Palliative Care: Research and Treatment

Aims: Response of single agent chemotherapy in improving quality of life in patients with recurrent head and neck cancers.

Methods and material: This is a study of the 18 patients with advanced cancers of head and neck, who had failed earlier attempts of radical treatment with Surgery, Radiotherapy ± chemotherapy and have residual or recurrent tumours, were treated with single agent Injection Methotrexate 50 mg/m2 weekly. Follow up visit complaints and clinical examination details were recorded. History regarding pain, speech and diet was collected for every visit. Severity of pain was divided with the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 pain scales. Symptom control was done with analgesics, antiemetic and infection control.

Results: Weekly single agent chemotherapy with injection Methotrexate has significantly improved the quality of life of patients. 38.8% of patients have shown good response with decrease in the tumour bulk by more than 50% and other 39% of patients have stable disease on Injection Methotrexate. 22.2% patients have shown disease progression on single agent chemotherapy. Overall 83.3% patients have shown improvement in Quality of life in terms of symptomatic control. After 6 weekly treatments with injection methotrexate 63% patients were pain free with 16% patients reported decrease in pain. 87.5% of patients have shown improvement in speech and diet. Improvement in symptoms has shown decrease in depression in cancer patients. Grade 3 toxicity observed was Neutropenia (11.1%), anaemia (11.1%) and Mucositis (16.6%) which was managed adequately. Median survival with good quality of life is 5.4 months.

Conclusions: Single agent methotrexate chemotherapy on an out-patient basis can provide good quality of life. Decrease in pain along with improvement in speech and diet has shown decrease in incidence of depression and overall positive impact on psychosocial status. Few cases have shown sustained regression of gross disease adding to maintained quality of life with better socio-economic compliance.