Rehabilitation in Head and Neck cancer: case report.

Case Diagnosis: squamous cell cancer of tongue

Case Description:

This is a case study of a 56y.o. male with squamous cell cancer of tongue managed with glossectomy, chemotherapy and radiotherapy, presented with seizure and infective endocarditis with a 21 mm aortic valve vegetation and underwent sternotomy and aortic valve replacement (AVR). He was started on 6 weeks of IV antibiotics. Post-op course was complicated by sternal infection, bradycardia with agonal breathing and a weak pulse for which the patient underwent cardiopulmonary resuscitation CPR and achieved return of spontaneous circulation (ROSC) and was re-intubated and managed with antibiotics. He had a tracheostomy placed and undergone aggressive pulmonary toileting and suctioning in acute care. As the patient was stabilized he was transferred to in patient rehabilitation.

Discussions: Cancer Rehabilitation can be preventative, restorative, supportive, and palliative. The rehabilitation goals changes as the cancer pathway alter.  Following any treatment for Head & Neck Cancer (HNC), physiatrist plays an essential role in preventing various complications and helping patients to mitigate impairments, and restoring function optimizing their quality of life.
Our patient, while being in the in-patient rehabilitation unit cancer rehabilitation issues were addressed including swallowing, pulmonary rehabilitation, upper extremity deep venous thrombosis prophylaxis, infection management, bowel and bladder issues, skin care and mental status evaluation. His cancer prognosis and future plans were discussed with his oncologist. He was discharged with palliative care plan in a safer condition and better quality of life.

Conclusions:

This report illustrates the significance of Physiatry involvement in management of cancer patients as most cancer patients experience some deconditioning that results in physical challenges. As the prognosis for most types of cancers improves, it becomes more important to ensure that all cancer patients regain maximum function in the broadest sense to maximize their independence.