title: Oral nutrition or the ability to speak: the choice faced by a cancer survivor.
abstract: Patients with head and neck cancer often suffer from breathing, speaking, and eating deficits, which negatively affect their quality of life. These patients are often observed to repeatedly contract aspiration pneumonia, resulting in prolonged hospital stays. To help prevent aspiration pneumonia, enteral nutrition is often provided. Although this method helps avoid pneumonia, patients need to give up eating by mouth. Because oral intake of food is closely related to patient quality of life, abandoning eating results in a strong internal conflict. This report describes the case of a cancer patient who experienced repeated aspiration pneumonias after neck surgery. The patient required enteral nutrition to avoid repeated bouts of pneumonia. However, the patient opted for laryngeal closure surgery to regain the ability to take food orally, at the expense of his voice. The patient's choice caused an ethical conflict for the attending medical professionals, highlighting the need for physicians to communicate with their patients to understand their patients' sense of values.
authors.affiliation: Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. yhatano@koto.kpu-m.ac.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hatano
authors.forename: Sawako
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Tsunakuni
authors.initials: T
authors.lastname: Ikka
authors.forename: Toyoshi
authors.initials: T
authors.lastname: Hosokawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukui
mesh_terms: D000368:Aged; D003657:Decision Making / Q000941:ethics*; D004750:Enteral Nutrition / Q000941:ethics*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D010166:Palliative Care / Q000941:ethics*; D010358:Patient Participation; D010817:Physician-Patient Relations / Q000941:ethics*; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control*; D013064:Speech Disorders / Q000209:etiology / Q000517:prevention & control*; D017741:Survivors