Rehabilitation, Supportive Care, and Survivorship
Function and rehabilitation
Head and neck treatment profoundly affects speech, swallowing, and appearance. Know that early involvement of speech-language pathology improves swallowing outcomes, that prophylactic swallowing exercises can reduce dysphagia, and that laryngectomy patients require alaryngeal communication planning (tracheoesophageal speech, electrolarynx, esophageal speech). Physical therapy and prosthodontics (including obturators for maxillary defects) are part of the plan.
Supportive care
Understand the pillars: pain management, nutrition (including feeding tube decisions and timing), oral care, management of xerostomia, and psychosocial support. Recognize depression, anxiety, and caregiver burden. Know that smoking cessation and alcohol counseling improve outcomes and reduce second primaries.
Survivorship
Survivorship care includes surveillance for recurrence and second primaries, thyroid function monitoring after neck radiation, dental and swallowing follow-up, and addressing late effects like trismus, fibrosis, and osteoradionecrosis. Know that HPV-related survivors have distinct follow-up considerations but still need surveillance.
Traps
Questions often test whether rehabilitation is started early versus after treatment ends, or whether a symptom (e.g., shoulder dysfunction after neck dissection) is recognized as a known morbidity requiring targeted rehab (spinal accessory nerve). Another trap is attributing all post-treatment symptoms to recurrence when they may be late effects.
Rule of thumb
For any survivorship item, ask: what function is at risk, what late effect is expected, and what surveillance is due? Example: after modified radical neck dissection, shoulder droop and pain suggest spinal accessory nerve dysfunction-refer for physical therapy rather than assuming recurrence.