Table 2.
Key recommendations for supportive treatment and survivorship care for SCCHN
| Pre-treatment evaluation | ||
| Multidisciplinary approach | Assessment and evaluation by multiple subspecialties of oncology | |
| Possible treatment de-intensification or organ preservation for HPV-positive or locoregional disease | ||
| Consider reconstruction if extensive surgical resection is required | ||
| Speech/language therapy | Voice therapy (use electrolarynx if necessary) | |
| Swallow exercise | ||
| Close follow-up and objective assessment of speech and swallowing function (patient-reported symptoms do not accurately reflect the level of morbidity) | ||
| Nutrition | Prophylactic or elective G tube feeding | |
| Dental and oral care | ||
| Survivorship care | ||
| Cancer surveillance | Cancer-specific history and physical exam every 1 to 3 months for the first year after the primary treatment, every 2 to 6 months in the second year, every 4 to 8 months in the 3rd to 5th years, and annually after the 5th year | |
| Patient education about the signs of early recurrence | ||
| Adequate and timely referral to oncologist or ENT specialist if detailed exam is needed | ||
| Adhere to national guidelines for second primary cancer prevention | ||
| Substance abuse | Proper counseling on smoking cessation and alcohol abstinence | |
| Screen for underlying mood disorder | ||
| Referral to cessation resources or psychiatrist if needed | ||
| Body and self-image | Assessment of body and self-image concerns | |
| Referral to psychiatrist if needed | ||
| Mood disorder | Evaluate survivors for depression, anxiety and screen for relevant social/financial/emotional distresses | |
| Social care for financial or employment challenges | ||
| Addiction recovery assistance for substance abuse | ||
| Pharmacologic treatment as indicated | ||
| Timely referral to psychiatrist | ||
SCCHN, squamous cell carcinoma of head and neck; HPV, human papilloma virus; ENT, ear nose throat.