Webmultidisciplinary team approach. Cancer Treat Rev. (2017) 39:90815. This relationship is decisive to ensure patient adherence and compliance to treatment and will also optimize healthcare resources. Recently, the ELAN-ONCOVAL (Elderly head and Neck Cancer-Oncology eValuation) study evaluating the use of a suited geriatric evaluation to stratify patients and guide therapy in patients 70 years old not amenable to surgery showed that, despite the initially planned treatment was changed only in 8% of the cases after a geriatric assessment, the number of patients requiring multidisciplinary interventions was significantly higher when the assessment was performed by geriatrician (71 vs. 51%) (117). Position Statement Summ. Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz J-P, Lichtman S, et al. WebThe multidisciplinary team involved in looking after hip fracture patients is extensive. doi: 10.1200/JOP.18.00078, 112. The keys to success for a team of this nature are open-minded learning, communication, and mutual respect for what each discipline brings to the table. Some authors for example, prefer to use cytoprotective agents such as amifostine (WR2721), which avoid cellular oxidation in healthy cells (richer in alkaline phosphatase) preserving their correct function (24, 25). J Clin Oncol. Kotake K, Suzukamo Y, Kai I, Iwanaga K, Takahashi A. As regards the use of immune-checkpoint inhibitors in the elderly, the trials conducted thus far do not seem to suggest that higher toxicity should be expected in this subgroup of patients (123). CGA helps to identify patients who are fit enough to receive standard of care treatment, those who are vulnerable and require an adapted treatment, and those unfit to receive any treatment and should be managed with best supportive care only (102, 103). *Correspondence: Miren Taberna, mtaberna@iconcologia.net; Ricard Mesa, rmesia@iconcologia.net, Quality Assessment Across Disciplines in Head and Neck Cancer Treatment, View all One outcome of depression is suicide. Dental management of patients who have undergone oral cancer therapy. Figure 2. Effects of biodegradable hydrogel spacer injection on contralateral submandibular gland sparing in radiotherapy for head and neck cancers. (2010) 21 (Suppl. Oral complications in the treatment of cancer patients. JAMA Surg. It's the archer not the arrow. A multidisciplinary team may work with multiple patients, but each patient receives individualized attention The nurse must ensure that nursing care is incorporated into the design and implementation of clinical guidelines. doi: 10.4236/ijohns.2014.31004, 133. Sadeghi M, Keshavarz-Fathi M, Baracos V, Arends J, Mahmoudi M, Rezaei N. Cancer cachexia: diagnosis, assessment, and treatment. National Childrens Advocacy Center (2022) Koster and Bergsma described HNC as more emotionally traumatic than any other type of cancer (83). hospitalization, clinical trials). Geriatric assessment-identified deficits in older cancer patients with normal performance status. Most of head and neck cancer (HNC) units are currently led by MDTs that at least include ENT and maxillofacial surgeons, radiation and medical oncologists. (2005) 33:4049. Ahn M-J, D'Cruz A, Vermorken JB, Chen J-P, Chitapanarux I, Dang HQT, et al. Several agents can be recommended to reduce the severity of mucositis (i.e., oral Magic mouthwash, a combination of antibiotic, antihistaminic or local anesthetic, antifungal, topical corticoid and a base that helps the other components to properly cover the affected mucosa). Janssen A, Robinson T, Brunner M, Harnett P, Museth KE, Shaw T, et al. Radiotherapy is the backbone of the multimodality treatment in HNC. As this patient population is usually underrepresented in clinical trials, data on treatment efficacy and safety is scarce, and evidence-based guidelines are lacking (91). This fundamental frequency will be articulated in the oral cavity, generating different phonemes or speech sounds. Trauma, Violence, & Abuse, 20(2) Please enable scripts and reload this page. Barbe AG. Any dental treatment should be preventive, if possible, because any dental treatment after the oncologic treatments will be less effective (12, 3638). Kim DD, Ord RA. (2001) 49:16919. Psychosocial interventions for patients with head and neck cancer. doi: 10.1007/s10147-018-1328-x, 61. Ann Oncol. Eur J Cancer. Specific circuits are activated to support the patients according to their needs: assessment of nutritional status, swallowing and phonation, dental evaluation, psychosocial support, rehabilitation, evaluation of toxic habits, oncogeriatrics, and palliative care. Forging the way ahead for more research on and the better care in breast cancer. Sometimes, it will be necessary to refer patients to a social worker to assist them with any financial burden and facilitate the access to the appropriate financial resources. 96. (2005) 6386. The use of low-level light therapy in supportive care for patients with breast cancer: review of the literature. Specifically, in HNC, sarcopenia has been correlated with an increased rate of surgical complications in patients undergoing total laryngectomy (68) and with decreased overall survival in those treated with either radiotherapy alone (69) or with chemoradiotherapy (70). Arribas L, Hurts L, Taberna M, Peir I, Vilajosana E, Lozano A, et al. Relie A, Mazemda P, Arens C, Koller M, Glanz H. Investigating quality of life and coping resources after laryngectomy. Crit Rev Oncol Hematol. (2013) 214:38793. doi: 10.1200/JCO.2008.20.9288, 94. (2014) 14:427. doi: 10.1186/1471-2407-14-427, 116. Working together to ensure care and support is coordinated is crucial. The patient benefits from improved outcomes, decreased length of stay, decreased ventilator days, and improved communication with all caregivers. multidisciplinary team. Gomez-Millan J, Fernndez JR, Medina Carmona JA. Codas. No use, distribution or reproduction is permitted which does not comply with these terms. Association of body composition with survival and locoregional control of radiotherapy-treated head and neck squamous cell carcinoma. Multidisciplinary Teams and Collaboration in Child Abuse Investigations: A Bibliography (PDF - 714 KB) doi: 10.1371/journal.pone.0095968, 25. Ideally, the laryngectomized patient could develop more than one communication strategy, such as a combination of an esophageal voice and the tracheoesophageal voice, as they can easily coexist (Figure 5). Robijns J, Censabella S, Bulens P, Maes A, Mebis J. Reduced libido and sexual enjoyment are common in individuals following surgery or chemoradiation. World J Surg. Soria A, Santacruz E, Vega-Pieiro B, Gin M, Molina J, Villamayor M, et al. Eur Arch Otorhinolaryngol. (2018) 14:5416. Device Life of the tracheoesophageal voice prosthesis revisited. Impact of a specialized multidisciplinary tracheostomy team on tracheostomy care in critically ill patients. In term of coping, they had higher levels of anxious preoccupation than other cancer patients (84). The multidisciplinary approach emerged in oncology in the mid-1980s, when the addition of chemotherapy to radiotherapy and/or surgery was proven to improve survival. A multidisciplinary team (MDT) in oncology is defined as the cooperation between different specialized professionals involved in cancer care with the overarching goal of improving treatment efficiency and patient care. Peters TTA, van Dijk BAC, Roodenburg JLN, van der Laan BFAM, Halmos GB. Although not always feasible, face-to-face interaction is preferred; however, our tech-savvy world now allows for crucial interactions to be achieved electronically, as well. (2017) 71:6774. (2000) 36:228893. During this first visit, a comprehensive assessment of the patient is conducted, which includes medical and psychosocial status as well as support requirements. Vocal rehabilitation alternatives after total removal of the larynx Images courtesy of Atos medical. Kalsi T, Babic-Illman G, Ross PJ, Maisey NR, Hughes S, Fields P, et al. WebA multidisciplinary team or MDT for short is simply a diverse group of professionals working together. Nat Rev Cancer. Patients receiving chemotherapy, especially methotrexate, cyclophosphamide, cisplatin, and 5-fluorouracil, can suffer mucositis affecting the oral cavity health (14, 15). doi: 10.5306/wjco.v7.i2.220, 43. (2015) 51:5218. Br Dent J. Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy. J Clin Oncol. J Clin Oncol. Head and neck MDT and HNC units have been shown to be an effective tool to facilitate collaboration between professionals and hence improve care outcomes. Treatment of elderly patients with squamous cell carcinoma of the head and neck. (2017) 71:2633. The requirements of a specialist breast centre. The nurse will facilitate and coordinate the activities among all the specialists of the MDT, framing their activities in care plans and integrating healthcare processes in collaboration with other professionals involved in cancer care. 1):E105460. (2013) 18:56878. Thus, the work of the SLP should be integrated into a well-structured MDT that guarantee a good information flow among professionals who are specialists in the different related areas (136). This opens the floor for pharmacy to share concerns regarding medication orders or usage; respiratory therapy will review therapy response and pulmonary care status; and physical therapy will discuss progress, response to therapy, and the need to advance. Psychooncology. Joining the efforts from different professionals is thought to improve patient management in contrast with the old idea of a global treatment offered by a single physician. All authors acknowledge Marc Oliva for his support on this manuscript preparation and our head and neck multidisciplinary team for sharing the daily work in management and care of our patients. Support Care Cancer. Vocal rehabilitation in patients treated with a TL to restore oral communication requires a process of adaptation and readjustment to this new voice that is crucial in order to improve and restore their quality of life (129). Prognostic indication of sarcopenia for wound complication after total laryngectomy. Anxiety and depression is experienced by ~3040% of patients following treatment of HNC (85, 86). doi: 10.1001/jamaoto.2016.2771, 131. Crit Rev Oncol Hematol. JAMA Otolaryngol Head Neck Surg. doi: 10.1016/j.rpor.2013.09.008, 21. Predictors of competing mortality in advanced head and neck cancer. Malnutrition identified by the academy of nutrition and dietetics and american society for parenteral and enteral nutrition consensus criteria and other bedside tools is highly prevalent in a sample of individuals undergoing treatment for head and neck cancer. LA has received personal fees and non-financial support from Nutricia, Nestle Health Science and Merck. ESPEN guidelines on nutrition in cancer patients. - Tracheoesophageal speech (voice prosthesis). Symptom management during and after treatment with concurrent chemoradiotherapy for oropharyngeal cancer: a review of the literature and areas for future research. Head and neck cancer (HNC) involves multiple and biologically distinct diseases that require different therapeutic approaches. Some error has occurred while processing your request. The impairment of these functions can significantly impact patients' quality of life and psychosocial status, and highlights the crucial role of specialized nurses, dietitians, psycho-oncologists, social workers, and onco-geriatricians, among others. Ray-Chaudhuri A, Shah K, Porter RJ. doi: 10.1016/j.rpor.2016.09.008, 36. J Am Geriatr Soc. Grossberg AJ, Chamchod S, Fuller CD, Mohamed ASR, Heukelom J, Eichelberger H, et al. (2004) 4:27784. Psychosocial care of patients with head and neck cancer. The ELAN-ONCOVAL (ELderly heAd and Neck cancer-Oncology eValuation) study: Evaluation of the feasibility of a suited geriatric assessment for use by oncologists to classify patients as fit or unfit. (2018) 24:93341. (2018) 9:3945. doi: 10.1001/jamaoto.2017.0547, 69. J Cancer Surviv. Overall, the best communication system is the one that will provide the best results according to patient communicative needs and expectations. WebProfessionals who may contribute to the team include: general practitioners (GPs) practice and community health nurses allied health professionals health educators specialists Bellera CA, Rainfray M, Mathoulin-Plissier S, Mertens C, Delva F, Fonck M, et al. First anxiety, afterwards depression: psychological distress in cancer patients at diagnosis and after medical treatment. These included Childrens Advocacy Center directors, child trafficking coordinators, county and federal prosecutors, managers and caseworkers from the Malaria: Has your patient traveled recently? (B) Nutritional intervention in HNC patients according to the treatment plan. doi: 10.1016/j.ijrobp.2016.11.016, 42. Given the close location of HNC to vital anatomical structures, radiotherapy is often limited by the risk of toxicity to the surrounding organs at risk (20). The treatment of a patient after a stroke is multidisciplinary, requiring the support of several members of a team of medical professionals. Ann Oncol. doi: 10.1002/14651858.CD012744, 26. Methodologically, the main goal is to achieve care results more efficiently, as it will allow a better control of professional resources ultimately impacting on health costs (7). (2005) 55:24152. The classic risk factors associated to HNC such as tobacco and alcohol habits need to be addressed. Medical oncology department has received sponsorship for grants from Merck. doi: 10.1016/j.ejca.2008.02.033, 46. Oral cryotherapy (30-min session) is a good preventive method in patients receiving 5-fluorouacil (12) and benzamine hydrochloride is a positive anti-inflammatory option. (2017) 143:72 doi: 10.1001/jamaoto.2016.2881, 136. Lonkvist CK, Lnbro S, Vinther A, Zerahn B, Rosenbom E, Primdahl H, et al. doi: 10.1002/hed.20221, 57. The significant acute and late toxicities that come with these therapies have an impact in the quality of life of patients hence pose an extra challenge when deciding the best treatment strategy in elderly patients with HNC (96). doi: 10.1016/j.cden.2017.08.009, 37. doi: 10.1089/acm.2018.0143, 18. Soc Sci Med. doi: 10.1097/CAD.0b013e328344282a, 93. Most of the studies evaluating therapy according to age in HNC patients did not show significant differences in survival between young and elderly patients (118). Devins GM, Stam HJ, Koopmans JP. Versus Control-No multidisciplinary team approach. doi: 10.1177/0148607116672264, 48. The first functional units created in Europe were the breast cancer treatment units. doi: 10.1080/01635581.2018.1506492, 76. The evolution of upcoming radiation modalities such as proton-based radiotherapy with better selectivity of the tissue to be irradiated might help reducing further these toxicities (22, 23). A comprehensive assessment and monitoring of HNC patients by specialized MDTs will result in better treatment adherence and tolerance, reduction in long-term side effects, improved quality of life and ultimately improved treatment outcome and survival. doi: 10.1016/j.critrevonc.2006.10.003, 117. Bauml J, Seiwert TY, Pfister DG, Worden F, Liu SV, Gilbert J, et al. (2003) 15:21327. Can J Psychiatry. Potential toxicities and affected structures by chemotherapy, radiotherapy and/or surgery are summarized on Table 1. Morton RP, Davies ADM, Baker J, Baker GA, Stell PM. Every breast cancer patient has different needs, and every diagnosis requires personalised care. In fact, the benefits of these teams are so well recognized that the World Health Organization, along with other national organizations, has developed care models and professional practice standards that use the multidisciplinary team as the basic foundation for care. Sarris EG, Harrington KJ, Saif MW, Syrigos KN. For the healthcare organization, the benefits are financial in nature. A proper follow-up by an SLP expert of patients with phonatory prostheses is associated with better overall results in their rehabilitation (133). doi: 10.1016/S1470-2045(12)70259-0, 110. (2018) 127:91104. (2008) 72:135561. However, none of them discussed the potential benefits of incorporating the translational research teams within these units (6, 138). Brugel L, Laurent M, Caillet P, Radenne A, Durand-Zaleski I, Martin M, et al. Psychosocial impact of laryngectomy mediated by perceived stigma and illness intrusiveness. Stress Health. The nurse ensures that patient referrals from primary care or local specialists are scheduled in a timely manner to avoid delays, and links patients that require multimodality treatment with the physicians from the different departments (i.e., ENT surgical oncology, radiation oncology and/or medical oncology). doi: 10.1634/theoncologist.2012-0427, 92. doi: 10.1245/s10434-013-3375-x, 120. doi: 10.1038/bjc.2017.202, 105. The voice, in addition to the basic instrument for human communication, is for everyone a hallmark of self-identity (127) and reveals aspects such as personality traits, mood or gender. The success of a translational project involving patient care is based on the coordination of the team. The main challenge is how to identify the right patients for the right treatment. A multidisciplinary team also includes: Allied health professionals: An allied health professional (AHP) is a trained professional who works with others in the multidisciplinary team to support cancer patients. Proposed recommendations to succeed in the integration of clinical and translational research within the MDT and HNC units are: - Elect a coordinator for clinical and translational research within the unit. The vulnerable elders survey: a tool for identifying vulnerable older people in the community. (2014) 9:e95968. However, given the high prevalence of malnutrition in HNC patients, an early complete nutritional assessment of all patients incorporating dietetic counseling even in those well-nourished seems to be more effective (44). Patterns of care in older patients with squamous cell carcinoma of the head and neck: a surveillance, epidemiology, and end results-medicare analysis. doi: 10.1111/jocn.13879, 39. Importantly, postsurgical complications, or toxicity rates were not influenced by chronological age. The Gold Standard to establish the frailty profile of the elderly is the Comprehensive Geriatric Assessment (CGA). In any case, continued oral hydration and the use of saliva substitutes (olive oil, betaine, or xylitol gum) are always advisable (35). Eur J Cancer Care. Bascones-Martnez A, Muoz-Corcuera M, Gmez-Font R. Oral secondary effects of radiotherapy and chemotherapy in cancer of the cervicofacial region. Sonis ST. Herbert & Bromfield (2019) (2016) 122:153343. doi: 10.1200/JCO.2016.70.1524, 41. Multimodality treatment in HNC is associated with significant acute and long-term toxicity and represents an additional challenge in the elderly. Enhanced recovery after surgery: a review. Assessing taste and smell alterations in cancer patients undergoing chemotherapy according to treatment. The care is patient-centered, more efficient, and more cost-effective, and both patient and professional satisfaction are improved. Who is part of the Multidisciplinary Team? Villa A, Akintoye SO. Figure 5. Oral Oncol. Oral Dis. The addition of the latter group of professionals improved the quality of cancer care by preventing and diminishing treatment side-effects, which in turn improved patient adherence and compliance to therapies (2). The heterogeneity of symptoms in HNC patients due to tumor location often overlap with local toxicity, and can all interfere with oral intake. Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review. The input that basic researchers can receive from clinicians might be useful to guide translational projects. Ann Oncol. (2007) 25:182431. This is especially common among patients with HNC, and it is important to help them coping with these psychosocial aspects into their routine cancer care throughout the illness trajectory. doi: 10.1016/j.oraloncology.2015.02.097, 122. (2013) 18:3715. However, the optimal treatment should be decided considering both geriatric and oncological variables trying to find the proper balance between the tumor stage, the expected treatment benefit and toxicity and its potential impact on quality of life as well as the increased risk of toxicity and expected overall survival in the elderly. Multidisciplinary patient rounds have become a staple in most organizations that provide care to the critically ill. As a result of the aging of the Western population and of a long lifetime exposure to tobacco, alcohol and other carcinogens, HNC in older patients is becoming a growing problem (89, 90). J Geriatr Oncol. (2010). doi: 10.1200/JCO.2007.11.1922. It was not until 1998 at the First European Breast Cancer Conference that many medical societies focused on breast cancer treatment claimed that breast cancer care, which includes diagnosis, treatment, genetic counseling, psycho-social support, and research, should be assembled in specialized units within an institution (4). Bossola M. Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: a narrative review. They will meet Geriatric assessment is superior to oncologists' clinical judgement in identifying frailty. doi: 10.1007/s004050100380, 89. Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature. If this is the case for you, ask your treatment team to appoint one for you as soon as possible. This is extremely important for those patients who undergo multimodal treatment, either concurrently or sequentially (i.e., definitive concurrent chemo-radiation, surgery followed by adjuvant radiation with/without chemotherapy). BMC Health Serv Res. It can decrease the appetite leading to reduced oral intake and weight loss. Interdisciplinary Care Teams, Patient Navigators, and Community Health Workers These models focus on the use of interdisciplinary care teams, patient navigators, and community health workers (CHWs) to help address social determinants of health (SDOH) in healthcare settings. In addition to the nutritional support, symptom-management (i.e., analgesia), psycho-oncological counseling, and speech and language rehabilitation therapy will be essential to improve their quality of life. Since CGA requires an expert physician to interpret the results and therefore consumes time and resources, several screening tools like Vulnerable Elders Survey (VES-13) (106) or Geriatric-8 (G8) (107) have been developed to distinguish fit patients who are able to receive standard treatment from those who need a wider geriatric evaluation (108110). This is the perfect opportunity to discover changes in patient status and review the care plan and discharge planning. When voice alternatives fail, electrolarynx is an excellent solution to allow oral communication. (A) Nutritional intervention in HNC patients according to the nutritional status. Nowadays, over a half of all newly diagnosed HNCs are in patients 65 years and it is estimated that in the next decade this will increase by more than 60% (89, 90). Speech-language pathology care and short- and long-term outcomes of laryngeal cancer treatment in the elderly. Multidisciplinary team meetings are a recognised component of palliative care as well as in a range of other care settings (eg, cancer). Mesa R, Garcia-Saenz JA, Lozano A, Pastor M, Grau JJ, Martnez-Trufero J, et al. Cancer. Hamaker ME, Jonker JM, de Rooij SE, Vos AG, Smorenburg CH, van Munster BC. Figure 3. Similarly, the human papilloma virus (HPV) is a new risk factor, sexually transmitted, associated with a new profile of the HNC patient, with particular emotional needs. Potential outcomes of chemotherapy, radiotherapy and surgery and the affected structures implicated. Wolters Kluwer Health, Inc. and/or its subsidiaries. Gil F, Costa G, Hilker I, Benito Ll. Please try after some time. Dent Clin North Am. (2017) 17:400. doi: 10.1186/s12885-017-3388-0, 73. J Altern Complement Med. J Radiat Res. You may be trying to access this site from a secured browser on the server. Fearon KCH. Kabata P, Jastrzebski T, Kakol M, Krl K, Bobowicz M, Kosowska A, et al. doi: 10.1017/S0022215116000402, 78. (2012) 20:211120. The oral management of patients who have received radiotherapy to the head and neck region. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology study. To date, HNC MDTs have been successfully implemented in many countries and are now considered standard of care for the management of HNC patients (6). Childrens Advocacy Center of Suffolk County A multidisciplinary team is a unit of health care professionals who specialize in different fields and work together. doi: 10.1016/j.otorri.2018.01.003, 137. Curr Opin Support Palliat Care. Additionally, the integration of translational research teams in tumor boards and MDTs can help reducing the existing gap between current clinical practice and basic research. Clinical recommendations for defining platinum unsuitable head and neck cancer patient populations on chemoradiotherapy: a literature review. Provides information and resources to help with onboarding new multidisciplinary team members. (2015) 112:143544. doi: 10.1007/s11764-018-0687-7, 77. Rao AD, Coquia S, De Jong R, Lin O, Alvarenga F, Bchser D, et al. doi: 10.1016/j.critrevonc.2018.05.006, 52. (2001) 56:M14656. MT and RM: review concept, review design, and interpretation. An example of these teams at work can be seen in many ICUs. Some studies have integrated progressive resistance training programs during cancer treatment showing successful patient adherence and improvement in quality of life (71, 72). J Laryngol Otol. Domains evaluated in Comprehensive Geriatric Assessment (CGA). While the survival benefit from chemotherapy remained similar across age, older patients had higher rates of toxicity (nephrotoxicity, diarrhea, and thrombocytopenia) (119). A few clinical guidelines for the nutritional management of HNC patients have been published (77, 78). Progressive resistance training in head and neck cancer patients during concomitant chemoradiotherapy design of the DAHANCA 31 randomized trial. (2017). (2018) 27:263844. MDT Orientation Manual (PDF - 7,902 KB) In the meantime, organ-preservation strategies started to develop in HNC with the use of new available therapeutic techniques (1). Hence, these professionals should be integrated in HNC MDTs. (2015) 51:7959. Objective and subjective voice outcomes after total laryngectomy: a systematic review. J Clin Oncol. Two head and neck cancer sites alone (tongue and pharynx) accounted for almost 20% of the total suicides among male patients with cancer (87). Nutr Hosp. Wendrich AW, Swartz JE, Bril SI, Wegner I, de Graeff A, Smid EJ, et al. doi: 10.1634/theoncologist.2013-0325, 119. Based on this information, patients with a same geriatric profile might be considered fit enough to be treated with single-modality but not with a multi-modality treatment. Received: 21 March 2019; Accepted: 16 January 2020; Published: 20 March 2020. J Cranio-Maxillofac Surg. Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. After the surgery, patient can be taught laryngeal techniques by an SLP expert through an intensive and structured work. doi: 10.1093/annonc/mdu210, 109. Charalambous A, Lambrinou E, Katodritis N, Vomvas D, Raftopoulos V, Georgiou M, et al. Can J Surg. (2017) 36:1148. Nutr Cancer. Accumulating evidence suggests that up to 90% of HNC patients develop acute nutrition impairment due to the symptoms generated by the tumor location and treatment toxicity (i.e., dysphagia, mucositis) (73, 74). In addition, involving translational research teams should also be considered, as it will help reducing the existing gap between basic research and the daily clinical practice. They may also be described as interdisciplinary teams or multi-professional teams. may email you for journal alerts and information, but is committed The use of gastrostomy feeding tube is still a matter of debate (5963). (2001) 258:5147. Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, et al. It is also necessary to systematically evaluate patient's progress during the therapy in order to identify difficulties that could make this strategy impossible, and adapt it to patient possibilities. Zinc supplements have shown to be useful to improve the dysgeusia in a few studies (1719). (2006) 15:14654. (2012) 23:216672. Head Neck. Physician nurse coloration was strengthened by regular ward rounds (4 days a week). MA has received personal fess from Rovi, Aspen and Novartis.
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