July 27th is World Head and Neck Cancer Day. We at Oncology Recovery Services Inc., are taking this opportunity to raise awareness about the physical side effects related to treating head and neck cancer and to educate about the ways a specialised physiotherapist can assist to reduce them. Surgery, chemotherapy, and radiation therapy are used to treat head and neck cancer. These interventions can save your life but may leave you with some potentially long-term side effects.
Side effects that may arise as a result of surgery
One of the side effects of head and neck surgery is the injury to the accessory nerve. The accessory nerve innervates the trapezius muscle and controls its movement. The trapezius muscle is the large muscle sitting most superficially on the shoulder and is involved in arm and neck movements. This muscle plays an important role in the elevation of the arm, especially when we lift our arm above the head. Injury to this nerve, therefore, can affect the function of this muscle, resulting in weakness and reduced shoulder and neck movement. This can impact on everyday activities. Surgery further causes scarring, local swelling, and potential tissue thickening, often referred to as fibrosis.
Additional side effects may therefore include pain, altered sensations, such as numbness, limited mouth opening, compromised swallowing or altered speech.
Side effects that may arise as a result of radiotherapy and chemotherapy
The side effects of radiation treatment tend to be localised to the area that is being treated. Radiation burns the skin and causes tissue and vascular stiffness, resulting in skin and or muscle tightness and local swelling. Patients can experience marked skin redness, burning sensation, reduced neck or jaw movement, discomfort and dry mouth. The side effects of radiotherapy are usually exacerbated if chemotherapy is also administered. This is because the chemotherapy increases the local toxicity of radiation.
Head and neck lymphoedema
A common side effect for patients who have been treated for head and neck cancer is lymphoedema. Lymphoedema is the accumulation of fluid in the tissue space, as a result of damage to the lymphatic system. The lymphatic system, responsible for fluid transport, consists of vessels ducts and lymph nodes, which carry fluid from our tissues into the main blood circulation. The lymphatic system clears away waste products and excess fluid that naturally accumulates in our tissues and therefore prevents fluid build-up. When the lymphatic system is damaged from radiation and or the surgical removal of lymph nodes, the clearing function is compromised. Fluid can build up, resulting in swelling. It can present as a soft, painless swelling, but can also develop to a firm, thick consistency leaving skin indentations on pressure.
Head and neck lymphoedema can occur both internally and externally. When lymphoedema develops internally within the oral cavity or the throat, it can affect functions like breathing, speech, swallowing and chewing. Patients with internal lymphoedema commonly describe tightness in the throat, difficulty swallowing and sometimes breathing. External lymphoedema, located on the outside of the neck or around the face, may impact on neck or jaw movement. External lymphoedema, when severe, may lead to issues with body image and social avoidance.
How can a physiotherapist help?
The physical side effects of cancer treatment very often have an impact on quality of life. The role of a specialist physiotherapists is to manage these physical limitations. Advanced understanding of the anatomy of the head and neck is the foundation of being a specialised head and neck physiotherapist. Part of our job is to help patients understand the reasons behind their limitations. Explaining what happens when the nerves are damaged, why muscles are weakened, or why limitations of movement occur, is an important part of the management process. Describing the function of the lymphatic system and why swelling happens when the lymph nodes are removed, or the lymphatic pathways are compromised, ensures that the patient understands the process.
The next step is to identify the individual’s side effects of their cancer treatment, such as muscle tightness or swelling through a thorough assessment, before applying targeted therapy. This can range from manual techniques to relieve tension and encourage correct muscle use, to prescribing exercises to gradually strengthen weakened muscles. Head and neck lymphoedema, a common side effect, can be reduced by administering lymphatic massage to direct the fluid away from the affected areas. In addition, the application of compression around the head or neck area is sometimes recommended to assist with minimising swelling. It is very important that patients report the side effects they are experiencing to their treating specialist, as early management can prevent manifestation of symptoms.
To work towards a fast recovery, we include the patient in the treatment and always prescribe self-management strategies, such as exercises or simple massage techniques to perform at home. The severity of symptoms and the timing of the intervention determines the frequency of visits to the physiotherapist. Our motto is: The more you do, the less you will need us. Some of the side effects may however require ongoing monitoring or maintenance to prevent deterioration over time.
In conclusion, a head and neck specialist physiotherapist identifies and reduces physical side effects of head and neck cancer treatment. It is important to note that not all side effects develop immediately after cancer treatment. The role of a head and neck cancer specialist physiotherapist, who understands the cancer treatments for head and neck is not only to assess and deliver a targeted physiotherapy intervention but also prevent possible secondary side effects that may develop overtime.
Our team, highly specialised in cancer care and lymphoedema management, can support you during and after your cancer treatment. We will always liaise with your treating team of doctors and other health care providers to ensure a seamless transition between disciplines and to provide best possible care.
Written by Orsi Kokai