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Recommendations for Care of Survivors of Head and Neck Cancer

To identify the key insights or developments described in this article
1 Credit CME

Head and neck cancer affects about 66 000 patients and causes 15 000 deaths annually in the US.1 More than 90% of cases are due to squamous cell carcinoma (SCC) that originates from the oral cavity, oropharynx, and larynx.2 The epidemiology of SCC of the head and neck (HNSCC) has shifted in recent decades, with an increase in human papillomavirus (HPV)–associated SCC of the oropharynx and a decrease in tobacco- and alcohol-associated SCC,3 with important race and sex differences in access to care and survival.4 Patients often present with locoregionally advanced disease, leading to important morbidities of speech, deglutition, and cosmesis that stem both from the disease and its treatment, which often involves a combination of surgery, chemotherapy, and radiation. Most recurrences occur in the first few years after treatment. The National Comprehensive Cancer Network (NCCN) recommends integration of primary care in survivorship care within 1 year of completion of treatment, complementary to the oncology team. There has been an increased focus and maturation of the concept of cancer survivorship since previous efforts.4 The current guidelines offer a concise summary of best practices for this integrated care.

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Article Information

Corresponding Author: Ari J. Rosenberg, MD, University of Chicago, 5841 S Maryland Ave, MC 2115, Chicago, IL 60637 (arirosenberg@medicine.bsd.uchicago.edu).

Published Online: October 6, 2022. doi:10.1001/jama.2022.17064

Conflict of Interest Disclosures: None reported.

References
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Siegel  RL , Miller  KD , Fuchs  HE , Jemal  A .  Cancer statistics, 2022.   CA Cancer J Clin. 2022;72(1):7-33. doi:10.3322/caac.21708PubMedGoogle ScholarCrossref
2.
Mody  MD , Rocco  JW , Yom  SS ,  et al.  Head and neck cancer.   Lancet. 2021;398(10318):2289-2299. doi:10.1016/S0140-6736(21)01550-6PubMedGoogle ScholarCrossref
3.
Ellington  TD , Henley  SJ , Senkomago  V ,  et al.  Trends in incidence of cancers of the oral cavity and pharynx—United States 2007-2016.   MMWR Morb Mortal Wkly Rep. 2020;69(15):433-438. doi:10.15585/mmwr.mm6915a1PubMedGoogle ScholarCrossref
4.
Nekhlyudov  L , Lacchetti  C , Davis  NB ,  et al.  Head and neck cancer survivorship care guideline.   J Clin Oncol. 2017;35(14):1606-1621. doi:10.1200/JCO.2016.71.8478PubMedGoogle ScholarCrossref
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Vawda  N , Banerjee  RN , Debenham  BJ .  Impact of smoking on outcomes of HPV-related oropharyngeal cancer treated with primary radiation or surgery.   Int J Radiat Oncol Biol Phys. 2019;103(5):1125-1131. doi:10.1016/j.ijrobp.2018.11.046PubMedGoogle ScholarCrossref
6.
Cadoni  G , Giraldi  L , Petrelli  L ,  et al.  Prognostic factors in head and neck cancer: a 10-year retrospective analysis in a single-institution in Italy.   Acta Otorhinolaryngol Ital. 2017;37(6):458-466. doi:10.14639/0392-100X-1246PubMedGoogle ScholarCrossref
7.
Goyal  N , Day  A , Epstein  J ,  et al.  Head and neck cancer survivorship consensus statement from the American Head and Neck Society.   Laryngoscope Investig Otolaryngol. 2021;7(1):70-92. doi:10.1002/lio2.702PubMedGoogle ScholarCrossref
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McDowell  L , Rischin  D , Gough  K , Henson  C .  Health-related quality of life, psychosocial distress and unmet needs in older patients with head and neck cancer.   Front Oncol. 2022;12:834068. doi:10.3389/fonc.2022.834068PubMedGoogle ScholarCrossref
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Osazuwa-Peters  N , Simpson  MC , Zhao  L ,  et al.  Suicide risk among cancer survivors.   Cancer. 2018;124(20):4072-4079. doi:10.1002/cncr.31675PubMedGoogle ScholarCrossref
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Cramer  JD , Grauer  J , Sukari  A , Nagasaka  M .  Incidence of second primary lung cancer after low-dose computed tomography vs chest radiography screening in survivors of head and neck cancer.   JAMA Otolaryngol Head Neck Surg. 2021;147(12):1071-1078. doi:10.1001/jamaoto.2021.2776PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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