{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T16:31:56Z","timestamp":1791045116508,"version":"4.1.0"},"reference-count":19,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliative Medicine Reports"],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:p>Airway obstruction is a distressing and potentially life-threatening complication in patients with advanced head and neck cancers, particularly squamous cell carcinoma (SCC) of the pharynx. This case highlights the clinical, ethical, and interdisciplinary complexities involved in managing airway compromise in the context of progressive disease and limited treatment options. A 75-year-old man with recurrent SCC of the soft palate, nasopharynx, oropharynx, and hypopharynx, recently initiated on pembrolizumab and radiation therapy, presented with dysphagia, stridor, and intermittent tumor bleeding. Imaging revealed a large pharyngeal mass causing critical airway narrowing. Plans for tracheostomy to manage anticipated radiation-induced edema were aborted following the patient\u2019s acute neurological deterioration, with imaging confirming bilateral carotid artery occlusions and a new stroke. With poor prognosis and elevated risk of carotid blowout syndrome (CBS), further disease-directed treatments were deemed inappropriate. A multidisciplinary team, including palliative care, oncology, and ENT, facilitated a transition to comfort-focused care, emphasizing symptom control, airway management, and emotional support. The patient was transferred to inpatient hospice for end-of-life care. This case underscores the multifactorial nature of airway obstruction in advanced pharyngeal SCC, including tumor burden, treatment-related edema, and vascular complications. It highlights the importance of risk stratification for tracheostomy, especially in the setting of stroke, bleeding risk, and impending CBS. Symptom management was pivotal in maintaining comfort. Nonpharmacologic strategies and psychosocial-spiritual support further contributed to comprehensive end-of-life care. Individualized, multidisciplinary, and patient-centered approaches are essential when curative therapies are no longer appropriate in advanced head and neck cancer. Prioritizing comfort, clear communication, and integrative symptom management can optimize quality of life and support dignity at the end of life.<\/jats:p>","DOI":"10.1177\/10966218251368266","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T17:25:17Z","timestamp":1759944317000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Imminent Respiratory Collapse in Advanced Head and Neck Cancer: A Case Report and Discussion"],"prefix":"10.1177","volume":"6","author":[{"given":"Molly","family":"Svendsen","sequence":"first","affiliation":[{"name":"Division of Palliative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Edwin","sequence":"additional","affiliation":[{"name":"Division of Palliative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"issue":"6","key":"e_1_3_3_2_2","first-page":"464","article-title":"Head and neck cancer: An overview of recent advances in treatment and management","volume":"36","author":"Ang KK","year":"2010","unstructured":"Ang KK, , Harris J, , Garden AS, et al. Head and neck cancer: An overview of recent advances in treatment and management. Cancer Treatment Reviews, 2010; 36(6):464\u2013470.","journal-title":"Cancer Treatment Reviews"},{"issue":"9","key":"e_1_3_3_3_2","first-page":"1287","article-title":"Management of airway complications in patients with head and neck cancers","volume":"31","author":"Genden EM","year":"2009","unstructured":"Genden EM, , McGill ML. Management of airway complications in patients with head and neck cancers. Head & Neck, 2009; 31(9):1287\u20131296.","journal-title":"Head & Neck"},{"issue":"4","key":"e_1_3_3_4_2","first-page":"243","article-title":"The role of tumor stage in airway obstruction in patients with head and neck cancer. Annals of Otology","volume":"122","author":"Mathis KL","year":"2013","unstructured":"Mathis KL, , Richards DK. The role of tumor stage in airway obstruction in patients with head and neck cancer. Annals of Otology. Rhinology, Laryngol, 2013; 122(4):243\u2013248.","journal-title":"Rhinology, Laryngol"},{"issue":"5","key":"e_1_3_3_5_2","first-page":"551","article-title":"Dysphagia and airway complications in head and neck cancer patients","volume":"106","author":"Low TH","year":"2012","unstructured":"Low TH, , Anthony D. Dysphagia and airway complications in head and neck cancer patients. J Surg Oncol, 2012; 106(5):551\u2013558.","journal-title":"J Surg Oncol"},{"issue":"13","key":"e_1_3_3_6_2","first-page":"2539","article-title":"Chemoradiation-related airway complications in head and neck cancers","volume":"31","author":"Best SR","year":"2013","unstructured":"Best SR, , Choi K. Chemoradiation-related airway complications in head and neck cancers. J Clin Oncol, 2013; 31(13):2539\u20132545.","journal-title":"J Clin Oncol"},{"issue":"6","key":"e_1_3_3_7_2","first-page":"2281","article-title":"Impact of smoking on the prognosis of head and neck cancer patients","volume":"147","author":"Zhang Z","year":"2014","unstructured":"Zhang Z, , Li Q. Impact of smoking on the prognosis of head and neck cancer patients. J Thoracic Cardio Surgery, 2014; 147(6):2281\u20132287.","journal-title":"J Thoracic Cardio Surgery"},{"issue":"8","key":"e_1_3_3_8_2","first-page":"603","article-title":"The impact of age and sex on tracheostomy requirements in head and neck cancer patients. Annals of Otology","volume":"124","author":"Choi SJ","year":"2015","unstructured":"Choi SJ, , Lee SJ. The impact of age and sex on tracheostomy requirements in head and neck cancer patients. Annals of Otology. Rhinology, Laryngol, 2015; 124(8):603\u2013609.","journal-title":"Rhinology, Laryngol"},{"issue":"9","key":"e_1_3_3_9_2","first-page":"2687","article-title":"Demographic factors influencing airway management decisions in head and neck cancer","volume":"273","author":"Patel S","year":"2016","unstructured":"Patel S, , Nixon IJ. Demographic factors influencing airway management decisions in head and neck cancer. European Archives Oto-Rhino-Laryngol, 2016; 273(9):2687\u20132695.","journal-title":"European Archives Oto-Rhino-Laryngol"},{"issue":"1","key":"e_1_3_3_10_2","first-page":"159","article-title":"Tumor location as a predictor of airway obstruction in oral cavity squamous cell carcinoma patients","volume":"127","author":"Jiang L","year":"2017","unstructured":"Jiang L, , Yi X. Tumor location as a predictor of airway obstruction in oral cavity squamous cell carcinoma patients. Laryngoscope, 2017; 127(1):159\u2013164.","journal-title":"Laryngoscope"},{"issue":"5","key":"e_1_3_3_11_2","first-page":"1781","article-title":"Preoperative tracheotomy in advanced head and neck cancer: Risks and complications","volume":"46","author":"Gong L","year":"2014","unstructured":"Gong L, , Zhao Q. Preoperative tracheotomy in advanced head and neck cancer: Risks and complications. J Head Neck Surgery, 2014; 46(5):1781\u20131787.","journal-title":"J Head Neck Surgery"},{"key":"e_1_3_3_12_2","first-page":"35","article-title":"Obstructive sleep apnea and airway management in head and neck cancer patients","volume":"34","author":"H\u00f6ijer J","year":"2017","unstructured":"H\u00f6ijer J, , Bergstr\u00f6m R. Obstructive sleep apnea and airway management in head and neck cancer patients. Sleep Medicine Reviews, 2017; 34:35\u201344.","journal-title":"Sleep Medicine Reviews"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.03465"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2020.07.021"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hyac206"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j760"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.14785"},{"issue":"1","key":"e_1_3_3_18_2","first-page":"CD005177","article-title":"Interventions for noisy breathing in patients near to death","volume":"2008","author":"Wee B","year":"2008","unstructured":"Wee B, , Hillier R. Interventions for noisy breathing in patients near to death. Cochrane Database Syst Rev, 2008; 2008(1):CD005177; doi: 10.1002\/14651858.CD005177.pub2","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-021-03125-w"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.30157"}],"container-title":["Palliative Medicine Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10966218251368266","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10966218251368266","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10966218251368266","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T02:48:26Z","timestamp":1777690106000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10966218251368266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,1]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,6,1]]}},"alternative-id":["10.1177\/10966218251368266"],"URL":"https:\/\/doi.org\/10.1177\/10966218251368266","relation":{},"ISSN":["2689-2820","2689-2820"],"issn-type":[{"value":"2689-2820","type":"print"},{"value":"2689-2820","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,1]]},"article-number":"10966218251368266"}}