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Case report
Head and neck cancer end of life care: complex challenges
  1. Naomi Taylor,
  2. Julie Christie and
  3. Donna Wakefield
  1. Palliative Medicine, North Tees and Hartlepool NHS Foundation Trust, Stockton-upon-Tees, UK
  1. Correspondence to Dr Naomi Taylor, Palliative Medicine, North Tees and Hartlepool NHS Foundation Trust, Stockton-upon-Tees, TS19 8PE, UK; naomitaylor{at}doctors.org.uk

Abstract

Head and neck cancers frequently carry a poor prognosis and are commonly associated with complex medical needs and symptoms. Timing of referral to specialist palliative care teams (SPCTs) is challenging. We present the case of a 57-year-old woman with locally highly advanced head and neck cancer. The patient had highly complex medical needs including a tracheostomy to maintain airway patency, artificial feeds via jejunostomy and impaired communication due to hearing loss, tracheostomy and fatigue. She required support with advance care planning and complex symptom management of pain related to abdominal skin excoriation due to leakage of gastric contents; bleeding of necrotic tumour; anxiety and discomfort due to displacement of tracheostomy. Care by an integrated SPCT allowed smooth transition from hospital to community settings with smooth ongoing management despite highly complex needs. This complex symptom management included tracheostomy removal in the home towards the end of life.

  • Cancer
  • Symptoms and symptom management
  • Head and neck
  • Pain
  • Dyspnoea

https://doi.org/10.1136/bmjspcare-2022-003644

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    Footnotes

    • X @DonnaWakefield_

    • Contributors NT, JC and DW all assisted the patient. NT gained consent from the patient's NOK. DW and NT reviewed the literature and wrote the initial drafts. NT, DW, JC contributed to reviewing and editing further drafts and agreed on the final version of the article for submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.