April heralds the promise of spring flowers and warmer temperatures. It is also the month set aside to raise awareness of Head and Neck Cancer, those cancers that occur in the larynx, throat, lips, mouth, nose and salivary glands. The American Cancer Society estimates there will be 66,470 new cases of head and neck cancer in the United States in 2022. In the past, the disease was commonly seen among older people with a history of smoking and drinking alcohol; however, the fastest growing segment of patients are young, healthy, non-smoking individuals due to the risk posed by the human papilloma virus (HPV).
Patients with head and neck cancer often receive chemotherapy as well as radiation that can cause taste changes and difficulty swallowing. As a result these patients can experience severe weight loss, malnutrition and dehydration which in turn, can lead to a decreased quality of life and delays in treatment. If a patient cannot eat and drink, the healthcare team may recommend a feeding tube. This is a small, flexible tube that is inserted into the body and delivers liquid nutrition. The tube is a short-term solution that allows a person to get an adequate amount of calories and nutrients. It is important for patients and family members to know that while they have a tube they are still able to eat by mouth. A person can eat according to their ability, and in fact, are encouraged to do so, but they have another avenue to obtain the nutrition they need to maintain their weight and energy levels. In a recent study, patients with tubes expressed relief that they did not have to battle with each meal and to worry about getting inadequate nutrition and losing weight. They felt that having a tube reduced the stress related to having to eat enough food. Negative aspects of the tube included practical difficulties with handling the tube and pain or irritation around the insertion site. This study found that having a feeding tube did not compromise the patient’s quality of life, an important indicator during cancer care. And another survey found that while patients can struggle with certain aspects of managing the tube they recognized its value and role in their survival. The decision to get a feeding tube can be a difficult one and one that should involve the patient and family as well as members of the health care team.
Once cancer treatment is completed and their symptoms have subsided, patients can begin eating more and the feeding tube can be removed. A sore throat caused by the radiation usually starts to improve 2 weeks after the final treatment and they gradually recover a normal sense of taste. Recently, the popular actor Stanley Tucci, opened up about his diagnosis and treatment for head and neck cancer. After losing more than 30 pounds, he required a feeding tube to help him meet his nutritional needs and following treatment, it took him several months to regain his ability to eat. He offers patients hope when he talks about the joy and excitement of being able to eat again without pain and to experience the wonderful taste of food. And for people who have struggled to eat during treatment that can be just as welcome as spring flowers and warmer temperatures.
Ehrsson Y, Sundberg K, Laurell G, Langius-Eklof A. Head and Neck Cancer Patients’ Perceptions of Quality of Life and How it is Affected by the Disease and Enteral Tube Feeding During Treatment. Upsala Journal of Medical Sciences 2015; 120:280-289.
Williams G, White H, Sen M, Prestwich R. Patients’ Experience of Enteral Feeding Following (chemo) Radiotherapy for Head and Neck cancer: A Qualitative Study. Clin Nutr. 2019 Jun; 38 (3): 1382-1389.
People Magazine, March 21, 2022; 38-43.