Late Effects of Radiation Treatment in Head and Neck Cancer Survivors
By Jeffrey W. Cash, DDS
Survivors of head and neck cancer endure an exceedingly difficult journey. Late effects of radiation treatment become apparent years after they have been cured. As a dentist who has worked with patients faced with this life changing diagnosis, I wanted to try and summarize some of issues I have heard about from those under my care and from health care providers.
A common phrase I hear from survivors is that radiation is the “gift that keeps on giving.” Some say this to me in a humorous manner, but there is always a tone of sarcasm. The goal of radiation is to stop and cure the cancer, but those receiving it move forward with permanent side effects. Among those encountered are reduced or absent saliva, infections, progressive scarring, as well as difficulties wearing dental prosthetics. Together with the emotional and physical scars, these are continuous reminders of their illness. It hurts their ability to live full and happy lives.
What is Going to be the Biggest Problem?
The biggest complaint reported to me is the persistent lack of saliva. Radiation does a good job killing cancer tissue, but our saliva glands are extremely sensitive to it. The salivary gland locations make it difficult to avoid them in treatment. There are techniques to reduce exposure, however, few finish treatment without some damage.
Why is that so important? Our bodies have evolved so our mouth is a moist environment. The entire oral cavity is a delicately balanced system that relies on staying hydrated to function properly. If you change one part of that, the balance shifts and problems arise.
Without enough saliva, survivors lose the ability lubricate their mouth. This causes difficulty controlling acids, impairs speech, makes it hard to eat food, creates problems wearing dentures, and fight infections. Just one of these issues is enough to cause disruption in a sufferer’s daily life. Imagine not being able to talk to family or coworkers comfortably, to eat lunch, or wear your denture due to pain. This is a reality for hundreds of thousands of survivors every day.
What Else Changes?
The tissues and teeth also change after radiation. Teeth show changes that make them more prone to chipping. Muscles show scarring that requires physical therapy. Plus, survivors see a reduction in blood supply to bone making it difficult to heal.
While the brittleness of the teeth and muscle scarring can be managed to some extent, poor blood supply to the bone is beyond people’s ability to control. Very often, prior to beginning treatment, patients undergo the removal of some or all of their teeth. This becomes a significant problem for surgeons and patients after radiation if work is needed. If a survivor’s natural tooth becomes unfixable, the only option is to remove it, and many who have lost their teeth want to use dental implants to resolve this.
Both tooth removal and placement of implants are surgeries. Both are invasive and traumatic. A good blood supply is needed to heal. In areas of radiation, every patient is susceptible to developing osteoradionecrosis or ORN. This is when the surgery site does not heal due to the lack of a sufficient blood supply. The result can require removal of large amounts of bone to halt the process and reach areas with better blood flow. Unfortunately, this isn’t always possible and disfiguring surgeries can result.
Nobody Should Go It Alone.
Being the survivor of head and neck cancer requires a lifetime of care and support. All health care providers should inform them of what to be aware of before, during, and after treatment. The first line of defense is knowledge. Knowing what the long-term effects of treatment are is critical for these patients so they can better manage themselves. Until treatments other than radiation are developed, survivors will continue to experience these issues. Everyone involved in the care process (patients, physicians, dentists, and dental hygienists) should work closely together for the best result.