Head and Neck Cancer: role of clinical nurse specialist & dietitian
Article by: Lou Tjaw and Belinda Reeves
Nurse Specialist Surgical Oncology and Head and Neck Cancer Dietitian
Patients having treatment for head and neck cancer have increased nutritional requirements, especially to aid wound healing.
MercyAscot runs a unique outpatient service for these patients incorporating nutritional expert advice alongside complex wound care to ensure the patient receives a holistic approach to recovery. Nurse Specialist Lou Tjauw and Dietitian Belinda Reeves describe how the service works.
Head and neck carcinoma is on the rise and is now the fifth most common cancer worldwide. In New Zealand between 2000 and 2010, 1,916 cases were diagnosed, and this rate continues to increase. Risk factors include smoking, alcohol consumption, UV light exposure, and trending upwards is the human papillomavirus (HPV) type 16.
MercyAscot Head and Neck service – a multidisciplinary team approach
For patients with head and neck cancer, their journey begins with a GP referral to the Neck Lump clinic, part of the MercyAscot Head and Neck service at MercyAscot Hospital. Approximately 11% of patients will result in a cancer diagnosis. The MercyAscot head & neck specialists run weekly multidisciplinary meetings (MDMs) attended by surgeons, radiation and medical oncologists, a nurse specialist and dietitian. The key benefits of the MDMs have been:
- improved treatment planning
- improved patient outcomes
- improved continuity of care
- improved coordination of services, effective communication, resulting in excellent long-term results for patients and their families.
Treatment options for these patients varies depending on their pathology and extent of cancer spread. A combination of surgery, including major free flap surgery, adjuvant radiation and chemotherapy is discussed. These treatment options can have a lifelong impact on a patient.
Clinical Nurse Specialist
The nurse specialist is an essential position to support head and neck cancer patients, and their families, as they come to terms with their diagnosis and undergo treatment. Lou ensures they receive excellent, seamless, patient-focused care throughout the entirety of their cancer journey. From diagnosis to survivorship.
Working within a strong and effective multidisciplinary team (MDT) is crucial for the co-ordination and care of these patients. Postsurgery, Lou is involved in complex wound care, tracheostomy education/support, radiation and chemotherapy symptom control and support. As well as referrals to the MDT at relevant time’s dependant on their stage of treatment. An example being speech therapy being fundamental during and following treatment for maintaining and improving swallow function.
Working alongside Belinda, dietitian, combining their specialities has shown vast improvements in the patient’s recovery, decreased length of stay, nutritional status, wound healing, and avoiding potential complications. The added value is of having their continual support during and following completion of their treatment.
Key Contributions of the Clinical Nurse Specialist for head & neck cancer
Research shows up to 52% of patients are malnourished even before treatment starts. early and intensive nutritional support can reduce weight loss before, during and after treatment completion, improving outcomes, quality of life and performace status. Early nutrition intervention can include dietary education about food fortification, texture modification and oral nutrition support. Weight loss is a major prognostic indicator of poor survival and impaired response to cancer treatment.
Why these patients are at increased risk of malnutrition
The role of the clinical nurse and dietitian as part of the patient journey:
Lou and Belinda attend the weekly MDMs , and meet with patients before their surgery, where they complete a thorough nutritional and holistic needs assessment. Patients are given in-depth information about their journey ahead, such as the need for nasogastric feeding post-surgery, dietary progression, mouth cares, wound care, ERAS (Enhanced Recovery after Surgery), and the psychological impact head and neck surgery may have on them. If a patient requires a gastrostomy tube before treatment, they will be referred for placement of tube pre-operatively.
Case study of Free Flap Head and Neck surgery:
With free flap head and neck surgery, patients have extensive wounds that run a high risk of breakdown without adequate nutrition. Forearm, rectus, latissmus dorsi or fibula free flap surgery is