Skip to main content
SpringerLink
Log in

The role of palliative care in relapsed and metastatic head and neck cancer patients in a single ESMO integrated oncology and palliative care centre

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

A Correction to this article was published on 05 August 2022

This article has been updated

Abstract

Background

Palliative care (PC) for patients with advanced cancer improves symptom management and quality of life and may promote home deaths. Limited data are available regarding PC in advanced head and neck cancer (HNC) patients. The aim of this study was to describe the type of care and modalities of integration of specialized PC in a population of relapsed and/or metastatic head and neck cancer patients, followed in a single institution over 4 years.

Methods

Between January 2016 and December 2019, data on patients with relapsed and/or metastatic head and neck cancer not suitable for curative treatment diagnosed at the Oncology Institute of Southern Switzerland were reviewed retrospectively. Site, type and lines of treatment, treatment response, referral to specialist palliative care (yes or no), type of symptoms, tracheostomy and/or feeding-tube presence, and site of death were documented. Comparisons were made between patients benefitting from PC integration vs standard care.

Results

Eighty-six patients with relapsed/metastatic HNC were identified, 63 (73.3%) of whom were referred to specialized PC. Patients were mainly men (66, 76.7%), with a median age of 69 years (range 44–95). The most common site of tumour was the oropharynx (31, 36%), followed by the larynx (21, 24.4%), oral cavity (19, 22.1%), hypopharynx (14, 16.3%), and unknown primary (1, 1.2%). Forty-four patients (51.2%) were treated with systemic treatment. The median time interval between the diagnosis and palliative care referral was 1.7 months. At the time of our analysis, 69 patients had died (58 in the PC group and 11 in the non-PC group). Fifteen patients (25.9%) in the PC group and 4 (36.4%) in the non-PC group had received aggressive treatment (chemotherapy, tracheostomy and/or feeding tube) in the last month of life, with no significant difference between groups (p = 0.44). There was no difference in the incidence of home death (19.1% PC group vs 9.1% non-PC group, p = 0.67) or presence of caregiver (69.8% PC group vs 78.2% non-PC group, p = 0.58) between groups, while palliative care was associated with more opioid use (90.5% vs 17.4%, p < 0.0001). Patients in the PC group had a shorter survival compared to the non-PC group (5.7 vs 19.9 months, p = 0.0063).

Conclusions

This study shows that patients appear to be at risk of receiving inappropriate invasive treatments close to death and of dying in hospital settings. Further research is needed to investigate how early PC may affect decision-making around treatments and improve HNC patients’ holistic wellbeing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and materials

Not applicable.

Code availability

Not applicable.

Change history

References

  1. Forastiere AA, Metch B, Schuller DE, Ensley JF, Hutchins LF, Triozzi P, Kish JA, McClure S, VonFeldt E, Williamson SK (1992) Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck: a Southwest Oncology Group study. J Clin Oncol 10(8):1245–1251. https://doi.org/10.1200/JCO.1992.10.8.1245

    Article  CAS  Google Scholar 

  2. Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, Erfan J, Zabolotnyy D, Kienzer HR, Cupissol D, Peyrade F, Benasso M, Vynnychenko I, De Raucourt D, Bokemeyer C, Schueler A, Amellal N, Hitt R (2008) Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 359(11):1116–1127. https://doi.org/10.1056/NEJMoa0802656

    Article  CAS  Google Scholar 

  3. Burtness B, Harrington KJ, Greil R, Soulières D, Tahara M, de Castro Jr G, Psyrri A, Basté N, Neupane P, Bratland Å, Fuereder T, Hughes B, Mesía R, Ngamphaiboon N, Rordorf T, Wan Ishak WZ, Hong RL, González Mendoza R, Roy A, Zhang Y, KEYNOTE-048 Investigators (2019) Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. Lancet (Lond, Engl) 394(10212):1915–1928. https://doi.org/10.1016/S0140-6736(19)32591-7

    Article  CAS  Google Scholar 

  4. Hui D, Kim SH, Roquemore J, Dev R, Chisholm G, Bruera E (2014) Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer 120(11):1743–1749. https://doi.org/10.1002/cncr.28628

    Article  Google Scholar 

  5. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742. https://doi.org/10.1056/NEJMoa1000678

    Article  CAS  Google Scholar 

  6. Goldwasser F, Vinant P, Aubry R, Rochigneux P, Beaussant Y, Huillard O, Morin L (2018) Timing of palliative care needs reporting and aggressiveness of care near the end of life in metastatic lung cancer: a national registry-based study. Cancer 124(14):3044–3051. https://doi.org/10.1002/cncr.31536

    Article  Google Scholar 

  7. Patil VM, Singhai P, Noronha V, Bhattacharjee A, Deodhar J, Salins N, Joshi A, Menon NS, Abhyankar A, Khake A, Dhumal SB, Tambe R, Muckaden MA, Prabhash K (2021) Effect of early palliative care on quality of life of advanced head and neck cancer patients: a phase III trial. J Natl Cancer Inst 113(9):1228–1237. https://doi.org/10.1093/jnci/djab020

    Article  Google Scholar 

  8. Lin YL, Lin IC, Liou JC (2011) Symptom patterns of patients with head and neck cancer in a palliative care unit. J Palliat Med 14(5):556–559. https://doi.org/10.1089/jpm.2010.0461

    Article  Google Scholar 

  9. Terrell JE, Ronis DL, Fowler KE, Bradford CR, Chepeha DB, Prince ME, Teknos TN, Wolf GT, Duffy SA (2004) Clinical predictors of quality of life in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 130(4):401–408. https://doi.org/10.1001/archotol.130.4.401

    Article  Google Scholar 

  10. Crawford GB, Dzierżanowski T, Hauser K, Larkin P, Luque-Blanco AI, Murphy I, Puchalski CM, Ripamonti CI, ESMO Guidelines Committee (2021) Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines. ESMO Open 6(4):100225. https://doi.org/10.1016/j.esmoop.2021.100225

    Article  CAS  Google Scholar 

  11. Roberge C, Tran M, Massoud C, Poirée B, Duval N, Damecour E, Frout D, Malvy D, Joly F, Lebailly P, Henry-Amar M (2000) Quality of life and home enteral tube feeding: a French prospective study in patients with head and neck or oesophageal cancer. Br J Cancer 82(2):263–269. https://doi.org/10.1054/bjoc.1999.0913

    Article  CAS  Google Scholar 

  12. Penner JL, McClement S, Lobchuk M, Daeninck P (2012) Family members’ experiences caring for patients with advanced head and neck cancer receiving tube feeding: a descriptive phenomenological study. J Pain Symptom Manage 44(4):563–571. https://doi.org/10.1016/j.jpainsymman.2011.10.016

    Article  Google Scholar 

  13. Raijmakers N, van Zuylen L, Costantini M, Caraceni A, Clark J, Lundquist G, Voltz R, Ellershaw JE, van der Heide A, OPCARE9 (2011) Artificial nutrition and hydration in the last week of life in cancer patients. A systematic literature review of practices and effects. Ann Oncol 22(7):1478–1486. https://doi.org/10.1093/annonc/mdq620

    Article  CAS  Google Scholar 

  14. Baumstarck K, Boyer L, Pauly V, Orleans V, Marin A, Fond G, Morin L, Auquier P, Salas S (2020) Use of artificial nutrition near the end of life: results from a French national population-based study of hospitalized cancer patients. Cancer Med 9(2):530–540. https://doi.org/10.1002/cam4.2731

    Article  Google Scholar 

  15. Wiegert E, da Costa Rosa KS, Dos Santos R, Dos Santos DA, de Freitas R, de Oliveira LC (2022) The use of nutrition support near the end of life for hospitalized patients with advanced cancer at a reference center: Two realities. Nutr Clin Pract 37(2):425–434. https://doi.org/10.1002/ncp.10737

    Article  Google Scholar 

  16. Mayland CR, Ho QM, Doughty HC, Rogers SN, Peddinti P, Chada P, Mason S, Cooper M, Dey P (2021) The palliative care needs and experiences of people with advanced head and neck cancer: a scoping review. Palliat Med 35(1):27–44. https://doi.org/10.1177/0269216320963892

    Article  Google Scholar 

  17. Mott FE, Adams KC (2019) Advance care planning and end-of-life issues in head and neck cancer. J Palliat Care 34(1):18–20. https://doi.org/10.1177/0825859718788768

    Article  Google Scholar 

  18. Earle CC, Landrum MB, Souza JM, Neville BA, Weeks JC, Ayanian JZ (2008) Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol 26(23):3860–3866. https://doi.org/10.1200/JCO.2007.15.8253

    Article  Google Scholar 

  19. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18(9):1437–1449. https://doi.org/10.1093/annonc/mdm056

    Article  Google Scholar 

  20. Rabow MW, Dibble SL, Pantilat SZ, McPhee SJ (2004) The comprehensive care team: a controlled trial of outpatient palliative medicine consultation. Arch Intern Med 164(1):83–91. https://doi.org/10.1001/archinte.164.1.83

    Article  Google Scholar 

  21. Mayland CR, Doughty HC, Rogers SN, Gola A, Mason S, Hubbert C, Macareavy D, Jack BA (2021) A qualitative study exploring patient, family carrier and healthcare professionals’ direct experiences and barriers to providing and integrating palliative care for advanced head and neck cancer. J Palliat Care 36(2):121–129. https://doi.org/10.1177/0825859720957817

    Article  Google Scholar 

  22. Sethi R, Panth N, Puram SV, Varvares MA (2018) Opioid prescription patterns among patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg 144(4):382–383. https://doi.org/10.1001/jamaoto.2017.3343

    Article  Google Scholar 

  23. Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM, Ferrell BR, Loscalzo M, Meier DE, Paice JA, Peppercorn JM, Somerfield M, Stovall E, Von Roenn JH (2012) American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol 30(8):880–887. https://doi.org/10.1200/JCO.2011.38.5161

    Article  Google Scholar 

  24. Jordan K, Aapro M, Kaasa S, Ripamonti CI, Scotté F, Strasser F, Young A, Bruera E, Herrstedt J, Keefe D, Laird B, Walsh D, Douillard JY, Cervantes A (2018) European Society for Medical Oncology (ESMO) position paper on supportive and palliative care. Ann Oncol 29(1):36–43. https://doi.org/10.1093/annonc/mdx757

    Article  CAS  Google Scholar 

  25. Kagan SH, Morgan B, Smink T, DeMille D, Huntzinger C, Pauly M, Lynch MP (2020) The oncology nurse navigator as “gate opener” to interdisciplinary supportive and palliative care for people with head and neck cancer. J Oncol Navig Survivorship 11(8):259–266

    Google Scholar 

  26. Lo Nigro C, Denaro N, Merlotti A, Merlano M (2017) Head and neck cancer: improving outcomes with a multidisciplinary approach. Cancer Manage Res 9:363–371. https://doi.org/10.2147/CMAR.S115761

    Article  CAS  Google Scholar 

  27. Boëthius H, Saarto T, Laurell G, Farnebo L, Mäkitie AA (2021) A Nordic survey of the management of palliative care in patients with head and neck cancer. Eur Archiv Oto-Rhino-Laryngol 278(6):2027–2032. https://doi.org/10.1007/s00405-020-06310-2

    Article  Google Scholar 

  28. Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T, Stovall EL, Zimmermann C, Smith TJ (2017) Integration of palliative care into standard oncology care: american society of clinical oncology clinical practice guideline update. J Clin Oncol 35(1):96–112. https://doi.org/10.1200/JCO.2016.70.1474

    Article  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

    Vittoria Guro Espeli & Dylan Mangan

  2. Oncology Institute of Southern Switzerland, Palliative and Supportive Care Clinic, Bellinzona, Switzerland

    Tanja Fusi-Schmidhauser & Claudia Gamondi

Authors
  1. Vittoria Guro Espeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tanja Fusi-Schmidhauser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dylan Mangan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Claudia Gamondi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by VGE. The first draft of the manuscript was written by VGE and TF. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vittoria Guro Espeli.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The study was approved by cantonal research ethics committee (Comitato Etico Cantonale, Project-ID 2021-01538 CE 3925).

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised as second author’s last name was published incorrectly and corrected in this version.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Espeli, V.G., Fusi-Schmidhauser, T., Mangan, D. et al. The role of palliative care in relapsed and metastatic head and neck cancer patients in a single ESMO integrated oncology and palliative care centre. Eur Arch Otorhinolaryngol 279, 5897–5902 (2022). https://doi.org/10.1007/s00405-022-07535-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-022-07535-z

Keywords

Search

Navigation