Supportive Care for Patients with Sinonasal and Skull Base Tumors

Skull base and sinonasal neoplasms threaten basic functions, appearance, and quality of life. These tumors arise in close proximity to vital structures including the brainstem, cerebral cortex, cervical spine, nasal cavity, orbit, and pituitary gland. Patients presenting with skull base tumors report high symptom burden at presentation (prior to treatment) relative to other malignancies in the head and neck region. Surgical morbidity can also be substantial, as may be both acute and late effects of radiotherapy on normal tissues in this functionally critical region. Treatment advances and interdisciplinary supportive care help to lessen the functional impairments and the resultant loss of quality of life (QOL) that were once accepted as inevitable tradeoffs for cure. This chapter reviews functional and quality of life outcomes among patients treated for sinonasal and skull base malignancies. Evaluation and management protocols for swallowing and communication impairments will be presented, as well as considerations for management of lymphedema as it relates to both body image and functional outcomes. Recent progress in QOL and patient-reported outcome (PRO) measurement methods for this population will also be covered.