By Philip LoPresti, MD

After 32 years of treating patients with complications from radiation therapy, I thought I had experienced it all.

From fungal infections to ulcers, as a dermatologist, I was more familiar than most with the problems that head and neck cancer patients experience due to radiation. Often I would listen compassionately to patients describing their difficulties in swallowing, sleeping, eating, and speaking. Despite my patient experience in the office, I never fully appreciated the more subtle daily challenges that head and neck cancer patients endured until my personal experience as a patient.

After finding a small lump on the side of my throat, I was diagnosed with squamous cell cancer of the left tonsil and underwent a modified radical neck dissection in May 1997 at the Hospital of the University of Pennsylvania in Philadelphia. Radiation therapy would follow.

I knew what could also follow. Cancer patients treated with radiation beams that target the head and neck region are especially vulnerable to xerostomia, the medical term for chronic and severe dry mouth. It is the most common long-term side effect of head and neck radiation therapy and can affect one’s ability to perform the most common everyday activities—eating, talking, and swallowing.

Knowing the changes in my lifestyle that could result from radiation, I researched treatments that would help ease the side effects. One month prior to my surgery, the University had been approved to participate in a study to observe the effect of Ethyol® (amifostine), a drug that had shown promise in reducing severe dry mouth by protecting the salivary glands from radiation therapy. I volunteered to participate in the study and was fortunate to be chosen by random selection.

My treatments required me to be in the radiation therapy waiting area almost two hours daily, which gave me the opportunity to become acquainted with many patients as they came in for their daily radiation therapy. During the seven weeks of treatment, I was able to observe the effects of radiation on head and neck cancer patients, not only from the viewpoint of a physician, but now also as a fellow patient. Contrary to my expectations, I experienced no mouth sores, and although I experienced some difficulty with swallowing and speaking, it was far less than my fellow patients who were not being treated with Ethyol. Even during radiation therapy, I was eating foods with gravy and sauces.

I never realized that most patients who have had radiation to the head and neck area have difficulty eating bread until one day when I joined two ladies for breakfast who had experienced similar surgery and radiation therapy. As I approached their table from the cafeteria line, their eyes were wide in amazement. And as they looked at my tray, they both in unison exclaimed, “Phil, you can eat a bagel!”

My recovery from treatment was markedly improved in six weeks, and continues to improve to the present day. The long-term effects, in my professional opinion, are even more dramatic, and from a patient’s point of view, rather spectacular. I am now six years post-radiation and I can eat foods like breads and bagels without dunking. My speech is close to normal and I can even sing in church, although my range is more limited now. And, I do not walk through life with a water bottle in hand.

My advice to patients facing a diagnosis of head and neck cancer:

• Get informed by researching your diagnosis and treatment options.
  
• Talk with your doctor about your treatment and how to ease its potential side effects.
  
• Ask about clinical trials that might be right for you.
  

Head and neck cancer can affect what we all take for granted. But its treatment doesn’t have to.