relaxed tone: a laryngectomy. This proposal actually did upset me, although I seemed quiet and relaxed at that moment. The whole idea..., as if an ophthalmologist told someone with cataract, in a calm voice, that it’s also an option to replace the eyes with artificial eyes. My immediate answer was a robust and cheery “Well, no way!”. It’s like exchanging one handicap for another. Sure, the other handicap may be less severe than this one, but in this case, I’m still not convinced of that. I know a lot of people who underwent a laryngectomy and although there are variations between them, I don’t envy them. And so, I just keep going on, impatiently waiting for the invention of the century, the invention that actually makes my collateral damage manageable.’’
This is the story of Peter de Valença, who was treated 15 years ago for a tumor at the base of tongue. As discussed at length in the introduction and in various chapters, and as highlighted by this story, head and neck cancer (HNC) treatment, unfortunately, is a recipe for functional limitations afterwards. This is not only true for organ sacrificing treatment modalities, as in case of Peter de Valença, but also for organ-preserving treatment modalities.
Usually, functional issues occur not only in advanced HNC (stages III and IV), but also in patients with early stage HNC (stage I and II). For early-stage oropharyngeal carcinoma, two treatment options are available: surgery and radiotherapy. These treatment modalities, however, do differ with respect to (type and timing of ) post-treatment toxicity. Clarifying what these differences are is relevant for clinical decision making. Results of our prospective, non-randomized
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Discussion
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