Squamous cell carcinoma of head and neck (SCCHN) is one of the commonest cancers seen in India, constituting up to 25% of their overall cancer burden. Advanced SCCHN is a bad disease with a poor prognosis and patients usually die of uncontrolled loco-regional disease. Curative intent management of loco-regionally advanced SCCHN has become more evidence-based with active clinical research in the form of large prospective randomized controlled trials and meta-analyses. However, little has been written about palliative radiotherapy (PRT) in head and neck cancers. It is widely recognized that PRT provides effective palliation and improved quality-of-life in advanced incurable malignancies. It is in this context that this study proposes to review the existing literature on palliative radiotherapy in advanced incurable SCCHN to help formulate consensus guidelines and recommendations.

Cough is a common symptom in palliative medicine and the causes may be multifactorial. When problematic it invariably affects quality of life. Evaluation must begin with a detailed history and examination with consideration given to further tests and imaging. Treatment must begin with the identification and correction of any reversible causes in addition to emperic treatment. A logical approach and regular monitoring is advised.

Head and neck cancer recurrences after definitive radiotherapy present a difficult therapeutic problem, as only a small proportion of patients have resectable disease. When surgery is not possible, reirradiation might be a feasible option for selected patients, particularly those with favourable prognostic factors such as second primaries, nasopharyngeal or laryngeal tumours or delayed recurrences. Current evidence indicates that in this group of patients reirradiation offers better control rates than palliative chemotherapy. The loco regional control rates of reirradiation without surgery is 20% at five years and 27% at two years. The overall survival rate with reirradiation ranges from 10% to 35% at two years and 0% to 14.6% at five years. The first randomized trial directly comparing chemotherapy with reirradiation is in progress. This article outlines the indications for and results of reirradiation and chemotherapy in post radiotherapy recurrences of head and neck cancer.

Carcinoma of the esophagus is a dreadful disease because it causes a lot of distress to the patient due to its adverse effects on swallowing. Many patients present with large incurable disease or undergo disease progression and become incurable. Such patients are advised palliative and symptomatic care. The most distressing symptom that requires palliation in such patients is dysphagia. Many procedures are available for relief of dysphagia, but these are not readily available or are costly. We describe a simple, safe, cost effective and easy to do procedure for palliation of malignant dysphagia by insertion of Ryle's tube over a endoscopically placed guide wire especially suitable for patients of the poor socio-economic strata.

Terminal illness often throws up challenges that conventional treatments fail to address satisfactorily. Complimentary therapies such as foot massages are being rediscovered for their particular benefits in palliative care. This article includes a brief description of the process and discusses the author's experience with it's use.

Please feel free to print and use this article to support patients and their families. You may wish to translate or alter this depending on your local needs. If you are only using one section, remember to include the introduction. The advice contained in this article is aimed to support patients who have limited access to hospital care and equipment.