Supportive care for oral cancer

Supportive care helps people meet the physical, practical, emotional and spiritual challenges of oral 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 oral cancer and adjusting to life after treatment is different for each person, depending on the location of the tumour, the stage of the cancer, the organs and tissues removed during surgery, 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 oral cancer may have the following concerns.

How a person feels about themselves is called self-esteem. Body image is how a person sees their own body. Oral 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:

• scars
• skin changes
• changes to the shape of the face
• having to use a prosthesis
• difficulty speaking or eating
• weight loss

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. It may be a real concern for them and can cause considerable distress. They may be afraid to go out, afraid others will reject them, or feel angry or upset, even if the effects of treatment may not show on the outside of the body.

Reconstructive surgery helps to restore your appearance and improve chewing, swallowing and speaking. Ask questions and talk to your surgeon before surgery to find out what to expect about any changes in appearance. Be honest and let your healthcare team know if you have concerns.

If surgery for oral cancer affects your appearance, give yourself time to adjust. The first time you look at yourself in the mirror may be difficult. It may be helpful to have someone with you for support.

It can also help to talk to someone who has gone through a similar experience. There are tools that can help with changes to the face, such as camouflage makeup for scars or wearing scarves and hats.

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

Many people will have a dry mouth during and after treatment for oral cancer. Radiation therapy to the mouth or surgery that damages the salivary glands can cause dry mouth. Chemotherapy given along with radiation therapy (called chemoradiation) can often make dry mouth worse. Newer methods of giving radiation therapy, such as IMRT, can help to reduce this complication in many people.

Find out ways to manage dry mouth.

Surgery to the mouth, especially if it involves removing certain structures such as the tongue and jawbones, can cause difficulty chewing and swallowing. You may have pain or numbness that makes chewing difficult. You may be unable to hold food in your mouth if you can’t move your lips. Eating a soft diet can help manage difficulty chewing and swallowing. In some cases, you may need to have reconstruction or a dental prosthesis to replace a structure inside of your mouth.

If you have part of your tongue removed, a speech therapist (speech-language pathologist) can help you learn to use the remainder of your tongue for swallowing. Other ways to improve swallowing include changing your head posture and doing range-of-motion exercises for the jaw and tongue. A feeding device called a glossectomy spoon allows a person with only part of their tongue to place soft food at the back of the mouth, which helps with swallowing.

Find out more about difficulty swallowing.

Surgery that removes large parts of the tongue, jawbones or palate may cause speech problems. Reconstruction helps to reduce these complications, but it is often difficult to restore normal function. Oral prostheses such as dentures can make up for tissue lost during surgery and help improve speaking.

A speech therapist can assess speech problems and help to manage them. Speech therapists can teach you to use other ways to speak and communicate including adaptive communications devices, laryngeal speech, esophageal speech and a prosthetic voice box (larynx) if necessary.

Radiation therapy to the head, neck or mouth may damage the salivary glands and taste buds in the tongue, which can affect the way some foods taste. Chemotherapy drugs can also affect the taste cells in the mouth. Surgery to remove part or all of the tongue can cause a reduced or lost sense of taste.

Find out more about taste changes.

Radiation therapy to the head or neck can cause dental problems. Radiation therapy can damage the salivary glands so they do not produce as much saliva. Saliva helps to clean the teeth and gums, so there is a higher risk of developing cavities and gum disease when less saliva is made. Radiation can also affect tooth enamel, which increases the risk of tooth decay.

A checkup with a dentist or dental oncologist is done before treatment starts. Good mouth care is very important to prevent problems. Fluoride treatments may be given to help protect teeth from developing cavities. Regular visits to the dentist or dental oncologist after treatment are often recommended.

Difficulty chewing and swallowing, as well as loss of appetite, may lead to poor nutrition and weight loss. Steps can be taken to help increase appetite and help people to eat more and maintain good nutrition. Nutritional supplements may be recommended. A registered dietitian can often help people manage nutrition and loss of appetite.

Find out more about nutrition.

Radiation to the neck may cause decreased thyroid function (hypothyroidism). Between 30% and 40% of people receiving radiation therapy for head and neck cancers, including oral cancer, will develop hypothyroidism. Some symptoms of hypothyroidism include extreme fatigue, dry skin and hair, hair loss, weight gain and intolerance to cold.

If you have hypothyroidism after treatment for oral cancer, you may need to take daily medication to manage the thyroid gland.

To make decisions that are right for you, ask your healthcare team questions about supportive care.