Effective palliative care in head and neck cancer: need of the hour.

Sir,

Palliative care is an active field and is now standardized as a medical specialty with an innate interdisciplinary nature. As an interdisciplinary enterprise, the field of palliative care includes medicine, dentistry, nursing, social work, psychology, nutrition, and rehabilitation, although depth of support available from each discipline varies from establishment to establishment. The incidence and prevalence of head and neck cancer (including oral cavity) is increasing manifold all around the globe. The ratio of the affected patients to shortage of treating oncologists is disturbed in the present era of head and neck cancer. Head and neck cancer disproportionately affects those with the lowest income and the least education.[1] The majority of these cancers arise from the surface layers of the upper aerodigestive tract: The mouth, lip and tongue (oral cavity), the upper part of the throat and respiratory system (pharynx), and the larynx. Other UAT sites include the salivary glands, nose, sinuses and middle ear, but these cancers are relatively rare; cancer which originates in the nerves and bone of the head and neck is even rarer.[2] The identification and increased use of palliative care physicians and trained nurses who specialize in palliative care is one approach suggested to address this workforce shortage of oncologists. Most patient care is disease oriented, with a spotlight on the tumor, the treatment approach, and specialty consultation by various medical fields.[3] As very well stated in an article published in your esteemed journal, that the take-home message for oncologists and palliative care professionals should be that patients not given definitive therapy, but having responded exceptionally well to palliative treatment.[4] Patient-centered care broadens the center of attention and requires clear synchronization across specialties and disciplines and access to palliative care physicians and nurses. Physicians dealing with head and neck cancer cases cannot advocate what they do not know, and therefore, attending local and national presentations of palliative care to increase the knowledge base is an essential initial step. This can occur through local presentations, national and international meetings, online courses, and individual reading and investigations. Exploration of palliative research programs on treatment decision-making, family care, and advance guidelines are just a few of the areas that need thorough efforts. Patients should always be given full information about the expected effects of palliative interventions. Care should be taken when such treatment is proposed to ensure that patients understand that palliative treatment does not offer the prospect of cure: that the intention is to achieve improved quality of life, and potential benefits must be carefully balanced against adverse effects.[5] Thus, palliative care on a large scale at various establishments/institutions aiming to maintain patient comfort and dignity in such cases is the need of the hour.