Common Complications in Head and Neck Cancer Survivors
Judi Ebbert, PhD, MPH, RN | March 9, 2018
Treatment for head and neck cancer can leave survivors with an array of physical and emotional challenges. Luckily, there are reliable guidelines from the American Cancer Society in place that you and your health care team can use to help resolve any difficulties that may arise. While not everyone with head and neck cancer will have these problems, these evidence-based guidelines can help those who do experience complications.
Spinal accessory nerve palsy and shoulder problems
If you’ve had neck surgery due to your cancer, it may lead to palsy (tremors) and compromised shoulder function. Experts recommend you get a referral to a rehabilitation specialist, earlier rather than later, to treat this problem. A rehabilitation specialist is trained to help you reduce pain and disability. They can help improve your range of motion and increase your ability to perform essential daily tasks.
Trismus, or difficulty with mouth-related movement
Trismus occurs when movement of the mouth, such as swallowing and chewing, is compromised. Rehabilitation specialists and dental professionals should treat trismus as soon as it is diagnosed. They can prescribe nerve-stabilizing medicines to help reduce pain and muscle spasms, along with physical therapy and jaw stretching devices.
Cervical dystonia, muscle spasms, and neuropathies
Cervical dystonia is a painful condition in which neck muscles contract involuntarily, causing the head to twist to one side. A rehab specialist can help relieve these movements. Other issues include muscle spasms (painful cramping from contractions) and neuropathies, which are sensations of numbness or shooting pain, often in the hands and feet. Prescribed drugs such as gabapentin, duloxetine, pregabalin, and injected botulinum toxin type A can ease pain and spasms that come with these issues.
Change in taste or inability to taste
If your sense of taste changes, you may lose your desire to eat, which can lead to unhealthy weight loss. Your doctor should refer you to a registered dietitian for dietary counseling. Registered dietitians are trained to advise people on how to enhance flavor, identify unpleasant-tasting food that can be avoided, and provide more options that have greater appeal.
Swallowing issues: Dysphagia, aspiration, and stricture
Survivors with difficulty swallowing (dysphagia), accidental intake of food/liquid into the lungs (aspiration), or narrowing of the throat (stricture) need treatment from a team of professionals, such as a radiologist and a speech-language pathologist. Aspiration can lead to pneumonia and should be managed right away. For stricture, a speech-language pathologist can assess the cause. If there is expansion (dilation) of the esophagus, you should see a gastroenterologist or head and neck surgeon.
Gastroesophageal reflux disease (GERD)
Survivors are at increased risk of GERD, which can prevent healing of tissue that has undergone radiation. GERD can also increase risk of recurrence of head and neck cancer, and it increases risk for a second primary cancer as well as esophageal cancer. Lifestyle changes can reduce the effects of GERD: taking antacids, sleeping with a wedge pillow or 3-inch blocks under the head of the bed, not eating or drinking for three hours before bed, stopping tobacco use, and avoiding alcohol.
Hearing loss, vertigo, and vestibular neuropathy
Head and neck cancer survivors may also experience issues with vertigo, which is dizziness along with the sensation of spinning. Vestibular neuropathy, or inflammation of the nerves in the ear, including the nerve connecting the ear to the brain, is another problem you may face. For hearing loss, vertigo, or vestibular neuropathy, your primary care doctor should refer you to an ear specialist or audiologist.
Lymphedema, or swelling from buildup of lymphatic fluid
Lymphedema of the head and neck happens when lymphatic fluid builds up, causing swelling around the head and neck that can interfere with swallowing. A doctor should evaluate edema of the mouth and throat using a lighted scope as well as external photographs. A rehabilitation specialist can relieve the swelling by manual lymph draining or compression bandages.
Fatigue— lack of energy and physical or mental motivation — is common in cancer survivors. It can also be caused by anemia, thyroid dysfunction, and heart problems, which are treatable. In the absence of those problems, behavioral counseling and medication may improve mood disorders, poor sleep, and chronic pain. Regular physical exercise and cognitive behavioral therapy are also useful.
Sleep disturbance or apnea
Loud snoring and breaks or pauses in breathing while asleep may indicate a problem called sleep apnea. Seeing a sleep specialist for a sleep study can confirm this diagnosis. To reduce loud snoring, you can try nasal decongestants, nasal strips, sleeping in an upright position, and humidifiers. If you have dentures, it’s important to ensure they fit properly and are removed at night. Lastly, if necessary, your doctor may prescribe you a CPAP mask, which delivers pressurized air during sleep.
It’s important to have regular dental care to reduce risk for cavities and gum disease. Equally important is avoiding tobacco and alcoholic beverages, mouthwash with alcohol, spicy foods, very hot or very cold liquids, sugary beverages and gum, and acidic liquids. Survivors should follow good brushing and cleaning habits, use a remineralizing toothpaste with fluoride, and floss regularly. Make sure you are seeing a dentist who specializes in caring for people with cancer.
Mouth problems: Xerostomia, osteonecrosis, and oral infections
Use alcohol-free mouth rinses to reduce risk of dry mouth (xerostomia). A low-sucrose diet free of caffeine, spicy, and acidic food is helpful, as is drinking fluoridated tap water. Another issue called osteonecrosis, or bone breakdown from poor blood supply, may occur and cause pain and swelling. Treatment may include broad-spectrum antibiotics, saline irrigations, or hyperbaric oxygen therapy. If you’re experiencing mouth infections, your doctor may prescribe medication such as fluconazole.
Body and self-image concerns
Survivors may have disfigurement after certain treatments and surgeries, which can come with self-image concerns and distress, anxiety, and depression. Prescribed medicine and counseling can help with these issues. If you’re facing financial difficulties and employment issues after cancer, a social worker can offer resources. Contact Support for People with Oral and Head and Neck Cancer to find a support group and learn about the National Survivors Volunteer Network and other resources.