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Perspectives on Care at the Close of Life: CODA
June 11, 2008

Palliative Care for Patients With Head and Neck Cancer: “I Would Like a Quick Return to a Normal Lifestyle”

JAMA. 2008;299(22):2679. doi:10.1001/jama.299.22.2679

On April 16, 2008, Goldstein et al1 presented the case of Mr K, a 57-year-old financial analyst with a long history of precancerous and cancerous oral lesions. In 1997, a tongue lesion demonstrated dysplasia. It was treated with topical steroids and then by both laser and surgical excision. The lesion recurred in 1999 and a biopsy revealed superficially invasive well-differentiated squamous cell carcinoma. He underwent wide resection with all margins clear of carcinoma but with residual dysplasia at the edges. In April 2006, worsening tongue pain occasioned another biopsy, which showed recurrence of the squamous cell carcinoma. He was referred to Dr U, an oral and maxillofacial surgeon, who performed a right partial glossectomy and ipsilateral neck dissection. Treatment required multiple resections, followed by radiation therapy. Several months after treatment, the significant pain from burns around the chin and neck, ulcers on his lips, and bleeding in his mouth had all abated. He was able to return to work part time and resume his independent life.