NICE prioritises shoulder rehabilitation for head and neck cancer care

Progressive resistance training should start as soon as possible after surgery for head and neck cancers, says new guidance from the National Institute for Health and Care Excellence (NICE).


Specialist physios have welcomed the guidance because of the poor recognition of shoulder dysfunction among post-op patients

Published on 10 February, the document puts shoulder rehabilitation for this patient group into NICE guidance for the first time.

Role for physios

It says physiotherapists and other health professionals should prevent breathing difficulties by identifying people at risk of airways obstruction and where intervention is appropriate.

Specialist cancer physiotherapist Clare Lait said the guidance was particularly welcome because of the poor recognition of shoulder dysfunction among people who have had surgery for head and neck cancer.

‘We are not part of core multi-disciplinary teams for head and neck cancer, but I hope the guidance might help to reverse this,’ she said.

Team work

NICE recommends that healthcare professionals should consider involving a palliative care team and other specialists where this would help.

It calls for a management plan if surgical intervention is not appropriate, in conjunction with the patient, their carers and clinical staff.

On behalf of the Association of Chartered Physiotherapists in Oncology and Palliative Care (ACOPC), Delia Goddard said: ‘The guideline looks at both early and advanced disease, so covers a wide range of potential issues relevant to physiotherapists.

Post-op management

‘Whilst this guidance is relevant to therapists working in oncology and palliative care, the rehabilitation recommendations relate to post-operative management and therefore also have relevance to hospital physiotherapists who may not be specialists in oncology.’

NICE is keen for physiotherapists and other health professionals to warn patients how continuing to smoke can adversely affects outcomes and put them at risk of other cancers.

They should offer help to people to stop smoking, in line with the NICE guideline on stop smoking services, it says.

Ms Lait said there was a need for research and evidence about shoulder disfunction for this patient group.

‘When you ask patients about their treatment, it’s apparent that there is a huge lack of physiotherapy,’ she said.

Cardiorespiratory physiotherapy staff can use Inspire, the CSP’s collation of NICE guidelines, for guidance on their specialist area.

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