Nurses at the Cleveland Clinic are pushing to make survivorship care the norm for survivors of head and neck cancer.
Care for patients and survivors of head and neck cancer (HNC) should not end upon the completion of treatment, says Bridgett Harr, an oncology nurse from the Cleveland Clinic who helped build their survivorship program.
“It needs to just be routine for us. When ending treatment, you go right into survivorship care,” Harr said in an interview with CURE at the 2016 Annual Meeting of the American Society for Radiation Oncology (ASTRO), where she presented on survivorship with three of her colleagues, Kristine Adams, Molly Freeman and Sherry Soeder.
Earlier in the year, the Commission on Cancer (CoC) expanded their standard for survivorship care plans, though Harr said more research is still needed of the topic, proving what she has already seen in practice.
“Research is a relatively limited field for survivorship right now. We know that survivorship care is beneficial for patients, but there’s not research to show us that it is,” she said. “So we need to really work to get that research base to show that it is good and also look at the efficacy and utility of the care plans, as well as survivorship visits.”
For HNC survivors, that means focusing on healthy behaviors — such as smoking cessation — as well as addressing dryness, taste and appetite changes, speech and fatigue. Interventions include physical therapy, speech therapy massage and even acupuncture.
The Cleveland Clinic has an area for integrative medicine, where patients and survivors can get acupuncture in a group setting, making it more accessible and affordable to this population, especially since most insurance companies do not cover it.
“They typically use that for taste changes, sometimes fatigue, dryness in the mouth and pain,” Harr said. “It really does touch on most of the symptoms from head and neck cancer.”
For patients whose primary cancer was located near the mouth and tongue, speech therapy is often used after treatment to learn how to speak again and other ways to annunciate. For oropharyngeal cancer origins, the focus is more on reworking the techniques patients use to swallow.
While speech therapy is typically covered by most insurance plans, there are still barriers to access for survivorship care.
“It’s also that these patients are done with treatment. They’re not coming back every day,” she said. “It’s taking time out of their work days to come back for care. So it’s about making those appointments available later and seeing what we can do to help.”
There is also a fragmentation of care when it comes to the providers as well.
“Specifically, there’s a need for more collaboration among provider teams, development of IT-based strategies and leadership buy-in,” Soeder, a nurse practitioner in radiation oncology at the Cleveland Clinic said. “This means coming together — the oncology team and the primary team in joint education – teaching and learning from each other.”