Maintaining proper nutrition is a vital component of cancer treatment. Research suggests malnutrition impacts up to 80 per cent of cancer patients, and some studies indicate the likelihood of survival is decreased if a patient experiences as little as a 5 per cent drop in weight. Eating well and regularly helps patients maintain the energy stores necessary to complete invasive procedures such as surgery, chemotherapy and radiation.
Head and neck tumors, such as tumors of the tongue, tonsil and throat, can cause difficulty eating and swallowing. Swallowing difficulties can deprive patients of sharing meals with loved ones and increase risk of malnutrition — often resulting in social isolation, depression and weight loss. Weight loss can be detrimental, delaying procedures or even halting treatment entirely.
At Edmonton’s Cross Cancer Institute, the complex challenge of helping patients with head and neck cancer return to normal eating is tackled by a group of four professionals — dietitian Patty Tachynski, speech-language pathologist (SLP) Anna Sytsanko, nurse practitioner Karmen Schmidt and rehabilitation assistant Bev Mangano. This team coordinates their disciplines to customize treatment and help alleviate symptoms for head and neck patients.
“The patient doesn’t walk through treatment with one professional,” says dietitian Tachynski. “They actually often need several to get them through.”
Tachynski’s job is to identify patients who are at risk for malnutrition and to help them maintain their nutritional status during treatment. One obstacle for Tachynski is that, for head and neck patients, the nerves and muscles that generate swallowing can be impacted by the cancer itself. Inefficient swallowing can be dangerous, causing patients to choke on food or inhale liquids. It also disrupts caloric intake, heightening the threat of malnutrition.
To stave off this dangerous symptom, Tachynski works closely with SLP Anna Sytsanko, who sees patients with concerns about swallowing and communication.
The therapy Sytsanko provides is crucial, first assessing why the patient struggles to swallow before targeting and strengthening muscles with exercises that can enable them to eat. Relying on each other, Sytsanko says, is necessary to optimize care; it allows the team to understand patients — and their needs — comprehensively.
“You need to see the person as a whole, and treat swallowing difficulties in that framework,” Sytsanko says.
When medical issues emerge that fall outside Sytsanko and Tachynski’s expertise, they are supported by nurse practitioner Karmen Schmidt, who manages complications such as pain, infections and feeding tube referrals, which head and neck cancer patients sometimes require.
“I value the skillset that my colleagues have, and that I’m able to consult with them, discuss with them, learn from them, and collaboratively come up with a plan for our patients,” Schmidt says.
Working mostly behind the scenes to assist the others is rehabilitation assistant Bev Mangano. She sometimes sees patients for swallow or speech practice, but primarily keeps days organized and appointments running smoothly for the team. She also helps patients avoid social isolation during and after treatment, connecting those living too far to commute to the Cross with Telehealth videoconferencing sessions and arranging group therapy for patients seeking support.
Together, the team works within the larger operation of the Cross, coordinating with oncologists, nurses and many others. Within this spectrum of care, the team of four not only strives to provide the nourishment patients need during treatment, but also helps them take part in meals with family and friends again — feeding the body as well as the soul.
“No one can do it alone; we work together every day,” Sytsanko says. “And our care revolves around the patient.”