Introducing counselling for patients who suffer from head and neck cancer
Prof Dennis Kraus - North Shore-LIJ Cancer Institute, New York, USA
Can you tell us about your HPV discussion?
If you look during my 25 year career in head and neck surgery, one of the really tremendous developments has been the emergence of the human papilloma virus. So there was a time during my training in the late ‘80s where most patients who had oral cavity cancer suffered from the use of tobacco and alcohol. As a consequence of the sexual revolution we now see this sexually transmitted human papilloma virus that results in cancers both in the tonsil and the base of tongue. The good news is that this population of patients have a very good prognosis; the bad news is that this is a very difficult topic to address to patients. My component of the talk today was actually talking about counselling of patients. You have a patient who has a combination of a sexually transmitted disease and cancer and the stigma, the potential shame, the duress it puts on relationships can be really staggering for this patient population. So it’s not uncommon that I spend 45 minutes to an hour with each of these patients during their consultation and I spend a lot of time trying to explain to them how this shouldn’t change their relationship with their partner, how it shouldn’t change their sexual practices, how it doesn’t put their partner at any additional risk that they weren’t already under prior to this event. I think it’s really a critical component of what we do. It’s really important that we try to heal our patients but I don’t think we can ignore their soul and I think that this is really a tremendous part of what we’ve done and it’s something that I’ve been very passionate about. So I think that it’s a message that I personally try to get out and I hope that I’m impacting upon other people’s practices, how they interact with their patients.
Is this something that vaccination can eliminate altogether?
That is a very controversial issue. So I’d made some comments in the LA press a couple of years ago. There were a number of individuals in organised medicine who took exception, who said that there was not a level of proof that vaccination prevents the oncologic component of this disease. But all I can tell you is that I am eating my own cooking and that all three of my young adult children were vaccinated.
Could screening help?
Screening in this population is very difficult. As I talked about, in terms of this disease from the North American perspective, which was again a talk that we gave today, it was myself and my two predecessors as President of the American Head and Neck Society, Terry Day from the Medical University of South Carolina, Doug Girod from Kansas University. Roughly 75-80% of adults in the United States have been infected with HPV at some point in their life and our ability to screen for the disease is very limited and our ability to develop predictive models of who will eventually develop the cancer is also, at this juncture, fairly limited. So the ability to screen is very difficult. I have a number of patients who end up with small papillomas on their tongue or their tonsil; there are men whose wife or spouse have known cervical dysplasia, even have had cervix cancer, and they want to be screened. I’m certainly willing to offer that service but in terms of objective data that shows that it really changes outcome, I think that’s very limited.
