Oropharyngeal Cancer Case Study

Mr.C is a 60-year-old gentleman who was recently diagnosed with oropharyngeal cancer in July 2015 at the Jewish General Hospital. He lives with his two children, 19 and 21 years old, who are both in university studies. His CT scan showed a soft tissue mass on his right tonsil extending posteriorly to the oropharyngeal wall, involving to the right base of the tongue, blocking 75% of his airway. Two months before diagnosis, he was complaining of a sore throat, dysphagia, otalgia and frequent coughing with whitish sputum and blood clots. His curative treatment plan consisted of 30 treatments of radiation therapy, with weekly chemotherapy.

Cancer has affected many people in his family, where his brother died of pancreatic cancer, his father died

He has a medical history of a cardiac stent in 2004 and a history of gout, which is treated with Allopurinol.

At the time of diagnosis, he had an ECOG Performance status of 0, where he was fully active and able to carry out all pre-disease performance without any physical limitations. By week three of treatment, he had progressed to an ECOG of 2, where he was able to ambulate and still capable of all self-care but unable to carry out any work activities, which caused him to quit his job. He had stopped eating solid foods due to dysphagia and odynophagia, and lost 7.4% of his total body weight since July. Severe weight loss is categorized as more than 10% weight loss in six months and has a great impact on the patient’s nutrition status and quality of life (Petruson,

Silander & Hammerlid, 2005). He was not meeting his energy and protein requirements, was severely dehydrated and was experiencing xerostomia, anorexia, mucositis and was not compliant to his treatment plan or interventions.

Strengths, Deficits, Risks and Resources

CASE

All these factors lead to a reduced food intake, which affect nutritional status (Van Cutsem &

Arends, 2005). Furthermore, radiation induced xerostomia is a deficit because it can contribute to the dysphagia (Rosenthal, Lewin & Eisbruch, 2006). Dehydration is a deficit because it puts him at risk of xerostomia, due to dehydration of the mucous membranes (Davies, Broadley &

Beighton, 2001)

Resources

Mr. C has a big support system, where he lives with his two grown children, who encourage him to be compliant with treatment, who encourage him to keep well nourished, hydrated and well rested. He lives next door to his mother, who sometimes drives him and picks him up from his treatments, when his children cannot. He also has family friends who offer to drive and pick him up from appointments. He also has a huge support system at the hospital, especially from the nurses and dietician, who follow his nutrition and weight closely. See Appendix B for Mr. C’s eco-map. CASE STUDY

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Health Issue

Mr. C is at risk of malnutrition related to dysphagia, odynophagia, dysgeusia, xerostomia due to radiation