Function after oral oncological intervention, reconstruction and rehabilitation

Abstract

In the Netherlands, the incidence of oral cancer is increasing. Progress in (reconstructive) surgery, radiotherapy and chemotherapy, however, has improved survival and loco-regional control while trying to preserve or restore oral function and quality of life. Despite the progress in treatment, patients are still confronted with impairment or loss of essential functions. The deterioration of function may be caused by the tumour itself, but may also be induced by the oncological therapy. Surgery may result in tissue defects dependent on the localization, tumour size and cervical lymph node metastasis, whereas radiotherapy may result in troublesome and uncomfortable fibrosis which may worsen with time. This thesis describes investigations into the effects of oral oncological intervention, reconstruction and rehabilitation on function of the mouth, neck and shoulders. The outcomes are based on self-perceived experiences and objectively measured function in patients treated for oral cancer. Using self-perceived and objective outcomes, it was the intention to improve the knowledge of deterioration and recovery of function of these patients after oncological therapy, reconstruction and rehabilitation. First, a retrospective study was performed on self-perceived function of 158 patients treated for oral malignancies, in order to get information on the way these patients experience their oral abilities five years after oncological intervention. Secondly, 145 patients with a primary oral carcinoma were recruited for prospective evaluation of oral and oral-related functions. Exclusion criteria were previous or synchronous malignancies, cognitive impairment, and inability to understand Dutch. In addition 60 healthy people, matched for age, were recruited so that the outcomes of the patients could be compared with those of healthy controls. This thesis showed that more deterioration in function occurred when patients had larger tumours and had a higher degree of cervical lymph node metastasis. Larger tumours and more extended cervical lymph node metastasis have to be treated by more extended therapy. In our study we observed no further deterioration of function as a result of adjuvant radiotherapy in the period between shortly after surgery and shortly after radiotherapy. Thus, no significant short term effects of radiotherapy on function were observed. Possible effects of radiotherapy on function, however, may have been concealed by the ongoing effects of the surgical intervention. Within a year after intervention, function partly recovered depending on which function was performed. Recovery of function was less evident in patients with more intensive surgical intervention. It can be assumed that recovery will take more time for these patients. Our retrospective study learned that after five years part of the patients treated for oral cancer still reported deterioration in xerostomia, dental state, chewing, and lip competence. Research on revalidation interventions, such as (orofacial) physiotherapy, speech and swallow therapy, and dietetics is needed to further improve (oral) function after intervention. The physiotherapist, specialized in training and optimization of the mobility of the musculoskeletal system, may help to maximize rehabilitation of (oral) functions. Evaluating physiotherapy interventions, preferably by randomized clinical trials, will give information on whether rehabilitation treatment is successful in further reducing function deficit