Laryngeal cancer is a complex diagnosis for both patients and families. This article aims to provide guidance and support for families new to caring for a loved one with laryngeal cancer. We will discuss what to expect throughout the disease, the changes you may notice in your loved one, and how to provide optimal care from the initial diagnosis to the end.
Laryngeal cancer affects the larynx, also known as the voice box, which plays a vital role in breathing, swallowing, and speaking. When cancer strikes this essential organ, it presents significant challenges.
Understanding the Disease
Symptoms and Causes
Laryngeal cancer can exhibit various symptoms, including hoarseness, difficulty swallowing, persistent cough, and throat pain. Recognizing these signs early and seeking medical advice is crucial. Smoking and excessive alcohol use are common risk factors.
Diagnosis and Treatment
Diagnosis typically involves a physical examination, imaging tests, and a biopsy. Treatment options may include radiation therapy, surgery, or medication. Consult healthcare professionals to determine the best approach for your loved one's situation.
Changes You Might Observe
As a family member, being aware of the changes your loved one may undergo during their battle with laryngeal cancer is crucial. These changes can be physical and emotional.
Physical Changes:
Voice Changes: Hoarseness or loss of voice is common due to the cancer's location.
Swallowing Difficulties: Trouble swallowing can lead to weight loss.
Breathing Issues: Advanced cancer may cause breathing difficulties.
Emotional Changes:
Emotional Impact: A cancer diagnosis can trigger fear and anxiety.
Communication Challenges: Difficulty speaking can be frustrating and emotionally taxing.
What to Expect Towards End-of-Life
Symptoms for a hospice registered nurse caring for patients with laryngeal cancer may vary, but common symptoms include:
Cough: A persistent cough, especially in lung-involved cases.
Breathing Difficulties:Shortness of breath due to tumor affecting lung function.
Chest Pain: Reported by some due to cancer's impact on the lungs or nearby structures.
Fatigue: Severe cancer-related fatigue affecting daily life.
Odynophagia: Paint with swallowing.
Weight Loss: Often observed, linked to decreased appetite and energy expenditure.
Poor Appetite: Reduced desire to eat, contributing to weakness.
Disturbed Sleep Patterns: Insomnia or frequent awakenings affecting well-being.
Weakness and Debility: Muscle weakness makes daily activities challenging.
The following pharmacological and non-pharmacological methods can be used to manage a number of these symptoms:
Pharmacological Methods:
Cough: Medications such as cough suppressants or expectorants may be prescribed to help manage a persistent cough. Consider guaifenesin and dextromethorphan with or without nebulizers with consideration for albuterol-sulfate vs. ipratropium-bromide and albuterol sulfate (DuoNeb's).
Breathing Difficulties: Bronchodilators, corticosteroids, or oxygen therapy may improve lung function and alleviate shortness of breath.
Chest Pain: Pain medications, such as opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), may be prescribed to help manage chest pain.
Odynophagia: Nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids may be prescribed to manage pain associated with swallowing difficulties; also consider having the patient gargle with magic mouthwash before attempting to eat.
Disturbed Sleep Patterns: Sedative medications, such as benzodiazepines or non-benzodiazepines hypnotics, may be prescribed to help improve sleep quality.
Non-Pharmacological Methods:
Cough: Practicing deep breathing exercises, staying hydrated, and using a humidifier or steam inhalation may help alleviate a persistent cough.
Breathing Difficulties: Pulmonary rehabilitation, which includes breathing exercises and physical activity, can help improve lung function and reduce shortness of breath. Positioning, such as sitting in a high-backed chair, can aid in better lung expansion. Consider a small portable fan pointed towards the patient's left or right cheek to stimulate the trigeminal nerve. Consider teaching pursed lip breathing.
Chest Pain: Relaxation techniques, such as deep breathing or guided imagery, may help manage chest pain.
Odynophagia: To ease swallowing and reduce pain, a soft or liquid diet may be recommended. This can include foods that are easier to swallow, such as pureed or mashed foods and avoid hard, dry, or sticky foods. Also, consider a humidifier or steam inhalation, which can help keep the throat moist and reduce discomfort during swallowing.
Disturbed Sleep Patterns: Establishing a regular sleep schedule, creating a comfortable sleep environment, and practicing relaxation techniques before bed may help improve sleep quality.
Examples of Dietary Changes
Dietary changes that can help with swallowing difficulties in laryngeal cancer patients include:
Soft Diet: opt for foods that are easier to swallow, such as pureed or mashed foods, and avoid foods that are hard, dry, or sticky. Examples of soft foods include:
Pureed soups
Mashed potatoes
Smoothies
Yogurt
Pudding
Moistening Foods: Add sauces, gravies, or salad dressings to moisten foods and make them easier to swallow.
Avoiding Acidic or Spicy Foods: These foods can irritate the throat and cause discomfort during swallowing.
Chew Food Thoroughly: Chewing food longer allows for more contact with taste buds, which can help with taste changes and potentially improve the overall eating experience.
Sip Water or Other Liquids: Drinking water or other liquids while eating can help moisten the throat and make swallowing easier.
Avoiding Hot Foods: Hot foods can cause pain and discomfort in the mouth and throat, so it's best to consume foods at room temperature or cold.
Cut Food into Small Pieces: Cutting food into smaller, bite-sized pieces can make it easier to chew and swallow.
Using a Straw: Drinking with a straw can help move liquid past the painful parts of the mouth and throat, making it easier to swallow.
Avoiding Alcohol-based Mouthwash: Alcohol-based mouthwashes can further dry out the mouth, so it's best to use a mouth rinse made with ¼ teaspoon baking soda, ⅛ teaspoon salt, and 1 cup warm water.
Some clear liquids that can be consumed by laryngeal cancer patients with swallowing difficulties include:
Water: Sipping on water throughout the day can help with hydration and swallowing.
Non-acidic fruit juice: Choose fruit juices that are not too acidic, such as apple or pear juice, to avoid irritation in the throat.
Sports drinks can provide hydration and some electrolytes, which may benefit laryngeal cancer patients.
Broth: Clear, low-sodium broths can be a reliable source of hydration and provide some flavor.
Ensure® Clear or Boost® Breeze: These are nutritional drinks designed to be clear and provide some calories and nutrients for laryngeal cancer patients.
Some clear liquids that should be avoided by laryngeal cancer patients with swallowing difficulties include:
Acidic fruit juices: Citrus juices like orange or grapefruit juice can irritate the throat and cause discomfort.
Spicy liquids: Avoid hot sauces, spicy drinks, or anything that may cause a burning sensation in the throat.
Carbonated beverages can cause gas and bloating, which may worsen swallowing difficulties.
Alcoholic beverages: Alcohol can be drying and may irritate the throat, making swallowing more challenging.
Providing End-of-Life Care
There may come a time when the cancer treatment is no longer working, and your loved one is nearing the end of life. This can be an exceedingly difficult and emotional time for both of you. You may feel sad, angry, scared, or numb. You may also have many questions and concerns about what will happen and how to help your loved one. This section will give tips on providing end-of-life care and ensuring comfort and peace for your loved one.
Hospice Care:Hospice care focuses on making your loved one as comfortable as possible in the last months, weeks, or days of life. Hospice care does not try to cure cancer or prolong life but rather to relieve pain and other symptoms, such as nausea, shortness of breath, or anxiety. Hospice care also provides emotional and spiritual support for your loved one and family. Hospice care can be given at home, in a hospital, or at a hospice facility, depending on your loved one's needs and preferences. You can help your loved one by:
Talking to the doctor about hospice care. You can ask the doctor if your loved one is eligible for hospice care and when it might be appropriate to start. You can also ask the doctor for a referral to a hospice program in your area. You can find more information about hospice care from the National Hospice and Palliative Care Organization or the American Cancer Society.
Choosing a hospice program that meets your loved one's needs. You can compare hospice programs based on their services, staff, costs, and location. You can also visit the hospice facility or talk to the staff to understand their philosophy and approach. You can ask questions such as:
What services do you offer, and how often?
Who will be part of the hospice team, and how will they communicate with us?
How do you manage pain and other symptoms?
How do you provide emotional and spiritual support?
How do you handle emergencies or after-hours calls?
How do you coordinate with other healthcare providers?
How do you bill for your services, and what insurance do you accept?
Working with the hospice team to create a care plan. The hospice team will include a doctor, a nurse, a social worker, a chaplain, a counselor, a home health aide, and a volunteer. They will work with you and your loved one to create a care plan that reflects your loved one's wishes and goals. The care plan will include details such as:
What medications and treatments will your loved one receive, and how will they be administered?
What equipment and supplies will your loved one need, and how will they be delivered?
What comfort measures and complementary therapies will your loved one use, such as massage, music, or aromatherapy?
What emotional and spiritual support will your loved one and your family receive, such as counseling, prayer, or rituals?
What legal and financial matters must your loved one and your family address, such as advance directives, wills, or funeral arrangements?
Providing care and support for your loved one. You will be the primary caregiver for your loved one, but you will not be alone. The hospice team will visit your loved one regularly and be available by phone 24/7. They will teach you how to care for your loved one, such as giving medications, changing dressings, or using equipment. They will also monitor your loved one's condition and adjust the care plan. You can also ask for help from other family members, friends, or volunteers. You can help your loved one by:
Giving them their medications and treatments as prescribed and on time. Do not skip or change the doses without consulting the hospice team.
Keeping track of their pain and symptom level and how well the medications and treatments are working. Report any changes or concerns to the hospice team.
Providing comfort measures, such as massage, heat, ice, or distraction. You can also help them find a comfortable position, use pillows or cushions, or adjust the lighting or temperature in the room.
Being there for them emotionally and spiritually. Listen to their feelings and concerns without judging or interrupting. Try to be positive and hopeful but also realistic and honest. Share your feelings and fears with your loved one or someone you trust. You can also seek professional help from a counselor or therapist if you or your loved one are feeling overwhelmed, depressed, or anxious.
Emotional Well-being: The end of life can be a time of mixed emotions for your loved one and family. Your loved one may feel grateful, peaceful, or relieved but also sad, angry, or scared. They may also have regrets, unfinished business, or unfulfilled dreams. You can help your loved one by:
Help them find meaning and purpose in their lives. You can help them reflect on their life story, achievements, values, and legacy. You can also help them express their gratitude, forgiveness, or love to those who matter to them. You can use different methods like writing, drawing, recording, or making a scrapbook.
Helping them cope with their fears and worries. You can help them identify and address their sources of fear and worry, such as pain, suffering, loss of control, or the unknown. You can also help them find ways to reduce their anxiety and worry, such as talking, praying, meditating, or breathing. You can also help them find comfort and hope in their faith, beliefs, or philosophy.
Helping them create cherished memories. You can help them make the most of their time with their loved ones. You can help them plan and enjoy special occasions like birthdays, anniversaries, or holidays. You can also help them create meaningful gifts, such as letters, videos, or jewelry, for their loved ones to remember them.
Conclusion
Caring for a loved one with laryngeal cancer is challenging but an opportunity for support, love, and understanding. Staying informed, seeking medical guidance, and offering emotional support can significantly improve your loved one's quality of life during this grim time.
