Follow-Up Care for Laryngeal and Hypopharyngeal Cancer

Executive Summary

Follow-up care for laryngeal and hypopharyngeal cancers refers to the after-treatment protocols conducted by the healthcare team to look after recurrence, manage the side effects, and monitor the patients’ overall health. The follow-up care will include routine physical examinations, various medical tests (blood tests, urine tests) and scans to monitor a patient’s overall health status. A survivorship care plan is designed with the physician as per the health condition and requirements. The doctor may recommend rehabilitation. Rehabilitation includes various services such as therapies (physical and mental), pain management, career counselling, emotional counselling, diet and nutrition planning. Rehabilitative therapies and sessions help cope with, treat, and relieve these symptoms or side effects post successful cancer treatment. In the case of patients who have received treatment for laryngeal and hypopharyngeal cancers, rehab services will include physical therapies to help people in the movement and other physical activities. Sometimes people are required to master new skills to eat or speak. For instance, some options aid people in developing a unique voice or method of communicating, including esophageal speech, electrolarynx, and tracheoesophageal (TE) voice restoration. Proper care and guidance should be provided for patients to cope with mental stress, anxiety, and depression post-treatment of laryngeal and hypopharyngeal cancers. The primary goal of follow-up care post successful treatment is to check for any possible recurrence. Another important aspect of follow-up care is managing and relieving the side effects of treatment.

Follow-Up Care for Laryngeal and Hypopharyngeal Cancer

Care for people detected with laryngeal and hypopharyngeal cancers doesn’t end with active treatment. The health care team will develop a post-treatment care strategy as per a patient’s disease condition, called follow-up care. Every disease survivor should have a proper follow-up care routine. Follow-up care refers to seeing the health care provider post-treatment for regular medical check-ups and screening to evaluate your post-treatment health progress and disease condition. 

The follow-up care will include routine physical examinations, various medical tests (blood tests, urine tests) and scans, to monitor a patient’s overall health status. These tests and scan results will help the doctor analyze and detect any variation in the patient’s well-being, any other complication, symptoms or signs indicating any disease or side effects due to the treatment. Follow-up care focuses on addressing a patient’s physical health issues and prioritizes their mental well-being. Laryngeal and hypopharyngeal cancer survivors should utilize the opportunity to address any emotional, mental concerns to their doctor or health care team ​1​

Generally, the follow-up care for these cancers is every two months for the first year, then every four months for the next year, then every six months for the third year and once a year following that. Doctors may use different diagnostic tests and scans repeatedly over these years to evaluate your health and the chance of cancer recurrence ​2​.

You can design a survivorship care plan along with your physician. A survivorship care plan will consist of a full, detailed summary of your treatment, along with a follow-up plan designed as per your health condition and requirements. This plan will function as a tracker to monitor your condition post-treatment. It will ensure that you get regular, competent care to prevent any chance of the disease condition recurring or any side effects of treatment becoming worse. Follow up care should not be missed, especially in the case of serious disorders like laryngeal and hypopharyngeal cancers, as their behaviour cannot be predicted, and the possibility of these cancers recurring post successful treatment also cannot be discarded. Doctors can check for recurrence or distant metastasis through these follow-up check-ups and help treat them.

In Follow-up care, the doctor may recommend rehabilitation. Rehabilitation includes various services such as therapies (physical and mental), pain management, career counselling, emotional counselling, diet and nutrition planning. The ultimate goal of rehab is to aid survivors to regain control over their lives and encourage them to be self-sufficient, active and productive as much as possible. Rehabilitative therapies and sessions help cope with, treat, and relieve these symptoms or side effects post successful cancer treatment. Follow-up care and rehabilitation collectively focus on improving the quality and comfort of the life of cancer survivors. 

In the case of patients who have received treatment for laryngeal and hypopharyngeal cancers, rehab services will include physical therapies to help people in the movement and other physical activities. Also, there will be swallowing and speech therapies to help patients regain their basic skills like eating and talking. Timely evaluation and care can prevent patients from developing severe, permanent speech and swallowing problems. A rehabilitation medicine specialist can ensure that the patient gets the most appropriate and effective rehab services.

Sometimes after treatment, the patient may appear different physically and may find it challenging to perform basic physical tasks like talking, eating, walking etc. Hence, in such circumstances, caregivers and healthcare teams should provide sufficient mental support and encouragement to the patient and help them find support groups or services to strengthen their body and mind. Also, people should consult a speech pathologist and their healthcare team and carry out a proper evaluation to begin specific treatments for their illnesses and discomforts, thereby avoiding unnecessary complications.

Sometimes people are required to master new skills to eat or speak. For instance, some options aid people to develop a unique voice or method to speak. That include:

  • Esophageal speech: people can learn to use the throat muscles of the esophagus to produce sound and speak. It is called esophageal speech.
  • Electrolarynx: people can also use a battery-powered mechanical device called electrolarynx to speak. This device generates vibration that is either transmitted through the tissues of the neck or is directly delivered into the mouth via a plastic tube to produce voice and speech.
  • Tracheoesophageal (TE) voice restoration: Tracheoesophageal voice restoration is usually used by patients after a laryngectomy. The method of TE voice restoration is similar to that of normal laryngeal speech as it uses air from the lungs to produce voice, just like the speech before the patient’s laryngectomy. In this, a tiny, removable device called a voice prosthesis is placed in the stoma, and it allows the passage of air from the lungs into the esophagus for the production of sound. This sound then reaches the mouth to produce speech.

Not every person may be interested or can avail the opportunity to learn these speech methods. Before surgical procedures, people must consult an experienced speech pathologist to understand which rehabilitation method would suit their disease condition. 

People may appear different, feel weak and find it difficult to eat or talk post-treatment. Patients who have undergone a tracheostomy need to learn to take care of the stoma and maintain it clean.

Proper care and guidance should be provided for patients to cope with mental stress, anxiety, and depression post-treatment of head and neck cancers (or any disease in general). Today, most cancer care centres have support groups and services that offer survivors the support they require. These support services will have various therapies, counselling and other sessions to address the emotional concerns of the survivors.

The primary goal of follow-up care post successful treatment is to check for any possible recurrence. Head and neck cancers can be unpredictable; hence, proper follow-up check-ups are vital even after successful treatment and cure. A doctor who is familiar with your medical history will be able to guide you with personalised information regarding your risk of disease recurrence during follow-up check-ups.

The doctor may ask you different questions to evaluate your health condition. Depending on your disease condition’s type, stage, and gravity during the initial diagnosis and treatment, the doctor may prescribe various medical tests (blood/urine/imaging tests) and scans.

Suppose a person has had any of these cancers and uses tobacco at present. In that case, it is crucial to evaluate them closely to detect any possibility of second cancers that may develop in the esophagus, lungs, or any other locations in the neck or head region. People can even join clinical trials to prevent such second cancers or other diseases from occurring in the body.

Survivors can get triggered by anxiety and stress while coming for follow-up check-ups and waiting for the test results. They will be constantly worried about cancer recurring again in the body. In such cases, survivors are encouraged to openly communicate their fears with their doctor, who will help them get the necessary support. 

Another important aspect of follow-up care is managing and relieving the side effects of treatment. People may experience many long-term and short-term side effects while receiving treatment for cancer. The late side effects or long-term side effects tend to last for a more extended period (even months or years) post-treatment. These side effects can affect the physical and mental well-being of a survivor.

Patients should talk with their doctor or health care team regarding the treatment they will receive as per their cancer condition and what side effects they should expect, well before the treatment begins. If any side effects are expected to cause troubles, proper treatment and care should be provided to the patients to manage and relieve them. 

People who have received treatment for head and neck cancers like laryngeal and hypopharyngeal tumours are urged to make healthy life choices. They are encouraged to follow established guidelines like eating a healthy balanced diet, maintaining healthy body weight, undergoing screening tests as and when required, not indulging in unhealthy practices like drinking, smoking etc. They are also encouraged to perform physical activities without straining their bodies. Talk with your doctor or healthcare team, and design a plan to keep up a healthy lifestyle.

Survivors and the doctor should work together to design a personalised follow-up check-up and care plan. Survivors should make it a point to address or discuss any fears or concerns regarding their mental and physical health with their health care provider. Also, survivors should record all their treatments and medical history for future reference.  

Survivors can also enquire about who will lead their follow-up care to their doctor. Some people continue to see their oncologists or health care team, whereas others transition back to the supervision of another medical professional or their family doctor. Several factors like the type, grade, gravity of the disease condition, possible side effects, personal preferences etc., shape such decisions. 

If, in case, a medical professional who was not a part of your treatment leads your follow up care, be sure to share all relevant medical history and survivorship plans with them. This applies in the case of all future health care providers. This is very important, as it will help the new doctor plan your care based on your past medical details.

References

  1. 1.
    Major MS, Bumpous JM, Flynn MB, Schill K. Quality of Life After Treatment for Advanced Laryngeal and Hypopharyngeal Cancer. The Laryngoscope. Published online August 2001:1379-1382. doi:10.1097/00005537-200108000-00012
  2. 2.
    Vengaloor Thomas T, Nittala M, Bhanat E, Albert AA, Vijayakumar S. Management of Advanced-stage Hypopharyngeal Carcinoma: 25-Year Experience from a Tertiary Care Medical Center. Cureus. Published online January 16, 2020. doi:10.7759/cureus.6679