EXPERT OPINION
Meet the Expert : Irma Verdonck-de Leeuw
Irma Verdonck-de Leeuw originally graduated as a psychologist , speech pathologist and linguist and is now Professor of Psychosocial Oncology at the University Medical Centre Amsterdam . She spoke with us about head and neck cancer and , in particular , the European Head and Neck Society recommendations for head and neck cancer survivorship care .
Q Can you tell about your institution ?
A Professor Verdonck-de Leeuw explained that her head and neck team has 7 surgeons , three radiologists dedicated to head and neck cancers and two medical oncologists . However , she added that the centre also has a multi-disciplinary team that includes speech pathogists , physiotherapists , dieticians , psychologists and social workers . It is a busy department that sees around ‘ 500 new head and neck cancer diagnoses every year ’. However , the caseload comprises a mix of new and returning patients and at a weekly outpatient clinic , staff can see ’ 40 – 50 patients for their follow-up care on a clinic day .’
Q How common are head and neck cancers in the Netherlands ?
A According to Professor Verdonck-de Leeuw , there are approximately ‘ 3200 new head and neck cancers diagnosed every year in the Netherlands and the care is centralised in the university medical centres and the vancer centre .’ Across the whole of Europe , she thinks that the incidence of head and neck cancers is around 22 per 100,000 and believes that globally , such cancers are the fifth or sixth most common . The high incidence is a likely reflection of the heterogenous nature of the cancers in the head and neck area , such as those originating in mucosa of the oral cavity , throat , nose or larynx , which are distinct and relatively rare types of cancer .
Q What are the most common symptoms of head and neck cancers ?
A Professor Verdonck-de Leeuw described how typically , ‘ patients present with a complaint of a sore tongue , pain in the throat , a hoarse voice , a blocked nose , a lump in the neck or a problem with swallowing .’ While these symptoms might have other potential causes , she added that it was more likely to be a cancer , particularly where the duration of symptoms exceeded three weeks . In fact , she says that such symptoms should be considered as ‘ red flags ’ and a prompt to both patients and clinicians of a potential problem that warrants referral to a specialist . Although
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The drive to develop the guidelines came from the European Head and Neck Society and a steering committee within the society that organises the ‘ Make Sense campaign
patients are usually referred by their GP , an alternative route is via a dentist , who after an oral examination might spot something unusual and have a suspicion about cancer . She also mentioned that head and neck cancers are very rare below the age of 40 and that the mean age of affected patients is about 61 years of age .
Overall survival rates for head and neck cancer , she says , are between 55 % and 60 %. However , this is highly dependent upon the stage at which the cancer is detected and this is largely driven by patients ’ symptoms . For instance , a cancer of the vocal cords is more likely to be picked up at an earlier stage , simply because patients seek medical advice over the continued presence of hoarseness , such that the survival rate can be as high as 90 %. In contrast , patients with a cancer in the hypopharynx or the oral cavity are often asymptomatic and once symptoms occur , the cancer is more likely to be at an advanced stage ( such as 3 or 4 ) and thereby having a worse prognosis .
Q What are the main concerns or burdens for patients with head and neck cancers ?
A Professor Verdonck-de Leeuw described that once a patient receives a cancer diagnosis and begins a course of treatment , there are inevitably a number of concerns , including an initial ‘ uncertainty over whether the treatment is going to work , together with the burden of side-effects from therapy .’ She explained how adverse effects are particularly burdensome because the cancer might affect an individual ’ s ability to speak or swallow . This has a potentially huge impact not only upon the patient but also on other family members or carers , especially if the patient is unable to communicate their feeling or concerns . Such cancers also negatively impact a patient ’ s social life , as meeting friends for drinks or meals can create difficulties .
Q What are the main factors associated with the development of head and neck cancers ?
A She described how smoking and excessive alcohol use are important lifestyle