Quality of dying in head and neck cancer patients: the role of surgical palliation.
To study the role of surgery for symptom palliation in patients with advanced head and neck malignancy. Between 2000 and 2011, patients with locoregionally advanced cancer in the head and neck region, who chose surgical palliation for symptom control, were studied retrospectively. During the study period, 52 patients were included. The index tumour included carcinoma of the maxilla (23.1 %), tongue (19.2 %), larynx/hypopharynx (15.4 %), post-radiation sarcoma (11.5 %), primary sarcoma (11.5 %), carcinoma of the lower alveolus (11.5 %), nasal mucosal melanoma (3.9 %) and metastatic tumour in the head and neck region (3.9 %). The major symptoms included bleeding (53.9 %), tumour pain (19.2 %), dysphagia (11.5 %), non-healing ulcerations (7.7 %), airway obstruction (5.8 %) and pathological fracture of the mandible (1.9 %). Ligation of the carotid artery was performed in 10 patients, complete resection of tumour in 35, and surgical debulking of the tumour in 7 patients. Mean survival of the patients was 5.6 months. The majority of the patients achieved satisfactory and persistent control of symptoms. One patient died from pneumonia during the hospital stay, and the rest were discharged after a mean duration of 16.4 days. In selected patients, surgery is effective in palliating symptoms which are otherwise difficult to manage. Detailed planning and good communication is the key to success in improving the quality of dying.
Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, People's Republic of China. chanjyw@gmail.com
Jimmy Yu Wai
JY
Chan
Victor Shing Howe
VS
To
Stanley Tien Sze
ST
Wong
William Ignace
WI
Wei
D000402:Airway Obstruction / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology; D006258:Head and Neck Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011183:Postoperative Complications; D015996:Survival Rate; D013727:Terminal Care