Supportive care for laryngeal cancer

Supportive care helps people meet the physical, practical, emotional and spiritual challenges of laryngeal cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.

Recovering from laryngeal cancer and adjusting to life after treatment is different for each person, depending on the stage of the cancer, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A person who has been treated for laryngeal cancer may have the following concerns.

With a tracheostomy (trach), an opening (stoma) is created in the windpipe (trachea) through the front of the neck. After a trach, people breathe through the opening in the neck. People who have a partial laryngectomy as part of their treatment for laryngeal cancer may have a temporary trach. People who have a total laryngectomy as part of their treatment will have a permanent trach. Living with a trach may be frightening at first. However, most people adapt to the trach and live normally with it.

It takes time and patience to learn the new skills needed to care for the trach. Specially trained healthcare professionals, called enterostomal therapists, teach people how to care for the trach after surgery. They also offer support and advice after the person leaves the hospital. Laryngeal cancer support groups and associations are available to provide support and information.

Find out more about living with a tracheostomy.

Surgery or radiation therapy for laryngeal cancer can cause problems with speech. People who have a partial laryngectomy or radiation therapy for laryngeal cancer may experience hoarseness or weakness of voice. People who have a total laryngectomy cannot speak using their vocal cords and must learn new ways of speaking. A speech therapist (speech-language pathologist) can help you deal with changes in your voice and learn to speak again.

Find out more about speech therapy.

Surgery or radiation therapy for laryngeal cancer can cause problems with swallowing. A speech therapist can help you with swallowing problems.

Find out more about swallowing problems.

How a person feels about themselves is called self-esteem. Body image is how a person sees their own body. Laryngeal cancer and its treatments can affect a person’s self-esteem and body image. Often this is because cancer or cancer treatments may result in body changes, such as:

• voice changes
• a tracheostomy tube
• loss of the ability to speak and communicate as before
• skin changes
• scars
• hair loss
• loss of a body part, such as the larynx

Some of these changes can be temporary. Others will last for a long time or be permanent.

For many people, body image and how they think other people see them is closely linked to self-esteem. Some people who have a total laryngectomy may feel embarrassed about the stoma, which can affect self-confidence and cause emotional distress. The doctor, nurse and speech therapist can give information and support. Some people find it helpful to find emotional and practical support from other cancer survivors. The International Association of Laryngectomees has support groups in Canada.

Find out more about how to cope with problems of self-esteem and body image.

Taste changes can happen with treatment for laryngeal cancer. Radiation therapy to the head and neck can damage the salivary glands and taste buds in the tongue. This can affect the way some foods taste. Chemotherapy drugs can also affect the taste cells in the mouth. A person with a tracheostomy tube as a result of treatment for laryngeal cancer will also have changes to their ability to smell because air no longer passes through the nose. A person with a tracheostomy tube can learn new ways to smell.

Find out more about taste changes.

Many people will have a dry mouth during and after treatment for laryngeal cancer. Dry mouth may be worse with chemoradiation than with radiation alone. Dry mouth can make it hard to chew, swallow and talk. When it is severe, it can interfere with your ability to maintain good nutrition. The healthcare team takes steps to check for, prevent and manage a dry mouth. A registered dietitian can also give suggestions on how to maintain nutrition when dry mouth affects eating.

Find out more about a dry mouth.

Tooth decay (also called dental cavities or dental caries) is a late side effect of radiation therapy to the head and neck. Radiation therapy can damage the salivary glands so they do not produce as much saliva. Saliva helps to clean the teeth and gums, so when less saliva is made, there is an increased risk of developing cavities and gum disease.

A dental checkup is often done before treatment starts. Good mouth care is very important to prevent problems. Regular visits to the dentist after treatment are often recommended.

Difficulty swallowing, dry mouth and dental problems can lead to poor nutrition and weight loss. Steps can be taken to increase appetite, help people eat more and maintain good nutrition. Nutritional supplements may be recommended. A registered dietitian can often help people deal with loss of appetite.

Find out more about nutrition for people with cancer.

A person with laryngeal cancer may experience changes in their sexuality because of cancer or its treatment. Some people may feel uncomfortable with their bodies, especially if they have a tracheostomy. Having a tracheostomy tube changes the physical appearance as well as speech and breathing. Feeling uncomfortable about appearance can affect sexual intimacy. Sometimes problems with speaking can interfere with communications. It can take more effort to speak and the voice may lose some of the emotional overtones. If a hand-held speaking device is used, communication can be awkward and distracting during sex.

Partners may be uncertain or nervous about their first sexual experience after treatment. They may avoid intimacy, touching and sexual activity. All of these reactions are normal and are to be expected. Being aware of these reactions can help people with cancer and their partners understand and cope with the changes to their lives and relationships. Talking openly can help them overcome sexual concerns. While it may be awkward at first, partners should ask questions and discuss worries about sexuality with the doctor, other healthcare team members or an ostomy support organization.

Find out more about sexuality and cancer.

Radiation to the neck and some surgeries for laryngeal cancer can cause decreased thyroid function (hypothyroidism). The thyroid makes hormones that are important in regulating the breakdown of certain nutrients, promoting normal bone formation, regulating the nervous system and helping to maintain normal body temperature.

Symptoms of hypothyroidism include:

• fatigue and feeling sluggish
• dry skin and hair
• weight gain or difficulty losing weight
• being more sensitive to cold temperatures
• feeling sad or depressed

Follow-up tests for people treated for laryngeal cancer will include a blood test to check thyroid function. Treatment for hypothyroidism includes daily medicine to regulate the thyroid gland.

Osteoradionecrosis is the death of bone caused by radiation. People who have had radiation therapy to the head and neck are at risk of developing osteoradionecrosis in the lower jaw.

Find out more about osteoradionecrosis.

With trismus, it is hard to open the jaw. It occurs when scar tissue forms in the jaw muscles or joint. Trismus can be caused by surgery or radiation therapy for laryngeal cancer. If a person receives both surgery and radiation therapy, the risk of developing trismus is higher.

Find out more about trismus.

People with head and neck cancers, including laryngeal cancer, often experience emotional distress. The disease and treatment may cause a change in appearance, interruption to daily activities and lifestyle, and disruption that prevents them from taking part in their usual interests. This can lead to delays in rehabilitation, and this can cause more distress. Symptoms of emotional distress include worry, anxiety, fatigue, depression and changes in mood. Tell your doctor about your feelings. You may be given medicines and referred to a counsellor who will help you work through your feelings. Talking to someone who has had the same cancer and treatments may be helpful.

See a list of questions to ask your doctor about supportive care after treatment.