Small Concerns Sometimes Have Greatest Impact

“We do not know what we mean by cure because there is a great difference between cure and long-term survival.”
– Dr. Arthur Holleb

“Doc, they can put a person on the moon, but you can’t fix my dry mouth. Why is that?” He sits in the exam chair glumly holding a half empty water bottle. The cancer was gone, but the radiation therapy had destroyed his ability to make saliva. Every night, he wakes up two or three times to take a sip of water, and he gripes that he can’t get a good night’s sleep. His sense of taste is shot, he has trouble chewing, and he needs a glass of water in order to swallow almost anything. He would give anything to have enough moisture to eat a slice of bread or some crackers!

The man’s complaint brought to mind research conducted by Dr. Marcy List at the University of Chicago. Dr. List found that when newly diagnosed Head and Neck Cancer patients are asked to list the things that they most hope for from their treatment, the top three concerns are “being cured,” “living long,” and “living pain free.” Less than ten percent of new patients mention any concern about the possibility of trouble with “chewing,” “being understood,” “taste,” or “dry mouth” (J Clinical Oncology 2000; 18:877).

When survival itself is at stake, what rational person worries about seemingly trivial problems such as oral dryness or loss of taste? Each type of cancer and its treatment has its own constellation of potential long-term problems. It strikes me as sadly ironic that the very concerns that are the least worrisome when treatment begins often develop into the most bothersome months and years later.

Future oral cavity cancer survivors will have fewer problems thanks to increasingly sophisticated radiation therapy techniques. For the survivors in my practice, though, the dryness will forever be a nagging aggravation and each meal reminds them anew of the diagnosis that many would rather forget.

Bruce H. Campbell, MD, FACS
Professor of Otolaryngology and Communication Sciences
Chief, Division of Head and Neck Oncology
Interim Director, Froedtert & Medical College Cancer Center

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.