Case Study in Prevention

Head and neck cancer is one of the most challenging cancer groups when it comes to treatment side effects. Radiation to the mouth, throat, and surrounding structures can damage critical areas required for normal function. Damage to these areas can profoundly affect swallowing, speech, nutrition, oral health, and quality of life. If these symptoms become severe, the patient is at risk of complications, including aspiration, infection, and malnutrition. On top of the potential radiation side effects, the chemotherapy drugs used in head and neck cancer, commonly cisplatin, add further complexity.

Yet despite the intensity of these treatments, most patients receive very little education or prevention-focused support before therapy begins. This can be due to several factors, including the urgency to start treatment, limited health literacy, and time constraints on healthcare workers. The problem is that by the time side effects appear, options are limited, and the window for prevention has often closed.

The following case study is one that I have chosen to highlight, as it was one of the very few times that I have had the opportunity to work with a patient with head and neck cancer before they began treatment. This case is a perfect example of how early integrative care can make a meaningful difference.

Case Overview

A 48-year-old male was diagnosed with stage 3 squamous cell carcinoma of the head and neck, with Human Papillomavirus (HPV) suspected as a contributing factor. The primary symptom prompting this patient to seek medical review was a lump on the side of the neck. This lump was a cancerous lymph node, and the primary cancer site was still under investigation by his oncology team. While he awaited further medical work-up, he sought integrative care after hearing how much it had helped a close friend during treatment. With all the testing still ahead of him, we were fortunate to have three to four weeks of preventive preparation.

This timing, before treatment planning was completed, proved invaluable.

Why Timing Matters: The Window Before Treatment

Patients with head and neck cancers typically undergo:

• surgery
• radiation therapy
• chemotherapy (commonly cisplatin)
  

These treatments are life-saving, but they come with typical and sometimes severe side effects. One of the most debilitating is oral mucositis, an inflammatory, ulcerative reaction of the oral tissues caused by radiation and chemotherapy.

When mucositis becomes severe:

• eating becomes difficult or impossible
• swallowing can require medical intervention
• speaking is painful
• treatment delays may occur
• the radiation mask may no longer fit due to inflammation
• weight loss becomes rapid and dangerous
• the combination of breaks in the oral mucosa and the immunosuppressing treatments can lead to systemic infection.
  
  

Prevention is far more effective than treating mucositis once it has begun. However, prevention requires time, and most patients don’t receive proactive guidance until it’s too late.

Assessment & Early Priorities

During this patient’s first consultation, we explored key risk factors that could worsen treatment side effects. Two immediately stood out:

1. Smoking history
2. Poor oral health
   

Both factors significantly increase the likelihood and severity of mucositis during radiation therapy. Smoking impairs healing by depleting key nutrients, reducing blood flow, and exposing oral tissues to toxic chemicals. Poor oral health also substantially increases the risk, as dental plaque harbours harmful bacteria that can worsen oral mucositis. Cavities, broken teeth, or sharp edges create areas where bacteria accumulate and can physically irritate or damage the mucosa, increasing the risk of ulcers.

Oral Health: The Most Critical (and Most Overlooked) Factor

This patient had not seen a dentist in more than a decade.

Oral hygiene is one of the most critical steps in reducing the risk and severity of oral mucositis. It is one of the primary recommendations from the Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO). Yet, many patients never receive this advice early enough.

Because radiation to the head and neck significantly reduces the mouth’s and jaws ability to heal, all necessary dental work, such as extractions, treating decay, or smoothing sharp edges, should be completed before treatment begins. Once radiation has started, dental procedures become far more risky due to the heightened chance of infection and osteoradionecrosis (poor bone healing). For this reason, major dental work is generally not performed during radiation therapy, making early assessment and treatment essential for safety and for reducing complications like severe mucositis.

We initiated immediate steps to action:

• a full dental assessment
• professional cleaning
• any necessary restorative treatment
• guidance on oral hygiene practices he could begin immediately
• GP appointment to discuss options for smoking cessation

Developing a Personalised Pre-Treatment Integrative Plan

While the patient was undergoing a work-up, we used the time wisely to put more plans into action. Together, we created a personalised pre-treatment plan to support:

• healing and tissue resilience
• inflammation reduction
• immune health
• maintaining weight and nutrition
• addressing viral contribution
• reducing the expected side effects of radiation and cisplatin
• increasing readiness for treatment
  
  

This plan was designed to be flexible, with modifications made once final treatment dates and modalities were confirmed. Everything recommended was explicitly chosen for safety, compatibility, and evidence-informed supportive care, with certain elements to be paused once treatment began and others introduced. The patient was encouraged to share his integrative plan with his oncology team.

Outcome: Entering Treatment Prepared, Informed, and Supported

By starting early, this patient entered treatment with:

• optimised oral health, reducing his mucositis risk
• A clear plan for managing side effects
• improved understanding of expected symptoms and when to seek help
• better health literacy allows him to navigate treatment with confidence
• support for viral-related contributors
• a sense of control during an overwhelming process
  

Early support did not replace his medical treatment; it strengthened his ability to tolerate it.

The Bigger Picture: Why Prevention Is Not Standard in Conventional Care

In conventional cancer care, the focus is understandably on diagnosing and treating the cancer itself. Side-effect prevention, oral health, nutrition, symptom anticipation, and lifestyle factors often receive far less attention, particularly in the crucial weeks before treatment begins.

Patients frequently tell me:

“No one explained what I could do before treatment started.”

“I didn’t know dental work needed to be done earlier.”

“I thought I had to wait until side effects appeared.”

By the time symptoms emerge, the options are limited.  Early prevention is essential; it can’t be applied after the fact.

A Better Way Forward

Early integrative care fills a critical gap by identifying risk factors, strengthening the patient’s baseline health, preventing predictable complications, and improving treatment tolerance.

This approach is not an alternative nor is it in competition with standard oncology care; it is supportive, practical, and evidence-informed.

If You’ve Recently Been Diagnosed with Head & Neck Cancer

The most critical steps you take may be before treatment starts.

If you want help with:

• understanding the side effects of your specific treatment
• reducing preventable risks
• optimising  oral health
• preparing your body for intensive therapy
• buildiing a personalised plan that complements medical treatment
  

…early integrative care can make a meaningful difference.

You can enquire by making contact here and I’ll review your situation personally to see whether integrative care is appropriate and safe for your needs.