Competing Morbidities In Advanced Head And Neck Squamous Cell Carcinoma Concurrent Chemoradiotherapy: A Strong Implication Of A Multidisciplinary Team Approach

Abstract

Grazia Lazzari,1 Maria Assunta De Cillis,2 Giovanni Buccoliero,3 Giovanni Silvano1 1Radiation Oncology Unit, S. Giuseppe Moscati Hospital, Taranto 74100, Italy; 2Otorynolaringoiatry Unit, S. Giuseppe Moscati Hospital, Taranto 74100, Italy; 3Infection Diseases Unit, S. Giuseppe Moscati Hospital, Taranto 74100, ItalyCorrespondence: Grazia LazzariRadiation Oncology Unit, S. Giuseppe Moscati Hospital, Str. Per Martina Franca, Taranto 74100, ItalyTel +039-099 4585721Email [email protected]: Concurrent chemoradiotherapy (CCRT) is the standard approach for the treatment of locally advanced head and neck squamous cell carcinoma. Despite its undisputed advantages, CCRT is associated with acute and late toxicities, leading to unfavorable implications (eg, unplanned interruptions and noncancer-related mortality). The former prolongs the overall treatment time leading to a detrimental effect on tumor control. The latter consists of several noncancer morbidities arising from treatment-related toxicities, identifying a new pathway in cancer fate. This pathway has been termed noncancer mortality or competing mortality and consists of a series of treatment-competing morbidities, which nullify all therapeutic efforts aimed at curing these patients. The management of patients with head and neck squamous cell carcinoma who experience treatment-related toxicities is complex and requires expertise in oncological treatment as well as supportive care. The optimal management of these patients should start with knowledge regarding the most important competing morbidities developing during all phases of the disease (ie, from diagnosis to follow-up) to minimize treatment interruptions, ensure appropriate psychological support, and achieve the best oncological result. The purpose of the present review is to analyze the most important competing morbidities due to patient’s condition at baseline and CCRT, which could result in noncancer mortality. A multidisciplinary team approach is strongly required in the management of this disease.Keywords: competing mortality, head and neck squamous cell carcinoma, concurrent chemoradiotherapy, multidisciplinary team  

Keywords

• competing mortality
• head and neck squamous cell carcinoma
• concurrent chemoradiotherapy
• multidisciplinary team