About Your Mandibulectomy and Fibula Free Flap Reconstruction

About Your Surgery

This guide will help you prepare for your mandibulectomy surgery at Memorial Sloan Kettering (MSK), and help you understand what to expect after your surgery. Read through this guide at least once before your surgery and then use it as a reference in the days leading up to your surgery so that you can prepare. Bring this guide with you every time you come to MSK, including the day of your surgery, so that you and your healthcare team can refer to it throughout your care.

Mandibulectomy and Free-flap Reconstruction

A mandibulectomy is a surgery to remove all or part of your jaw (mandible). You may have a mandibulectomy if you have a tumor involving your jaw.

Figure 1. Fibula free flapFigure 1. Fibula free flap

Your jaw may be rebuilt using bone from another part of your body (the donor site). The bone may be taken from your fibula, which is the smaller of the 2 bones in your lower leg. An artery, vein, and soft tissue will also be removed with the bone. This is called a fibula free flap (see Figures 1).

The leg is the donor site that is most often used for jaw reconstructions. If your jaw is being rebuilt using bone from a different donor site or if bone will not be used in your reconstruction, your plastic surgeon will discuss this with you.

You may also need a skin graft to cover your donor site. A skin graft is made by taking the top layer of skin from one part of your body and moving it to the surgical site that needs to be covered. If a skin graft is needed, it will be removed from another area, usually the buttock or thigh. Your plastic surgeon will talk with you about the plan for your surgery.

Before Your Surgery

You will meet with your head and neck surgeon, your plastic surgeon, and your dentist. They will make sure it is safe for you to have surgery. They will also take computed tomography (CT) scan(s) and x-rays to assess the amount of tumor in your jaw. These will be used to make a model of your new jaw before surgery.

You may also have:

  • Photographs taken of your face that will be used during the reconstruction.
  • Scans that use special dye (angiograms), such as magnetic resonance (MR) or CT, of your donor site to evaluate the blood vessels in your donor site.

During Your Surgery

Your surgery will be done by 3 surgical teams: a head and neck team, a plastics team, and dental team.

Your head and neck surgeon will remove the tumor from your jaw and the soft tissue around it. At the same time, your plastic surgeon will remove the bone, tissue, and skin from your donor site. This will take 3 to 4 hours. Your head and neck surgeon will send the tumor and surrounding tissue to the Pathology Department for testing. Once your head and neck surgeon has completed his or her part of the surgery, the reconstruction can be done.

Your plastic surgeon will transfer the tissue from your donor site to reconstruct your jaw. The bone from your donor site will be shaped to match, as closely as possible, the piece of your jaw that was removed. Once this is complete, your plastic surgeon will attach the artery and vein from the donor site to an artery and vein in your head and neck area. This is done under a microscope. He or she will fix the new jaw bone in place with plates and screws and cover it with the soft tissue. Your plastic surgeon will then place stitches in your face and neck to connect them to the soft tissue. The reconstructive part of the surgery usually takes 6 to 8 hours.

During your reconstruction, your dentist may place temporary arch bars and rubber bands in your mouth (see Figure 2). These will keep your teeth and jaw correctly aligned. Your dentist will remove the rubber bands 5 to 7 days after your surgery and the arch bars 14 days after your surgery.

Figure 2. Arch bars and rubber bandsFigure 2. Arch bars and rubber bands

Mandibulectomy can cause swelling and difficulty breathing. To prevent this, a tracheostomy tube will be inserted into your trachea (windpipe) through an incision (surgical cut) in your neck, while you are still asleep. This will keep your airway open and make it easier for you to breathe.

Your surgery will also cause facial swelling, which will affect the way you eat, drink, and speak. This will slowly decrease as the area heals over several months. To help you get your nutrition, a nasogastric (NG) tube will be inserted during surgery. It goes through your nose and into your stomach. The NG tube will give you nutrients for the first 1 to 2 weeks while your jaw is healing. After your jaw has healed, the NG tube will be removed and you will gradually begin to eat and drink again. Your doctor will decide when it is safe to do so. How long this takes varies from person to person. It also depends on the extent of your surgery. Tell your healthcare team if you have any questions or concerns.

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Before Your Surgery

The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

Preparing for Your Surgery

You and your healthcare team will work together to prepare for your surgery.

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.

  • Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medication to help prevent them.
  • If you drink alcohol regularly, you may be at risk for other complications during and after surgery. These include bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.

Here are things you can do to prevent problems before your surgery:

  • Be honest with your healthcare provider about how much alcohol you drink.
  • Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
  • Tell your healthcare provider if you cannot stop drinking.
  • Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.

Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.

  • I take a blood thinner. Some examples are heparin, warfarin (Coumadin®), clopidogrel (Plavix®), and tinzaparin (Innohep®). There are others, so be sure your doctor knows all the medications you’re taking.
  • I take prescription medications.
  • I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
  • I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
  • I have sleep apnea.
  • I have had a problem with anesthesia in the past.
  • I have allergies, including to latex.
  • I am not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke.
  • I use recreational drugs.

About Smoking

People who smoke can have breathing problems and a higher risk of getting an infection when they have surgery. Smoking also slows would healing and increases the chance of problems with your reconstruction. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program at 212-610-0507.

About Sleep Apnea

Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems when you have surgery. Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.

Within 30 Days of Your Surgery

Presurgical Testing

Before your surgery, you will be given an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.

You can eat and take your usual medications the day of your PST appointment. During your appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who will be giving you medication to put you to sleep during your surgery). He or she will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers.

Your nurse practitioner will talk with you about which medications you should take the morning of your surgery.

It is very helpful if you bring the following with you to your PST appointment:

  • A list of all the medications you are taking, including patches and creams.
  • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram (echo), or carotid doppler study.
  • The name(s) and telephone number(s) of your doctor(s).

Complete a Health Care Proxy Form

If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. The person you identify is called your health care agent. If you are interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advanced directive, bring it with you to your next appointment.

Exercise

Try to do aerobic exercise every day, such as walking at least 1 mile, swimming, or biking. If it is cold outside, use stairs in your home or go to a mall or shopping market. Walking will help your body get into its best condition for your surgery and make your recovery faster and easier.

Eat a Healthy Diet

You should eat a well-balanced, healthy diet before your surgery. If you need help with your diet talk to your doctor or nurse about meeting with a dietitian.

10 Days Before Your Surgery

Review Your Medications

If you take vitamin E, stop taking it 10 days before your surgery. If you take aspirin, ask your surgeon whether you should continue. Medications such as aspirin, medications that contain aspirin, and vitamin E can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Purchase Hibiclens® Skin Cleanser

Hibiclens is a skin cleanser that kills germs for 6 hours after using it. Showering with Hibiclens before surgery will help reduce your risk of infection after surgery. Hibiclens is available at your local pharmacy without a prescription.

7 Days Before Your Surgery

Stop Taking Herbal Remedies and Supplements

Stop taking herbal remedies or supplements 7 days before your surgery. If you take a multivitamin, talk with your doctor or nurse about whether you should continue. For more information, please read Herbal Remedies and Cancer Treatment.

Watch a Virtual Tour

This video will give you an idea of what to expect when you come to Memorial Sloan Kettering’s main hospital on the day of your surgery.

2 Days Before Your Surgery

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil®, Motrin®) and naproxen (e.g. Aleve®). These medications can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

1 Day Before Your Surgery

Note the Time of Your Surgery

A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call 212-639-5014.

On the day of your surgery, go to the Presurgical Center (PSC) at MSK’s main hospital.

Presurgical Center (PSC)
1275 York Avenue (between East 67th and East 68th Streets)
New York, NY 10065
B elevator to 6th Floor

Shower With Hibiclens

The night before your surgery, shower using the Hibiclens solution. To use Hibiclens, open the bottle and pour some solution into your hand or a washcloth. Rub it gently over your body from your neck down and rinse. Do not let the solution get into your eyes, ears, mouth, or genital area. Do not use any other soap. Dry yourself off with a clean towel after your shower.

Sleep

Go to bed early and get a full night’s sleep.

Morning of Your Surgery

Shower With Hibiclens

Shower using Hibiclens just before you leave for the hospital. Use the Hibiclens the same way you did the night before. Do not use any other soap. Do not put on any lotion, cream, powder, deodorant, makeup, or perfume after your shower.

Take Your Medications

If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.

 

Things to Remember

  • Do not put on any lotions, creams, deodorants, makeup, powders, or perfumes.
  • Do not wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
  • Leave valuables, such as credit cards, jewelry, or your checkbook at home.
  • Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles, such as a rosary.
  • If you wear contact lenses, wear your glasses instead.
  • _________________________________________________________________
  • _________________________________________________________________

  • Only the money you may need for a newspaper, bus, taxi, or parking.
  • Your portable music player, if you choose. However, someone will need to hold this item for you when you go into surgery.
  • Your breathing machine for sleep apnea (such as your CPAP), if you have one.
  • If you have a case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary, bring it with you.
  • Your Health Care Proxy form, if you have completed one.
  • This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
  • _________________________________________________________________
  • _________________________________________________________________
  • _________________________________________________________________

 

Parking When You Arrive

Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that connects the garage to the hospital. If you have questions about prices, call 212-639-2338.

There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.

Once You’re in the Hospital

You will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar name may be having surgery on the same day.

Get Dressed for Surgery

You will be given a hospital gown, robe, and nonskid socks.

Meet With Your Nurse

Your nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them.

Meet With Your Anesthesiologist

He or she will:

  • Review your medical history with you.
  • Talk with you about your comfort and safety during your surgery.
  • Talk with you about the kind of anesthesia you will receive.
  • Answer any questions you may have about your anesthesia.
Prepare for Surgery

Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it is time for your surgery, your visitor(s) will be shown to the waiting area. Your visitors should read Information for Family and Friends for the Day of Surgery.

You will walk into the operating room or you can be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help circulation in your legs.

Your anesthesiologist will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia (medication to make you sleep) during your surgery.

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After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hosptial. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

What to Expect

When you wake up after your surgery, you will be taken to the Post Anesthesia Recovery Unit (PACU). Your visitors can visit you in the PACU after your surgery. You will stay in the PACU overnight so that your nurses can closely monitor your flap for 12 hours after your surgery.

You may not be able to open your mouth because of the rubber bands. You will not be able to talk because a tracheostomy tube will be in your windpipe. Your nurses will ask you “yes” or “no” questions about how you feel. You will be given an iPad to help you answer these questions. A dry erase board will also be available for you to write down what you need.

You will have tubes, drains, catheters (thin, flexible tubes), and other medical devices, including:

  • A humidifier collar placed over your tracheostomy tube. It will provide moist air to your lungs.
  • An IV line through which you will receive fluids, antibiotics, pain medication, and anticoagulants to prevent blood clots.
  • A urinary (Foley®) catheter to drain urine from your bladder. It will be removed 2 or 3 days after your surgery.
  • Drains (small tubes) in your neck and your donor site to allow fluid to drain. They are removed when the drainage is less than 1 ounce in 24 hours.
  • A feeding tube that goes through your nose into your stomach. This is called a nasogastric (NG) tube. You will get high-protein liquid feedings and some of your medications through this tube. You will not be able to eat and drink until the swelling from the surgery goes down.
  • A cast, splint, sling, or wound VAC (a special dressing that applies suction to your wound to improve healing) may be placed on the donor site. It will be removed 5 to 7 days after your surgery. If you have a cast, splint, or sling, a dressing will be placed underneath it.
  • Compression boots on 1 or both legs to help circulate blood to prevent blood clots. If your donor site was on one of your legs, that leg will not have a boot on it.

For the first week after your surgery, your doctors and nurses will monitor the blood supply to your jaw and nearby tissue. They will use a machine called a Doppler®. It is noisy, but painless. It will be used every hour for the first 2 days after your surgery. After 2 days, your doctor will decide how often the Doppler will be used. Your doctor and nurse will check that the flap feels warm to touch and appears similar in color to your surrounding skin.

It is very important to avoid pressure to your newly reconstructed jaw. You will not be able to use a pillow while in the hospital.

Your nurses and nursing assistants will care for your drains, tubes, and tracheostomy. As you begin to feel better, they will teach you how to do some of this care yourself.

Suctioning the Tracheostomy Tube

When you cough and breathe deeply, mucus from your lungs and the back of your throat will come through your tracheostomy tube. This mucus will have to be suctioned. Your nurse will do this frequently during the first few days after your surgery. He or she will then teach you how to do it yourself. For more information, please read Caring for Your Tracheostomy.

Once the swelling has decreased, you will have less mucus and the opening of the tracheostomy tube will be capped, so that you can breathe through your nose. If you are able to breathe normally and cough up mucus comfortably with the tracheostomy tube capped, the tracheostomy tube will be removed. If you go home with the tracheostomy tube in place, your nurse will teach you how to care for it. We will order a portable suctioning machine for you.

Nasogastric (NG) Tube Feedings

Your nurse will give you tube feedings through your NG tube for the first 1 to 2 weeks. Once the swelling begins to go down, your NG tube will be removed and you will be given clear liquids to drink and then soft foods to eat. How quickly your diet progresses will depend on your healing.

Caring for Your Donor Site

The leg is the donor site that is most often used for jaw reconstructions. If your jaw is being rebuilt using tissue from a different donor site, your nurse will tell you how to care for it.

You will stay in bed for the first 2 days after your surgery to help your leg heal. After 2 days, you can get out of bed and sit in a chair with your leg raised. It is important to keep your leg raised as much as possible for the first 3 weeks. This will help with the swelling and promote healing. Your doctor will tell you when you can begin walking again. You will need to use a walker at first, but you will be able to walk on your own over time.

During your hospital stay, your nurse will tell you how to care for your leg and skin graft, if you have one. When it is time to go home, he or she will give you specific instructions if you still need them.

Irrigating Your Mouth

Starting 5 days after your surgery, or as soon as your rubber bands are removed, your nurse will begin irrigating (wetting) your mouth with salt water and baking soda. This helps keep your mouth clean and moist.

You will continue to irrigate your mouth after you leave the hospital. Do this 3 to 4 times a day, in the morning, after meals, and at bedtime. Your nurse will give you an irrigation kit to take home with you.

Preventing Trismus

Trismus is a condition in which someone has difficulty opening their mouth. It can develop after surgery or radiation therapy. It is caused by soft tissue scarring or changes in the muscles around the jaw. You must do jaw exercises to prevent trismus. As soon as you are ready, your doctor or nurse will tell you how often to do them. For more information, read the resource Trismus.

Following a Puréed Diet

Most people will need to follow a puréed diet after they are discharged. This means that foods have to be put through a blender or food processor. Your dietitian will go over this diet with you. Your diet will progress as healing takes place. For more information, see Eating Guide for Puréed and Mechanical Soft Diets.

Commonly Asked Questions

How long will I be in the hospital?

The length of time you are in hospital depends on the extent of the surgery and how quickly you recover. On average, most people stay for 10 to 14 days.

Will I have pain?

You will have some pain after your surgery. Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain is not relieved, please tell your doctor or nurse. Your doctor will give you a prescription for pain medication before you leave the hospital.

Will I have pain when I am home?

The length of time each person has pain or discomfort varies. Follow the guidelines below to manage your pain.

  • Take your medications as directed and as needed.
  • Call your doctor if the medication prescribed for you doesn’t relieve your pain.
  • Do not drive or drink alcohol while you are taking prescription pain medication.
  • As your incisions heal, you will have less pain and need less pain medication. A mild pain reliever such as acetaminophen (Tylenol) or ibuprofen (Advil) will relieve aches and discomfort.
  • Pain medication should help you as you resume your normal activities. Take enough medication to make sure you can gradually increase your activities. Pain medication is most effective 30 to 45 minutes after taking it.
  • Keep track of when you take your pain medication. It will not be as effective if you allow your pain to increase. Taking it when your pain first begins is more effective than waiting for the pain to get worse.

How can I prevent constipation?

Pain medication may cause constipation, but there are steps you can take to prevent it, including exercising if you can. Walking is an excellent form of exercise. Drink plenty of water.
If these methods do not help, talk with your doctor or nurse. He or she may recommend over-the-counter or prescription medication.

When will my stitches be removed?

If you have stitches inside of your mouth, they will dissolve on their own and don’t need to be removed.

Your doctor will remove the stitches in your face and neck approximately 2 weeks after your surgery. If you have had radiation therapy to your face or neck, the stitches may stay in place for 3 to 4 weeks.

How do I care for my incisions?

  • Do not apply direct heat or cold to the incisions. They may be numb and you can easily burn yourself.
  • Do not use hot water bottles or heating pads. You should also avoid saunas and steam rooms.
  • Do not shave over your incisions while your stitches are in place. If you shave your face or neck, use an electric shaver.
  • Do not use perfume, cologne, after-shave, or perfumed moisturizers until your incisions are completely healed.
  • Avoid sun exposure. Once your head and neck surgeon determines that your incisions are completely healed, you may use a PABA-free sunscreen, with an SPF of 30 or higher, on your incisions.

When can I shower?

Your doctor or nurse will give you instructions on when you can shower.

When can I swim?

You can swim when you’ve been told that your incisions are completely healed. Avoid hot tubs, baths and swimming pools until then.

When can I resume my normal activities?

Your doctor or nurse will tell you when you can resume normal activities. This depends on the extent of your surgery and how quickly you recover.

When is it safe for me to drive?

Your doctor or nurse will tell you when you may resume driving. This will depend on the extent of your surgery and how quickly you recover.

When can I exercise?

Do not do strenuous exercise or lift any objects heavier than 5 pounds (2.3 kilograms) for 6 weeks. Talk with your doctor or nurse before resuming activities such as lifting and exercise.

When can I resume sexual activity?

Your doctor will tell you when you can resume sexual activity.

What type of follow-up care will I receive after I leave the hospital?

Both your head and neck surgeon and your plastic surgeon will need to see you after discharge. Call each surgeon’s office to schedule your follow-up appointment. Write down any questions you have and bring them with you.

When will I get my test results?

Your test results should be available 10 to 14 days after surgery. Your doctor will discuss them with you at your first follow-up appointment after your surgery.

How can I cope with my feelings?

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, or angry at one time or another. You may find that you cannot control some of these feelings. If this happens, it’s a good idea to seek emotional support.

The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It is always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to patients and their families. Whether you are in the hospital or at home, your nurses, doctors, and social workers are here to help you and your family and friends handle the emotional aspects of your illness.

What if I have other questions?

If you have any questions or concerns, please talk with your doctor or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm.

After 5:00 pm, during the weekend, and on holidays, please call 212-639-2000 and ask for the doctor on call for your doctor.

 

  • A temperature of 100.4° F (38° C) or higher
  • Increased discomfort, redness, or both around your incision line
  • Skin around your incision line that is hot to the touch
  • Drainage or accumulation of fluid from your incision site
  • Shortness of breath
  • New or increased swelling around your incision
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Resources

This section includes a list of MSK support services, as well as the resources that were referred to throughout this guide. These resources will help you prepare for your surgery and recover safely. Write down any questions you have and be sure to ask your doctor or nurse.

MSK Resources

Admitting
212-639-5014
Call to discuss private room or luxury suite options. If you want to change your room choice after your presurgical testing visit, call 212-639-7873 or 212-639-7874.

Anesthesia
212-639-6840
Call with questions about anesthesia.

Blood Donor Room
212-639-7643
Call for more information if you are interested in donating blood or platelets.

Bobst International Center
888-675-7722
MSK welcomes patients from around the world. If you are an international patient, call for help coordinating your care.

Chaplaincy Service
212-639-5982
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital, and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.

Counseling Center
646-888-0200
Many people find counseling helpful. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed.

Integrative Medicine Service
646-888-0800
Integrative Medicine Service offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

Look Good Feel Better Program
800-227-2345
Learn techniques to help you feel better about your appearance by taking a workshop or visiting the program online at www.lookgoodfeelbetter.org.

Patient-to-Patient Support Program
212-639-5007
You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, we are able to offer you a chance to speak with former patients and caregivers.

Patient Billing
646-227-3378
Call Patient Billing with any questions regarding preauthorization with your insurance company. This is also called preapproval. 

Patient Representative Office
212-639-7202
Call if you have any questions about the Health Care Proxy form or if you have any concerns about your care.

Perioperative Clinical Nurse Specialist
212-639-5935
Call if you have any questions about MSK releasing any information while you are having surgery.

Private Nursing Options
212-639-6892
Patients may request private nurses or companions. Call for more information.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.

Social Work
646-639-7020
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also refer you to community agencies and programs, as well as financial resources if you’re eligible.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call for more information.

For additional online information, visit LIBGUIDES on MSK’s library website at: http://library. mskcc.org. You can also contact the library reference staff at 212-639-7439 for help.

External Resources

The following are resources outside of MSK that you may find helpful:

Access-A-Ride
www.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who are unable to take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-227-2345
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
A comprehensive resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.com
800-813-4673
275 Seventh Avenue (between West 25th & West 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
http://cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for those who care for loved ones with a chronic illness or disability.

Chronic Disease Fund
www.cdfund.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that is part of the CDF formulary.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Free travel to treatment across the country using empty seats on corporate jets.

fertileHOPE
www.fertilehope.org
855-220-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

Hospital Hosts
www.hospitalhosts.com
National resource to help reduce costs related to medical travel needs such as air, car, and lodging near hospitals.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
http://lgbtcancer.com
Provides support and advocacy for the LGBT community, including an online support groups and a database of LGBT friendly clinical trials.

National Cancer Institute
www.cancer.gov

National Cancer Legal Services Network
www.nclsn.org
Free cancer legal advocacy program.

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.com
Lists Patient Assistance Programs for brand and generic name medications.

NYRx
www.nyrxplan.com
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medications.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides assistance with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people obtain medications that they have trouble affording.

Support for People with Oral and Head and Neck Cancer (SPOHNC)
www.spohnc.org
800-377-0928
Provides information and support for people with oral and head and neck cancer.

Additional Resources

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If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm at ____________________. After 5:00 pm, during the weekend, and on holidays, please call____________________. If there’s no number listed, or you’re not sure, call 212-639-2000.
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