Christopher E. Fundakowski - Head and Neck Cancer: Psychological and Psychosocial Effects

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There has been a dramatic shift in the way we talk about, approach, and treat head and neck cancer. In a world where many refer to the good old days as a thing of the past, that is not the case in head and neck cancer. The exciting times are right now as we approach cancer care in a way was unimaginable a decade ago. Radically morbid surgery is commonly the exception rather than the rule, and in many cases, the patient has no visible incision, dramatically reduced length of stay, and improved outcome. Reconstructive techniques continue to advance, and great lengths and planning are commonly undertaken by multiple teams before, during, and after surgery to tailor and optimize the function and appearance. Incredibly, free tissue transfers have become the standard of care for many surgical defects, and with the benefit of highly experienced teams, the days of cases running into the early morning hours are few. The administration of radiation has changed where we no longer see the woody necks that we used to. Immunotherapy has and will continue to be an exciting area that may prove to completely change the way we approach and think about cancer treatment.

While we commonly focus on survival as a major endpoint in cancer care, it is easy to sidestep the dramatic psychological and psychosocial impact that this diagnosis carries. Patient outcomes are much broader than survival. These are commonly complicated issues that take a great deal of time to tease out in a busy clinical setting, surgeons/oncologists commonly lack focused training in these areas, and successful interventions and management of these issues are difficult. Building teams which contain individuals with the appropriate expertise, experience, and availability for these patients is critical.

I have been fortunate to work with many talented head and neck cancer providers given the multidisciplinary nature of our field and am grateful for their input, contributions, and expertise which have made this text possible. The goal of this project was to examine in detail the many areas of impact for the patient who is traveling through the diagnosis and treatment of a head and neck cancer. The reader will be able to explore many of these issues in depth, such as the trends in diagnosis of head and neck cancer, advances and outcomes associated with minimally invasive surgery, long-term quality of life and functional outcomes, issues related to cancer pain, importance and impact of nutrition, how reconstructive advances affect functional outcomes, the impact of cancer recurrence, and financial consequences of cancer diagnosis and treatment.

Fortunately, I would say that our field as a whole understands the importance of these issues and invariably wants nothing but the best for our patients. It is our job now to develop workflows, resources, and a clinical environment that both integrates and places value on all of these facets, knowing that, ultimately, it will impact patient outcomes.

I would like to thank my wife, Aimee, who somehow has remained supportive and tolerant of my career while being an unbelievable mother and wife and full-time healthcare professional. I also owe the foundation and trajectory of my career to my other two families, Miami and Nashville. I am fortunate to have so many gifted clinicians who take part in this project. Thank you again for your time and efforts.