When the trauma of oral cancer is made manageable

SUPPORT NETWORK: From left, Liz Gould, speech and language therapist; Malvern patient John Bishop; Louise Pearson, a clinical nurse specialist, and Jo Kenyon, general manager of ENT and maxillofacial surgery.

SUPPORT NETWORK: From left, Liz Gould, speech and language therapist; Malvern patient John Bishop; Louise Pearson, a clinical nurse specialist, and Jo Kenyon, general manager of ENT and maxillofacial surgery.

First published in Features Worcester News: Photograph of the Author by

TALKING, breathing, eating, drinking, swallowing and speaking are things we all take for granted on a daily basis.

But all these abilities, each of them incalculably precious in itself, can become an ordeal for people recovering from surgery and/or radiotherapy following a diagnosis of head and neck cancer.

That is not to mention the other challenges – the shock of diagnosis, the prospect of complex surgery, the gruelling journeys to Cheltenham for radiotherapy for some Worcestershire patients and the psychological after-effects of surgery which can leave people feeling depressed and self-conscious about the way they look and sound.

But Worcestershire Acute Hospitals NHS Trust has a team of specialists to help people through every stage of what can be a hugely traumatic experience so a tough journey is far less arduous.

The team has a series of specialists to help people with head and neck cancer, from the consultant surgeons who carry out the operations to experts such as Liz Gould, a speech and language therapist with the head and neck team and Louise Pearson, a clinical nurse specialist, who helps make everything run more smoothly by ensuring biopsy results are processed quickly, the most vulnerable patients are fasttracked and patients get their scans carried out on time.

After surgery and/or radiotherapy patients are taught exercises to help them swallow and get them off artificial feeding, exercises to help them use their tongue if they have had part of it removed and vocal exercises to help them recover their speech as fast as possible.

Mrs Gould said: “There is no opportunity for patients to sit around and relax. The emphasis from the beginning is, ‘Let’s get you back to maximum function’.”

FACTS AND FIGURES

Oral cancer is the 12th most common cancer among men in the UK, accounting for almost two per cent of all new cases of cancer in men.

It is the 16th most common cancer among women, responsible for more than one per cent of all new cases of cancer in women.

There are about 120 new cases of head and neck cancer in Worcestershire each year.

RISK FACTORS FOR HEAD AND NECK CANCER

􀁥 Tobacco
􀁥 Alcohol
􀁥 Poor diet and nutrition
􀁥 Human papillomavirus and immunosuppression
􀁥 Oral lesions and conditions
􀁥 Sun exposure

SYMPTOMS

􀁥 Persistent pain in the throat
􀁥 Pain or difficulty with swallowing
􀁥 Persistent hoarseness or a change in voice
􀁥 Pain in the ear
􀁥 Bleeding in the mouth or throat
􀁥 Two types of lesions that could be precursors to cancer are leukoplakia (white lesions) and erythroplakia (red lesions)

􀁥 A lump or thickening in oral soft tissues
􀁥 Soreness or a feeling that something is stuck in the throat
􀁥 Difficulty chewing or swallowing
􀁥 Difficulty moving the tongue or jaw
􀁥 Numbness of the tongue or other parts of the mouth
􀁥 Swelling of the jaw that causes dentures to fit poorly or become uncomfortable.

THE FUTURE

Radiotherapy will be provided at Worcestershire Royal Hospital from 2014, meaning patients will no longer have to travel out of the county for treatment, making treatment far less stressful and timeconsuming.

A new oncology service will see the appointment of two new consultant oncologists and a team of specialist nurses to provide high quality care for cancer patients, working alongside colleagues in A&E, general medicine and haematology.

CASE STUDY: ‘WHAT I GOT AT WORCESTER WAS THAT PERSONAL TOUCH – AND YOU NEED IT’

A MAN who owes his life to the care he received at a Worcester hospital received support at every stage of his treatment – and after it finished.

John Bishop, aged 42, of Barnards Green, Malvern, was diagnosed with a tumour in his cheek in December last year following a biopsy performed at Worcestershire Royal Hospital.

He initially thought it could be an ulcer but because the symptoms remained for more than three weeks he went to his GP who urged him to have further tests.

Once he was told he had the tumour John needed time to come to terms with the diagnosis and so opted to have the surgery on January 9 after Christmas and New Year.

He said Mr Neal Barnard, a consultant oral maxillofacial surgeon, said it was important that he was ready for the surgery.

John said: “I had excellent care.

I hadn’t long been diagnosed.

There were logistical issues about coming in. It was exactly the right thing to do. The surgeon spoke to me for 25 minutes and reassured me I wasn’t putting myself in any significant danger.”

The operation itself, performed under general anaesthetic, lasted nine hours and involved three surgeons in what is one of the more serious procedures head and neck surgeons perform. First they had to remove the tumour from his cheek but also an area of tissue around it to contain the cancer. A graft was then taken out of his left arm to rebuild his face. Tissue also had to be taken from his abdomen to reconstruct the wrist.

John said he was ‘scared to death’ of having the operation but received reassurance throughout.

He said: “What I got at Worcester was that personal touch – and you need it. The last thing you want to do is feel like you’re a number and you’re going through a machine. I felt I was treated like a human being.

Lovely Liz (Gould, the speech and language therapist) went above and beyond the call of duty. There were instances where I was at rock bottom post-surgery. You feel like you have been brought to the ground because of the nature of what has been done to you. You feel completely helpless.”

After surgery John needed a nasogastric tube to administer food and medication but patients with more long-term needs who are classed as ‘nil by mouth’ need a percutaneous endoscopic gastronomy procedure.

Following the surgery John needed six weeks of radiotherapy at Cheltenham, condensed into five weeks but even after that finished it has not been plain sailing.

John, who lives alone, says he has suffered depression recently without the structure of treatment. He is also suffering from a dry mouth after losing salivary glands as part of the procedure, a burning sensation because of the radiotherapy, pain when drinking and eating which has led to loss of appetite, the loss of some sense of taste and difficulty opening his mouth because of the build-up of scar tissue.

But John was given valuable support post-treatment at “living well sessions” which allow patients who have been through a similar experience to share information and form friendships.

People can also learn from experts about how to manage fatigue, about claiming benefits or getting back to work and get advice from dietitians and physiotherapists, have counselling and discuss their concerns and hopes.

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