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Manduchi B, Fitch MI, Ringash JG, Howell D, Hutcheson KA, Martino R. The Acceptability of Behavioural Swallowing Interventions for Head and Neck Cancer Patients During Radiotherapy: A Qualitative Study Exploring Experiences of Clinical Trial Speech-Language Pathologists. Dysphagia 2024; 39:412-423. [PMID: 37914886 DOI: 10.1007/s00455-023-10625-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023]
Abstract
The PRO-ACTIVE randomized clinical trial offers 3 swallowing therapies to Head and Neck Cancer (HNC) patients during radiotherapy (RT) namely: reactive, proactive low- ("EAT-RT" only) and high-intensity ("EAT-RT + exercises"). Understanding the experiences of the trial Speech-Language Pathologists (SLPs) will be useful to inform clinical implementation. This study assessed SLP opinions of acceptability and clinical feasibility of the 3 trial therapies. 8 SLPs from 3 Canadian PRO-ACTIVE trial sites participated in individual interviews. Using a qualitative approach, data collection and thematic analysis were guided by the Theoretical Framework of Acceptability. Member checking was conducted through a follow-up focus group with willing participants. Seven themes were derived: intervention coherence, burden, barriers/facilitators, self-efficacy, attitude, ethicality, and perceived effectiveness. SLPs felt all 3 therapies had potential benefit yet perceived more advantages of proactive therapies compared to reactive. Compared to exercises, SLPs particularly endorsed the EAT-RT component. A major barrier was keeping patients motivated, which was impacted by acute toxicity and sometimes conflicting instructions from the healthcare team. Strategies utilized by to overcome barriers included: scaling exercises and/or diet up/down according to the changing patient needs and communicating therapy goals with healthcare team. A model was derived describing the perceived acceptability of the swallowing therapies according to SLPs, based on the interconnection of main themes. Proactive therapies were perceived as more acceptable to trial SLPs, for facilitating patient engagement. The perceived acceptability of the swallowing therapies was related to seven interconnected aspects of providers' experience. These findings will inform the implementation and potential uptake of the PRO-ACTIVE swallowing therapies in clinical practice.
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Affiliation(s)
- Beatrice Manduchi
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.
- The Swallowing Lab, University of Toronto, Toronto, ON, Canada.
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jolie G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosemary Martino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- The Swallowing Lab, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
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Flood T, Duffy O. The effectiveness of interprofessional peer-led teaching and learning for therapeutic radiography students and Speech and Language Therapy students. PLoS One 2024; 19:e0299596. [PMID: 38696414 PMCID: PMC11065204 DOI: 10.1371/journal.pone.0299596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/12/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Therapeutic Radiographers (RT) and Speech and Language Therapists (SLT) work closely together in caring for people with head and neck cancer and need a strong understanding of each others' roles. Peer teaching has been shown to be one of the most effective methods of teaching; however, no studies to date, have involved RT and SLT students. This research aims to establish the effectiveness and perceptions of peer-led teaching between undergraduate RT and SLT students in Ulster University. METHODS Twenty SLT students and 14 RT students participated. Knowledge tests were taken online before the peer-led teaching session (T1), after the session (T2) and 3 months later (T3). Students' perceptions of the experience were collected at the end of the session. Wilcoxon signed-rank tests were used to analyse the impact of the intervention on knowledge scores. Qualitative content analysis was used for open text response data. RESULTS RT students' own professional knowledge score at T2 was statistically significantly higher than the score at T1; the score at T3 was not deemed to be statistically significantly higher. RT students' SLT knowledge score at T2 and T3 was found to be statistically significantly higher than the score at T1. SLT students' own professional knowledge score was not statistically significantly higher at T2 or T3 than T1. They did have a statistically significantly higher score at T2 on the RT test, but score at T3 was not deemed to be statistically significantly higher. The majority of students across both professions agreed or strongly agreed that the peer-led teaching experience had a positive impact on their learning. CONCLUSION This investigation highlights the benefits of an interprofessional peer-led teaching intervention for RT and SLT students and the findings add to the evidence of more objective study of knowledge gain as a result of interprofessional peer teaching.
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Affiliation(s)
- Terri Flood
- School of Health Sciences, Institute of Nursing and Health Research, Ulster University Jordanstown Campus, Newtownabbey, County Antrim, Northern Ireland
| | - Orla Duffy
- School of Health Sciences, Institute of Nursing and Health Research, Ulster University Jordanstown Campus, Newtownabbey, County Antrim, Northern Ireland
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Toft K, Best C, Donaldson J. Assessment of patients with head and neck cancer using the MD Anderson Dysphagia Inventory: Results of a study into its comprehensiveness, comprehensibility and relevance to clinical practice. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38441996 DOI: 10.1111/1460-6984.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The MD Anderson Dysphagia Inventory (MDADI) is a widely used patient-reported outcome measure (PROM) which assesses dysphagia-related quality of life (QoL) in head and neck cancer (HNC). Despite its common use in HNC research and clinical practice, few of its psychometric properties have been reappraised since its inception. The aim of this study was to perform a survey-based qualitative analysis of UK HNC clinicians' perceptions of the content validity of the MDADI, evaluating it across the parameters of relevance, comprehensiveness and comprehensibility as per the COSMIN guideline for PROM assessment. RESULTS Four themes relating to the content validity of the MDADI were identified: (1) MDADI items lack clarity of definition of the terms 'swallowing', 'eating' and 'dysphagia'; (2) the MDADI is perceived to be overly negative in tone including items that service users may find distressing or disempowering; (3) items in the tool are exclusory to specific subgroups of patients, such as those who are nil by mouth or socially isolated; and (4) modifications to the MDADI were suggested and encouraged to make it more clinically useful and patient-centred. CONCLUSIONS This study indicates that MDADI's content validity is 'insufficient' when rated by COSMIN parameters. This has significant implications for its continued use in HNC research and clinical practice. Further re-evaluation of the content validity of the MDADI is warranted, with potential future amendment of items being indicated if the results of this study are corroborated in subsequent research. WHAT THIS PAPER ADDS What is already known on the subject The MD Anderson Dysphagia Inventory (MDADI) patient-reported outcome measure of dysphagia-related quality of life is widely used in clinical practice and international clinical trials. Content validity is considered to be the most important property of a tool when assessing its psychometric strengths and weaknesses; however, the MDADI's content validity has not been reappraised since its initial development. What this paper adds to existing knowledge This study presents UK speech and language therapists' opinions and experience of the content validity of the MDADI and this first reappraisal of its content validity since its initial development highlights several issues with this psychometric parameter of the tool. This study highlights that further re-evaluation of the content validity of the MDADI is warranted, with potential future amendment of items being indicated if the results of this study are corroborated in subsequent research. What are the potential or actual clinical implications of this work? Clinicians cannot assume that commonly used outcomes tools have strong psychometric profiles. Consideration of the content validity of outcomes tools during selection for use in clinical and research practice should be key, as this will encourage use of tools that produce relevant, valid data that can contribute meaningfully to patient-centred care.
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Affiliation(s)
- Kate Toft
- University of Stirling, Stirling, UK
- NHS Lothian; Western General Hospital, Edinburgh, UK
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Stradling EJ, Barnhart MK, Robinson RA, Mogg PJ, Ward EC, Smee RI. Implementing flexible endoscopic evaluation of swallow screening within annual cancer surveillance appointments to monitor for late-stage radiation-induced dysphagia: A feasibility study. Head Neck 2024; 46:615-626. [PMID: 38151916 DOI: 10.1002/hed.27615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Late-stage progressive decline of swallowing function after radiotherapy for head and neck cancer (HNC) is often difficult to monitor. This study examined the feasibility and clinical outcomes of speech-language pathology implementing flexible endoscopic evaluation of swallow (FEES) screening during annual cancer surveillance visits to monitor late-stage swallowing function. METHODS Patients >2 years post treatment who attended routine oncological visits underwent FEES screening. Feasibility (service data, stakeholder survey) and swallowing outcomes (oral intake, secretions, internal lymphedema, penetration-aspiration, and residue) were collected. RESULTS Screening was completed with 70% (50/71) of eligible patients. Medical staff and speech-language pathologists indicated the protocol was worthwhile and achievable to incorporate into practice. Almost all patients were willing to complete the protocol annually. FEES outcomes identified 84% with dysphagia versus only 26% self-reported dysphagia. CONCLUSION Findings indicate FEES screening incorporated into annual oncological reviews is feasible and effective at monitoring late-stage swallowing function following HNC.
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Affiliation(s)
- Emma J Stradling
- Department of Speech Pathology, Prince of Wales Hospital, South-Eastern Sydney Local Health District, Randwick, New South Wales, Australia
- Department of Radiation Oncology, Comprehensive Cancer Centre, POWH, Randwick, New South Wales, Australia
| | - Molly K Barnhart
- Department of Speech Pathology, Prince of Wales Hospital, South-Eastern Sydney Local Health District, Randwick, New South Wales, Australia
- Department of Radiation Oncology, Comprehensive Cancer Centre, POWH, Randwick, New South Wales, Australia
| | - Rachelle A Robinson
- Department of Speech Pathology, Prince of Wales Hospital, South-Eastern Sydney Local Health District, Randwick, New South Wales, Australia
| | - Penny J Mogg
- Department of Speech Pathology, Prince of Wales Hospital, South-Eastern Sydney Local Health District, Randwick, New South Wales, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Robert I Smee
- Department of Radiation Oncology, Comprehensive Cancer Centre, POWH, Randwick, New South Wales, Australia
- Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, New South Wales, Australia
- The Clinical Teaching School, University New South Wales, Kensington, New South Wales, Australia
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Zhu J, Wang X, Chen S, Du R, Zhang H, Zhang M, Shao M, Chen C, Wang T. Improving compliance with swallowing exercise to decrease radiotherapy-related dysphagia in patients with head and neck cancer. Asia Pac J Oncol Nurs 2023; 10:100169. [PMID: 36583099 PMCID: PMC9792737 DOI: 10.1016/j.apjon.2022.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Dysphagia, one of the most common complications in head and neck cancer (HNC) treated with radiotherapy, can severely affect patients' quality of life. Currently, because no "gold standard" treatment exists, swallowing exercise remains the main rehabilitation strategy for dysphagia. However, patients' compliance with long-term swallowing exercise is only 40%, thus, greatly compromising outcomes. This article aims to analyze thefactors influencing swallowing exercise compliance in patients with HNC and explains strategies developed to date for improved rehabilitation outcomes. Methods Research studies published between 2005 and 2022 were retrieved from seven databases: PubMed, Cochrane Library, Embase, CINAHL, CNKI, Wan Fang Database, and VIP Database, and 21 articles were shortlisted and systematically reviewed. Results The swallowing exercise compliance in patients with HNC undergoing radiotherapy was affected by multiple factors, including socio-demographic factors, illness-associated factors, treatment-associated factors, and psychosocial factors. Regarding the interventions, current strategies mainly address psychosocial issues via developing various education programs. Conclusions Different factors influencing swallowing exercise compliance are important and should be observed. Measures including developing multidisciplinary teams, applying innovative equipment, refining the intervention procedure, and applying systematic theory frameworks should be performed to achieve better outcomes of compliance interventions.
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Affiliation(s)
- Jizhe Zhu
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Xin Wang
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Suxiang Chen
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, WA, Australia
| | - Ruofei Du
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
- Academy of Medical Sciences of Zhengzhou University, Zhengzhou, China
| | - Haoning Zhang
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Menghan Zhang
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Mengwei Shao
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Changying Chen
- Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tao Wang
- College of Nursing and Health, Zhengzhou University, Zhengzhou, China
- Telethon Kids Institute, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- People’ s Hospital of Hebi, Hebi, China
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Hutchison A, Nund RL, Brown B, Ward EC, Wishart L. Using dosimetric information to guide dysphagia management in patients with head and neck cancer: Clinicians' knowledge and experiences. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:417-426. [PMID: 34651538 DOI: 10.1080/17549507.2021.1984578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: The use of dosimetric information to guide the management of dysphagia related to head and neck cancer (HNC) treatment is an emerging area of practice. In order to better meet the needs of people with dysphagia in HNC, it is important to explore how clinicians use this information to guide practice and also to identify factors that influence/discourage the use of dosimetric information.Method: A descriptive qualitative method was chosen and purposeful sampling with additional snowball sampling were used to recruit clinicians working within Australian cancer centres. To facilitate participation, clinicians were offered either a focus group or individual interview as a means to collect their perspectives. A total of 20 clinicians with varying years of clinical experience (range 2.5 - 29 years) were recruited. Eight participants took part in a focus group and 12 elected to participate in an individual interview. Content analysis was used to analyse transcripts.Result: Three main themes emerged from the transcripts: (1) clinician factors such as experience, confidence and knowledge and (2) clinical service factors such as staffing levels, clinical management pathways and system access influence use of dosimetric information; (3) patient factors such as demographics, surgical history and education needs influence dysphagia management plans.Conclusion: Speech-language pathologists' (SLPs') use of dosimetric information within HNC settings to direct patient management is emerging and varies between clinicians and workplaces. Given that dosimetric information potentially enables specialised dysphagia management planning for patients during their radiotherapy treatment, further education and training for speech-language pathologists in this area should be prioritised.
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Affiliation(s)
- Alana Hutchison
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rebecca Louise Nund
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Bena Brown
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology Department Princess Alexandra Hospital, Queensland Health, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Laurelie Wishart
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Martino R, Fitch MI, Fuller CD, Hope A, Krisciunas G, Langmore SE, Lazarus C, Macdonald CL, McCulloch T, Mills G, Palma DA, Pytynia K, Ringash J, Sultanem K, Theurer J, Thorpe KE, Hutcheson K. The PRO-ACTIVE trial protocol: a randomized study comparing the effectiveness of PROphylACTic swallow InterVEntion for patients receiving radiotherapy for head and neck cancer. BMC Cancer 2021; 21:1100. [PMID: 34645411 PMCID: PMC8513207 DOI: 10.1186/s12885-021-08826-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Swallowing therapy is commonly provided as a treatment to lessen the risk or severity of dysphagia secondary to radiotherapy (RT) for head and neck cancer (HNC); however, best practice is not yet established. This trial will compare the effectiveness of prophylactic (high and low intensity) versus reactive interventions for swallowing in patients with HNC undergoing RT. METHODS This multi-site, international randomized clinical trial (RCT) will include 952 adult patients receiving radiotherapy for HNC and who are at high risk for post-RT dysphagia. Participants will be randomized to receive one of three interventions for swallowing during RT: RE-ACTIVE, started promptly if/when dysphagia is identified; PRO-ACTIVE EAT, low intensity prophylactic intervention started before RT commences; or, PRO-ACTIVE EAT+EXERCISE, high intensity prophylactic intervention also started before RT commences. We hypothesize that the PRO-ACTIVE therapies are more effective than late RE-ACTIVE therapy; and, that the more intensive PRO-ACTIVE (EAT + EXERCISE) is superior to the low intensive PRO-ACTIVE (EAT). The primary endpoint of effectiveness is duration of feeding tube dependency one year post radiation therapy, selected as a pragmatic outcome valued equally by diverse stakeholders (e.g., patients, caregivers and clinicians). Secondary outcomes will include objective measures of swallow physiology and function, pneumonia and weight loss, along with various patient-reported swallowing-related outcomes, such as quality of life, symptom burden, and self-efficacy. DISCUSSION Dysphagia is a common and potentially life-threatening chronic toxicity of radiotherapy, and a priority issue for HNC survivors. Yet, the optimal timing and intensity of swallowing therapy provided by a speech-language pathologist is not known. With no clearly preferred strategy, current practice is fraught with substantial variation. The pragmatic PRO-ACTIVE trial aims to specifically address the decisional dilemma of when swallowing therapy should begin (i.e., before or after a swallowing problem develops). The critical impact of this dilemma is heightened by the growing number of young HNC patients in healthcare systems that need to allocate resources most effectively. The results of the PRO-ACTIVE trial will address the global uncertainty regarding best practice for dysphagia management in HNC patients receiving radiotherapy. TRIAL REGISTRATION The protocol is registered with the US Patient Centered Outcomes Research Institute, and the PRO-ACTIVE trial was prospectively registered at ClinicalTrials.gov , under the identifier NCT03455608 ; First posted: Mar 6, 2018; Last verified: Jun 17, 2021. Protocol Version: 1.3 (January 27, 2020).
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Affiliation(s)
- R Martino
- Department of Speech Language Pathology, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
- Rehabilitation Science Institute, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
- Department of Otolaryngology, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada.
| | - M I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - C D Fuller
- Division of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 7007 Bertner Ave, Houston, TX, TX 77030, USA
| | - A Hope
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada
| | - G Krisciunas
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, USA
| | - S E Langmore
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston, USA
| | - C Lazarus
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel, New York, NY, USA
| | - C L Macdonald
- Qualitative Health Research Consultants, Madison, WI, USA
| | - T McCulloch
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin-Madison, Madison, WI, U.S.A
| | - G Mills
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - D A Palma
- Department of Radiation Oncology, Western University, London, ON, Canada
| | - K Pytynia
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, 7007 Bertner Ave, Houston, TX, TX 77030, USA
| | - J Ringash
- Department of Otolaryngology, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada
| | - K Sultanem
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - J Theurer
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - K E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Canada
| | - K Hutcheson
- Division of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 7007 Bertner Ave, Houston, TX, TX 77030, USA.
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, 7007 Bertner Ave, Houston, TX, TX 77030, USA.
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Frowen J, Hughes R, Kiss N. Introduction of a speech-language pathology assistant role for swallow screening in a head and neck radiotherapy clinic. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:441-451. [PMID: 32862705 DOI: 10.1080/17549507.2020.1800818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Optimal care suggests that all moderate-high risk head and neck (H&N) cancer patients should receive speech pathology assessment, education and management when commencing radiotherapy. However this is not always feasible due to high patient numbers and limited staffing. The aim of this study was to investigate the implementation of a speech-language pathology assistant (SLP-A) role for swallowing screening and education in a multidisciplinary H&N treatment clinic. METHOD A detailed model of care and training module were developed to up-skill the SLP-A in the screening and education to be undertaken. A pre-test post-test design compared outcomes in two separate groups prior to and following SLP-A role implementation. Outcomes included: optimal care compliance, speech-language pathology time spent with complex patients, swallowing-related admissions and patient satisfaction. RESULT Twenty-six patients were included pre-implementation and 35 post-implementation, with 16 (46%) patients receiving SLP-A screening/education post-implementation. The proportion of eligible patients seen by speech-language pathology pre-implementation was 62%, compared to 94% seen by speech-language pathology or SLP-A post-implementation (p = 0.002). There was a (non-significant) increase in speech-language pathology time spent with complex patients post-implementation (total minutes per patient: mean 252, SD = 144 vs. 279, SD = 115). There was no increase in swallowing-related admissions, and a (non-significant) increase in patient satisfaction post-implementation, indicating no compromise to patient safety or satisfaction. CONCLUSION Implementing a speech-language pathology assistant role for screening patients within the H&N treatment clinic allowed delivery of optimal care and increased time for speech-language pathologists to spend with complex patients, without compromising patient safety or satisfaction.
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Affiliation(s)
- Jacqui Frowen
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rhys Hughes
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicole Kiss
- Geelong, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Australia
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9
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MacDonald C, Theurer JA, Fung K, Yoo J, Doyle PC. Resilience: an essential element in head and neck cancer survivorship and quality of life. Support Care Cancer 2021; 29:3725-3733. [PMID: 33201311 DOI: 10.1007/s00520-020-05873-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/02/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Individuals with head and neck cancer (HNCa) face myriad biopsychosocial challenges. Even after treatment completion, these challenges may cause continued disablement and diminished quality of life (QoL). Resilience may serve to minimize the disabling impact of HNCa and, in turn, maximize QoL. The purpose of this study was to formally assess resilience in HNCa survivors and explore its relationship with QoL. METHODS A cross-sectional descriptive study was conducted. Forty HNCa survivors completed three validated, self-report questionnaires pertaining to the collection of resilience and QoL data. Descriptive and correlational analyses were performed. RESULTS Resilience was identified in HNCa survivors and a positive correlation was found between resilience and QoL. CONCLUSIONS Data suggest that resilience may buffer the influence of HNCa on QoL. Thus, screening for reduced levels of resilience may proactively facilitate identification of those who are most vulnerable to the psychosocial impact of HNCa. Interventions that foster resilience may ameliorate the challenges of HNCa and maximize QoL.
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Affiliation(s)
- Chelsea MacDonald
- Laboratory for Well-Being and Quality of Life in Oncology, Rehabilitation Sciences, Western University, Elborn College, Room 2200, 1201 Western Rd., London, N6G 1H1, Canada.
| | - Julie A Theurer
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, London, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, London, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, London, Canada
| | - Philip C Doyle
- Laboratory for Well-Being and Quality of Life in Oncology, Rehabilitation Sciences, Western University, Elborn College, Room 2200, 1201 Western Rd., London, N6G 1H1, Canada
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, London, Canada
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Logan AM, Landera MA. Clinical Practices in Head and Neck Cancer: A Speech-Language Pathologist Practice Pattern Survey. Ann Otol Rhinol Laryngol 2021; 130:1254-1262. [PMID: 33733876 DOI: 10.1177/00034894211001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Clinical practices of speech-language pathologists (SLP) treating head and neck cancer (HNC) patients range widely despite literature trending toward best practices. This survey study was designed to identify current patterns and assess for gaps in clinical implementation of research evidence. METHOD A web-based survey was distributed to SLPs via listserv and social media outlets. Descriptive statistics and group calculations were completed to identify trends and associations in responses. RESULTS Of 152 received surveys, the majority of respondents were hospital-based (86%) and had greater than 5 years of experience (65%). There was group consensus for the use of prophylactic exercise programs (95%), recommendations for SLP intervention during HNC treatment (75%), and use of maintenance programs post-treatment (97%). Conversely, no group consensus was observed for use of pre-treatment swallow evaluations, frequency of service provision, and content of therapy sessions. Variation in clinical decision making was noted in use of prophylactic feeding tubes and number of patients taking nothing by mouth during treatment. No associations were found between years of experience and decision-making practices, nor were any associations found between practice setting and clinical decision making. CONCLUSION Despite the growing body of literature outlining evidence-based treatment practices for HNC patients, clinical practice patterns among SLPs continue to vary widely resulting in inconsistent patient care across practice settings. As compared to prior similar data, increased alignment with best practices was observed relative to early referrals, implementation of prophylactic intervention programs, and intervention with the SLP during the period of HNC treatment.
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Affiliation(s)
- Ashley M Logan
- Dr. Pallavi Patel College of Health Care Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA.,Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Mario A Landera
- Dr. Pallavi Patel College of Health Care Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA.,Department of Otolaryngology, University of Miami School of Medicine, Miami, FL, USA
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11
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Pfister DG, Spencer S, Adelstein D, Adkins D, Anzai Y, Brizel DM, Bruce JY, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Eisele DW, Fenton M, Foote RL, Galloway T, Gillison ML, Haddad RI, Hicks WL, Hitchcock YJ, Jimeno A, Leizman D, Maghami E, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rocco JW, Rodriguez CP, Shah JP, Weber RS, Weinstein G, Witek M, Worden F, Yom SS, Zhen W, Burns JL, Darlow SD. Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:873-898. [DOI: 10.6004/jnccn.2020.0031] [Citation(s) in RCA: 313] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Treatment is complex for patients with head and neck (H&N) cancers with specific site of disease, stage, and pathologic findings guiding treatment decision-making. Treatment planning for H&N cancers involves a multidisciplinary team of experts. This article describes supportive care recommendations in the NCCN Guidelines for Head and Neck Cancers, as well as the rationale supporting a new section on imaging recommendations for patients with H&N cancers. This article also describes updates to treatment recommendations for patients with very advanced H&N cancers and salivary gland tumors, specifically systemic therapy recommendations.
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Affiliation(s)
| | | | - David Adelstein
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Douglas Adkins
- 4Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Yoshimi Anzai
- 5Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | | | - David W. Eisele
- 12The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Moon Fenton
- 13The University of Tennessee Health Science Center
| | | | | | | | | | | | | | | | - Debra Leizman
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Bharat B. Mittal
- 22Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - James W. Rocco
- 23The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | - Sue S. Yom
- 27UCSF Helen Diller Family Comprehensive Cancer Center
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12
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Baudelet M, Van den Steen L, Duprez F, De Bodt M, Deschuymer S, Goeleven A, Hutsebaut I, Mariën S, Meersschout S, Nevens D, Nuyts S, Peeters M, Specenier P, Van den Brekel M, van der Molen L, Vandenbruaene C, Vanderveken O, Van Dinther J, Van Laer C, Vauterin T, Verstraete H, Van Nuffelen G. Study protocol for a randomized controlled trial: prophylactic swallowing exercises in head-and-neck cancer patients treated with (chemo)radiotherapy (PRESTO trial). Trials 2020; 21:237. [PMID: 32122397 PMCID: PMC7053144 DOI: 10.1186/s13063-020-4171-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/13/2020] [Indexed: 01/10/2023] Open
Abstract
Background Dysphagia is a common and serious complication after (chemo)radiotherapy (CRT) for head-and-neck cancer (HNC) patients. Prophylactic swallowing exercises (PSE) can have a significantly positive effect on post-treatment swallowing function. However, low adherence rates are a key issue in undermining this positive effect. This current randomized trial will investigate the effect of adherence-improving measures on patients’ swallowing function, adherence and quality of life (QOL). Methods This ongoing trial will explore the difference in adherence and swallowing-related outcome variables during and after PSE in HNC patients performing the same therapy schedule, receiving different delivery methods. One hundred and fifty patients treated in various hospitals will be divided into three groups. Group 1 performs PSE at home, group 2 practices at home with continuous counseling through an app and group 3 receives face-to-face therapy by a speech and language pathologist. The exercises consist of tongue-strengthening exercises and chin-tuck against resistance with effortful swallow. The Iowa Oral Performance Instrument and the Swallowing Exercise Aid are used for practicing. Patients are evaluated before, during and after treatment by means of strength measurements, swallowing and QOL questionnaires. Discussion Since low adherence rates undermine the positive impact of PSE on post-treatment swallowing function, there is need to develop an efficient PSE protocol maximizing adherence rates. Trial registration ISRCTN, ID: ISRCTN98243550. Registered retrospectively on 21 December 2018.
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Affiliation(s)
- Margot Baudelet
- Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
| | - Sarah Deschuymer
- Department of Radiation Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Ann Goeleven
- Department of ENT, University Hospitals Leuven, Swallowing Clinic, Leuven, Belgium.,Department of Head and Neck Surgery, University Hospitals Leuven, Swallowing Clinic, Leuven, Belgium
| | - Isabel Hutsebaut
- Department of Radiation Oncology, AZ Sint-Jan General Hospital, Bruges, Belgium
| | - Steven Mariën
- Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Sabine Meersschout
- Department of Radiation Oncology, AZ Sint-Jan General Hospital, Bruges, Belgium
| | - Daan Nevens
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Radiation Oncology, Iridium Kanker Netwerk, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Sandra Nuyts
- Department of Radiation Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Marc Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Pol Specenier
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Michiel Van den Brekel
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Faculty of Humanities, University of Amsterdam, Spui 21, 1012 WX, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Caroline Vandenbruaene
- Department of Speech-Language Pathology and Audiology, Sint-Jan General Hospital, Bruges, Belgium
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Joost Van Dinther
- Department of Otorhinolaryngology, Sint-Augustinus Hospital, Antwerp, Belgium
| | - Carl Van Laer
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Tom Vauterin
- Department of Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan General Hospital, Bruges, Belgium
| | - Hilde Verstraete
- Department of Radiation Oncology, Iridium Kanker Netwerk, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
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13
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Wall LR, Ward EC, Cartmill B, Hill AJ, Isenring E, Byrnes J, Porceddu SV. Prophylactic swallowing therapy for patients with head and neck cancer: A three-arm randomized parallel-group trial. Head Neck 2020; 42:873-885. [PMID: 31903689 DOI: 10.1002/hed.26060] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 12/05/2019] [Accepted: 12/17/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Intensive prophylactic swallowing therapy can mitigate dysphagia in patients with oropharyngeal (OP) SCC, however, presents service challenges. This trial investigated the clinical efficacy of three service models delivering prophylactic swallowing therapy during (chemo)radiotherapy ([C]RT). METHODS Patients (n = 79) with OPSCC receiving (C)RT were were randomized to: (a) clinician-directed face-to-face therapy (n = 26); (b) telepractice therapy via "SwallowIT" (n = 26); or (c) patient self-directed therapy (n = 27). Swallowing, nutritional, and functional status were compared at baseline, 6-weeks, and 3-months post-(C)RT. Patients' perceptions/preferences for service-delivery were collated posttreatment. RESULTS Service-delivery mode did not affect clinical outcomes, with no significant (P > .05) between-group differences or group-by-time interactions observed for swallowing, nutrition, or functional measures. Therapy adherence declined during (C)RT in all groups. SwallowIT and clinician-directed models were preferred by significantly (P = .002) more patients than patient-directed. CONCLUSIONS SwallowIT provided clinically equivalent outcomes to traditional service models. SwallowIT and clinician-directed therapy were preferred by patients, likely due to higher levels of therapy support.
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Affiliation(s)
- Laurelie R Wall
- Centre for Functioning and Health Research, Queensland Health, Queensland, Australia.,Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia.,Centre of Research Excellence in Telehealth, The University of Queensland, Queensland, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Queensland Health, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia.,Centre of Research Excellence in Telehealth, The University of Queensland, Queensland, Australia
| | - Bena Cartmill
- Centre for Functioning and Health Research, Queensland Health, Queensland, Australia.,Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Queensland, Australia
| | - Anne J Hill
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia.,Centre of Research Excellence in Telehealth, The University of Queensland, Queensland, Australia
| | - Elizabeth Isenring
- Department of Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Sandro V Porceddu
- Radiation Oncology Department, Princess Alexandra Hospital, Queensland Health, Queensland, Australia.,School of Medicine, The University of Queensland, Queensland, Australia
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14
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Cimoli M, Oates J, McLaughlin E, Langmore SE. Exploring Consistency and Variation in Fibreoptic Endoscopic Evaluation of Swallowing Practice in Australia. Folia Phoniatr Logop 2019; 72:429-441. [PMID: 31639815 DOI: 10.1159/000503132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fibreoptic endoscopic evaluation of swallowing (FEES) is an imaging technique used by speech-language pathologists (SLPs) and some other health professionals to assess swallowing. OBJECTIVES The primary aim was to gain an insight into FEES practices in Australia by characterising SLPs who use FEES and identifying areas of consistency and variation in practice. The secondary aim was to explore factors associated with variation in practice. METHOD Cross-sectional survey methodology was used. The link to a web-based survey was e-mailed to 351 SLPs who practised in adult dysphagia. RESULTS The participation rate for the study was 18.8% (n = 66). Twenty-two SLPs (38.6%) used FEES. These SLPs represented a cross-section of workplace settings, caseloads, clinical and training experiences. Consistency and variation in FEES procedural and assessment practices were identified. Some procedural aspects of FEES varied according to whether a medical practitioner was present, type of FEES training, and number of FEES conducted per month. CONCLUSION This research represents a benchmark in the knowledge of how FEES is used in Australia. Despite the small number of participants, the findings provide a foundation from which future research questions can be generated. More extensive examination of the use of FEES by SLPs is warranted. Further research is also required to establish methods for attaining and maintaining competency and to achieve consensus on which aspects of swallowing are assessed when using FEES and how the examination should be conducted.
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Affiliation(s)
- Michelle Cimoli
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia, .,Speech Pathology Department, Austin Health, Heidelberg, Victoria, Australia,
| | - Jennifer Oates
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Emma McLaughlin
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Speech Pathology Department, Castlemaine Health, Castlemaine, Victoria, Australia
| | - Susan E Langmore
- Department of Otolaryngology, School of Medicine, Boston University, Boston, Massachusetts, USA
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15
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Moroney LB, Ward EC, Helios J, Crombie J, Burns CL, Blake C, Comans T, Chua B, Kenny L, Hughes BGM. Evaluation of a speech pathology service delivery model for patients at low dysphagia risk during radiotherapy for HNC. Support Care Cancer 2019; 28:1867-1876. [DOI: 10.1007/s00520-019-04992-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
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16
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Perlow HK, Ramey SJ, Farnia B, Silver B, Kwon D, Chinea FM, Sotnick SC, Klein LB, Elsayyad N, Samuels MA, Freedman L, Yechieli R, Samuels SE. Nutrition and Swallowing Therapy in Head and Neck Cancer: Utilization of Care and Preventative Efficacy. Nutr Cancer 2019; 70:1290-1298. [PMID: 30633586 DOI: 10.1080/01635581.2018.1557220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine the impact of ethnicity, Spanish language preference, socioeconomic status, and treatment setting on utilization of supportive services before radiotherapy (RT) among head and neck cancer patients and to determine whether a lack of these services is associated with an increased rate of adverse events. METHODS AND MATERIALS Demographic, staging, and treatment details were retrospectively collected for patients treated at a safety-net hospital (n = 56) or adjacent private academic hospital (n = 183) from January 1, 2014, to June 30, 2016. Supportive care services evaluated were limited to speech/swallowing therapy and nutrition therapy. Adverse events and performance measures examined included weight loss during RT, gastric tube placement, emergency department visits, hospital admissions, and missed RT days. RESULTS On multivariable analysis, patients receiving treatment at the safety-net hospital were less likely to receive speech/swallowing services. Receiving speech/swallowing therapy before treatment was associated with less weight loss during treatment, and in conjunction with nutrition therapy, was associated with fewer missed RT days. CONCLUSION Safety-net hospital treatment was associated with a lack of utilization of pre-RT speech/swallowing therapy which in turn was associated with increased weight loss. Interventions aimed at improving utilization of these services would improve treatment tolerance and patient outcomes.
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Affiliation(s)
- Haley K Perlow
- a Miller School of Medicine , University of Miami , Miami , Florida , USA
| | - Stephen J Ramey
- b Department of Radiation Oncology, Sylvester Comprehensive Cancer Center , University of Miami , Miami , Florida , USA
| | - Benjamin Farnia
- b Department of Radiation Oncology, Sylvester Comprehensive Cancer Center , University of Miami , Miami , Florida , USA
| | - Ben Silver
- a Miller School of Medicine , University of Miami , Miami , Florida , USA
| | - Deukwoo Kwon
- b Department of Radiation Oncology, Sylvester Comprehensive Cancer Center , University of Miami , Miami , Florida , USA.,c Department of Biostatistics and Bioinformatics , University of Miami , Miami , Florida , USA
| | - Felix M Chinea
- b Department of Radiation Oncology, Sylvester Comprehensive Cancer Center , University of Miami , Miami , Florida , USA
| | - Sandra C Sotnick
- d Clinical Nutrition at Sylvester Comprehensive Cancer Center , University of Miami , Miami , Florida , USA
| | - Lesley B Klein
- d Clinical Nutrition at Sylvester Comprehensive Cancer Center , University of Miami , Miami , Florida , USA
| | - Nagy Elsayyad
- b Department of Radiation Oncology, Sylvester Comprehensive Cancer Center , University of Miami , Miami , Florida , USA
| | - Michael A Samuels
- b Department of Radiation Oncology, Sylvester Comprehensive Cancer Center , University of Miami , Miami , Florida , USA
| | - Laura Freedman
- b Department of Radiation Oncology, Sylvester Comprehensive Cancer Center , University of Miami , Miami , Florida , USA
| | - Raphael Yechieli
- b Department of Radiation Oncology, Sylvester Comprehensive Cancer Center , University of Miami , Miami , Florida , USA
| | - Stuart E Samuels
- b Department of Radiation Oncology, Sylvester Comprehensive Cancer Center , University of Miami , Miami , Florida , USA
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17
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Liu J, Gao J, Wu CX, Bai DX, Li X, Guo XX, Yu JY, Xiao QQ, Bao XR, He LC, Zhong YZ, Chen S. Reliability, validity and responsiveness of the Mandarin (Simplified) Chinese version of the EORTC QLQ-OH45 among cancer patients. Eur J Cancer Care (Engl) 2019; 28:e12987. [DOI: 10.1111/ecc.12987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/12/2018] [Accepted: 12/07/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Jie Liu
- Chengdu University of Traditional Chinese Medicine; Chengdu China
| | - Jing Gao
- Chengdu University of Traditional Chinese Medicine; Chengdu China
| | - Chen-Xi Wu
- Chengdu University of Traditional Chinese Medicine; Chengdu China
| | - Ding-Xi Bai
- Chengdu University of Traditional Chinese Medicine; Chengdu China
| | - Xing Li
- Chengdu University of Traditional Chinese Medicine; Chengdu China
| | - Xiao-Xiao Guo
- Chengdu University of Traditional Chinese Medicine; Chengdu China
| | - Jing-Ya Yu
- Chengdu University of Traditional Chinese Medicine; Chengdu China
| | - Qing-Qing Xiao
- Chengdu University of Traditional Chinese Medicine; Chengdu China
| | - Xin-Ru Bao
- Chengdu University of Traditional Chinese Medicine; Chengdu China
| | - Lian-Ci He
- Chengdu University of Traditional Chinese Medicine; Chengdu China
| | - Yi-Zhu Zhong
- Chengdu University of Traditional Chinese Medicine; Chengdu China
| | - Shi Chen
- Chengdu University of Traditional Chinese Medicine; Chengdu China
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18
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Economic Analysis of a Three-Arm RCT Exploring the Delivery of Intensive, Prophylactic Swallowing Therapy to Patients with Head and Neck Cancer During (Chemo)Radiotherapy. Dysphagia 2018; 34:627-639. [DOI: 10.1007/s00455-018-9960-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 11/07/2018] [Indexed: 12/22/2022]
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19
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Cowie J, Boa S, King E, Wells M, Cairns D. Electronic Swallowing Intervention Package to Support Swallowing Function in Patients With Head and Neck Cancer: Development and Feasibility Study. JMIR Form Res 2018; 2:e15. [PMID: 30320300 PMCID: PMC6181202 DOI: 10.2196/formative.9703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Many patients undergoing treatment for head and neck cancer (HNC) experience significant swallowing difficulties, and there is some evidence that swallowing exercises may improve outcomes, including quality of life. This feasibility study developed an evidence-based, practical Swallowing Intervention Package (SiP) for patients undergoing chemoradiotherapy (CRT) for HNC. As part of the study, an electronic version of SiP (e-SiP) was concurrently developed to support patients to self-manage during treatment. This paper reports on the e-SiP component of this work. Objective The objective of our study was to develop and conduct a preliminary evaluation of an electronic support system (e-SiP) for patients undergoing CRT for HNC. Methods The study was conducted using a recognized mHealth development and evaluation framework and involved health professionals and patients who were undergoing CRT for HNC. The scoping stage of e-SiP development investigated the potential usefulness of the app, exploring how e-SiP would look and feel and what content would be appropriate to provide. Patient and carer focus groups and a health professionals’ consensus day were used as means of data gathering around potential e-SiP content. A repeat focus group looked at an outline version of e-SiP and informed the next stage of its development with regard to refining the requirements for the tool. This was followed by further development and a testing stage of e-SiP that involved the coding of a prototype, which was then evaluated using a series of steering group meetings, semistructured interviews with both patients and health care professionals, and analysis of e-SiP log data. Results Feedback from focus groups and health professional interviews was very positive, and it was felt e-SiP use would support and encourage patients in conducting their swallowing exercises. However, of the 10 patients who were offered e-SiP, only 2 opted to use it. For these patients, the aspects of the e-SiP app were considered useful, in particular, the ease of keeping a diary of exercises performed. Interviews with users and nonusers suggested significant barriers to its use. Most significantly, the lack of flexibility of the platform on which e-SiP could be accessed appeared a dominant factor in deterring e-SiP use. Conclusions The results suggest that further research needs to be conducted around the implementation of e-SiP. This involves evaluating how e-SiP can be better integrated into usual care and through patient training and staff engagement, can be perceived as a beneficial tool to help support patients in conducting swallowing exercises.
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Affiliation(s)
- Julie Cowie
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Sally Boa
- Strathcarron Hospice, Denny, United Kingdom
| | - Emma King
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Mary Wells
- Nursing, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - David Cairns
- Department of Computing Science and Maths, University of Stirling, Stirling, United Kingdom
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20
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Radiotherapy for cutaneous head and neck cancer and parotid tumours: a prospective investigation of treatment-related acute swallowing and toxicity patterns. Support Care Cancer 2018; 27:573-581. [PMID: 30019149 DOI: 10.1007/s00520-018-4352-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Reports of acute treatment-related dysphagia and toxicities for patients with parotid tumours or cutaneous head and neck cancer (HNC) are limited. This study aimed to describe the severity and timing of dysphagia and related toxicities experienced during radiotherapy for cutaneous HNC and parotid tumours, to inform the nature of future speech pathology (SP) service models required during treatment. METHODS Prospective study of 32 patients with parotid tumours and 36 with cutaneous HNC undergoing curative non-surgical management. Dysphagia and acute toxicity data was collected weekly during treatment and at 2, 4 and 12 weeks post-treatment using the Functional Oral Intake Scale, diet descriptors and CTCAE v4.0. RESULTS In both groups, minimal treatment toxicities (grades 0-1) were observed. Xerostomia and dysgeusia were the most frequently reported grade 2 toxicities. Only 3% of parotid patients and 6% with cutaneous HNC experienced grade 3 dysphagia. Full or soft texture diets were maintained by > 70% of patients in both groups. Symptoms peaked in the final week of treatment and rapidly improved thereafter. Apart from xerostomia < 10% of patients had any grade 2 toxicity at 12 weeks post-treatment. CONCLUSION Patients in these subgroups of HNC experienced minimal treatment-related toxicity during radiotherapy. As such, the need for supportive symptom management by SP is low. Models that involve interdisciplinary surveillance of symptoms with referral to SP only when required may be best suited for these individuals to ensure issues are identified whilst minimising patient burden created by unnecessary routine SP appointments.
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21
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Greco E, Simic T, Ringash J, Tomlinson G, Inamoto Y, Martino R. Dysphagia Treatment for Patients With Head and Neck Cancer Undergoing Radiation Therapy: A Meta-analysis Review. Int J Radiat Oncol Biol Phys 2018; 101:421-444. [DOI: 10.1016/j.ijrobp.2018.01.097] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 12/29/2022]
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Webster KT, Tippett D, Simpson M, Abrams R, Pietsch K, Herbert RJ, Eisele DW, Gourin CG. Speech‐language pathology care and short‐ and long‐term outcomes of oropharyngeal cancer treatment in the elderly. Laryngoscope 2017; 128:1403-1411. [DOI: 10.1002/lary.26950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/29/2017] [Accepted: 09/07/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Kimberly T. Webster
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandU.S.A
| | - Donna Tippett
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandU.S.A
| | - Marissa Simpson
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandU.S.A
| | - Rina Abrams
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandU.S.A
| | - Kristine Pietsch
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandU.S.A
| | - Robert J. Herbert
- Department of Health Policy and Managementthe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandU.S.A
| | - David W. Eisele
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandU.S.A
| | - Christine G. Gourin
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandU.S.A
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Burns CL, Kularatna S, Ward EC, Hill AJ, Byrnes J, Kenny LM. Cost analysis of a speech pathology synchronous telepractice service for patients with head and neck cancer. Head Neck 2017; 39:2470-2480. [DOI: 10.1002/hed.24916] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/24/2017] [Accepted: 07/13/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Clare L. Burns
- Speech Pathology and Audiology Department; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- The University of Queensland; School of Health and Rehabilitation Sciences; Brisbane Queensland Australia
- Centre for Research Excellence in Telehealth; The University of Queensland; Brisbane Queensland Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation; Queensland University of Technology; Brisbane Queensland Australia
| | - Elizabeth C. Ward
- The University of Queensland; School of Health and Rehabilitation Sciences; Brisbane Queensland Australia
- Centre for Research Excellence in Telehealth; The University of Queensland; Brisbane Queensland Australia
- Centre for Functioning and Health Research, Metro South; Brisbane Queensland Australia
| | - Anne J. Hill
- The University of Queensland; School of Health and Rehabilitation Sciences; Brisbane Queensland Australia
- Centre for Research Excellence in Telehealth; The University of Queensland; Brisbane Queensland Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics; Menzies Health Institute Queensland, Griffith University; Brisbane Australia
| | - Lizbeth M. Kenny
- Central Integrated Regional Cancer Services; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Cancer Care Services; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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Strojan P, Hutcheson KA, Eisbruch A, Beitler JJ, Langendijk JA, Lee AWM, Corry J, Mendenhall WM, Smee R, Rinaldo A, Ferlito A. Treatment of late sequelae after radiotherapy for head and neck cancer. Cancer Treat Rev 2017; 59:79-92. [PMID: 28759822 PMCID: PMC5902026 DOI: 10.1016/j.ctrv.2017.07.003] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/05/2017] [Accepted: 07/09/2017] [Indexed: 12/21/2022]
Abstract
Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.
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Affiliation(s)
- Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne W M Lee
- Center of Clinical Oncology, University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - June Corry
- Radiation Oncology, GenesisCare, St. Vincents's Hospital, Melbourne, Victoria, Australia
| | | | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Italy
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25
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Britt CJ, Gourin CG. Contemporary management of advanced laryngeal cancer. Laryngoscope Investig Otolaryngol 2017; 2:307-309. [PMID: 29085911 PMCID: PMC5655558 DOI: 10.1002/lio2.85] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2017] [Indexed: 01/05/2023] Open
Abstract
The treatment of advanced laryngeal cancer has undergone a paradigm shift in recent years, with an increase in chemoradiation for organ preservation and a decrease in primary surgery. This review will summarize the contemporary management of advanced laryngeal cancer and discuss treatment‐related toxicity and strategies to improve outcomes. Level of Evidence NA.
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Affiliation(s)
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery Baltimore Maryland U.S.A
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26
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Application of telepractice for head and neck cancer management: a review of speech language pathology service models. Curr Opin Otolaryngol Head Neck Surg 2017; 25:169-174. [DOI: 10.1097/moo.0000000000000357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Lawson N, Krisciunas GP, Langmore SE, Castellano K, Sokoloff W, Hayatbakhsh R. Comparing dysphagia therapy in head and neck cancer patients in Australia with international healthcare systems. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:128-138. [PMID: 27093099 DOI: 10.3109/17549507.2016.1159334] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE The Australian healthcare system has invested heavily in multidisciplinary cancer care teams. Despite such investments, guidelines that clearly delineate standard of care dysphagia treatment are lacking and services provided to Head and Neck Cancer (HNC) patients are not always consistent. There is little consensus regarding the frequency and intensity of dysphagia therapy. This is largely due to a lack of well-designed clinical trials that establish the efficacy of any dysphagia therapy in this patient population. The aim of this study was to evaluate HNC dysphagia therapy patterns among Australian speech-language pathologists (SLPs). METHOD A 22 question internet-based survey was administered to a web-based professional interest group. Results were analysed by institution type and individual clinical experience. RESULT A response rate of 46% was achieved (67 out of 144 surveyed). This survey identified several aspects of dysphagia management that were provided uniformly in addition to many aspects of care that showed a lack of consensus. CONCLUSION By comparing the results of this survey with existing international best-evidence treatment guidelines, the development of uniform Australian guidelines may be facilitated. However, more authoritative data on dysphagia treatment efficacy is needed to provide uniform evidence-based HNC dysphagia treatment guidelines.
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Affiliation(s)
- Nadine Lawson
- a Princess Alexandra Hospital - Speech Pathology , Woolloongabba , Queensland , Australia
| | | | - Susan E Langmore
- b Boston University Medical Centre - Otolaryngology , Boston , MA , USA
- c Boston University - Speech Language Hearing Science , Boston , MA , USA , and
| | - Kerlly Castellano
- b Boston University Medical Centre - Otolaryngology , Boston , MA , USA
| | - William Sokoloff
- b Boston University Medical Centre - Otolaryngology , Boston , MA , USA
| | - Reza Hayatbakhsh
- d University of Queensland - School of Population Health, University of Queensland , Herston , Queensland , Australia
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28
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Govender R, Smith CH, Gardner B, Barratt H, Taylor SA. Improving swallowing outcomes in patients with head and neck cancer using a theory-based pretreatment swallowing intervention package: protocol for a randomised feasibility study. BMJ Open 2017; 7:e014167. [PMID: 28348190 PMCID: PMC5372094 DOI: 10.1136/bmjopen-2016-014167] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The incidence of head and neck cancer (HNC) in the UK is rising, with an average of 31 people diagnosed daily. Patients affected by HNC suffer significant short-term and long-term post-treatment morbidity as a result of dysphagia, which affects daily functioning and quality of life (QOL). Pretreatment swallowing exercises may provide additional benefit over standard rehabilitation in managing dysphagia after primary HNC treatments, but uncertainty about their effectiveness persists. This study was preceded by an intervention development phase to produce an optimised swallowing intervention package (SIP). The aim of the current study is to assess the feasibility of this new intervention and research processes within a National Health Service (NHS) setting. METHOD AND ANALYSIS A two-arm non-blinded randomised controlled feasibility study will be carried out at one tertiary referral NHS centre providing specialist services in HNC. Patients newly diagnosed with stage III and IV disease undergoing planned surgery and/or chemoradiation treatments will be eligible. The SIP will be delivered pre treatment, and a range of swallowing-related and QOL measures will be collected at baseline, 1, 3 and 6 months post-treatment. Outcomes will test the feasibility of a future randomised controlled trial (RCT), detailing rate of recruitment and patient acceptance to participation and randomisation. Salient information relating to protocol implementation will be collated and study material such as the case report form will be tested. A range of candidate outcome measures will be examined for suitability in a larger RCT. ETHICS AND DISSEMINATION Ethical approval was obtained from an NHS Research Ethics Committee. Findings will be published open access in a peer-reviewed journal, and presented at relevant conferences and research meetings. TRIAL REGISTRATION NUMBER ISRCTN40215425; Pre-results.
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Affiliation(s)
- Roganie Govender
- University College London Hospital, Head & Neck Cancer Centre, London, UK
- Department of Behavioural Science & Health, University College London, London, UK
| | - Christina H Smith
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Benjamin Gardner
- Department of Behavioural Science & Health, University College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK
| | - Helen Barratt
- Department of Applied Health Research, NIHR CLAHRC North Thames, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
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29
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Burns CL, Ward EC, Hill AJ, Kularatna S, Byrnes J, Kenny LM. Randomized controlled trial of a multisite speech pathology telepractice service providing swallowing and communication intervention to patients with head and neck cancer: Evaluation of service outcomes. Head Neck 2017; 39:932-939. [PMID: 28225567 DOI: 10.1002/hed.24706] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/04/2016] [Accepted: 12/09/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to present our evaluation of a new speech pathology telepractice service supporting the swallowing and communication management of patients with head and neck cancer. METHODS A multicenter randomized controlled trial was conducted within a large public cancer service. Referrals from speech pathologists at 3 regional sites (spoke sites) were managed by a specialist clinician from a cancer center (hub site) either via standard care (phone/email support/appointments at the hub site) or a newly established telepractice service (online consultation between the hub site and spoke site). RESULTS Eighty-two referrals (39 for standard care and 43 for telepractice care) were managed. Service efficiency favoring the telepractice model was reported with a significant reduction in the number (p = .004) and duration (p = .024) of contact events required to manage the referrals. Higher consumer and clinician satisfaction was also reported for the telepractice service. CONCLUSION A speech pathology telepractice service benefits both the patient and health provider through higher service efficiency and treatment satisfaction. © 2017 Wiley Periodicals, Inc. Head Neck 39: 932-939, 2017.
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Affiliation(s)
- Clare L Burns
- Speech Pathology and Audiology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South, Brisbane, Queensland, Australia
| | - Anne J Hill
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, Queensland, Australia
| | - Sanjeewa Kularatna
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Lizbeth M Kenny
- Central Integrated Regional Cancer Services, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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30
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Cartmill B, Wall LR, Ward EC, Hill AJ, Porceddu SV. Computer Literacy and Health Locus of Control as Determinants for Readiness and Acceptability of Telepractice in a Head and Neck Cancer Population. Int J Telerehabil 2016; 8:49-60. [PMID: 28775801 PMCID: PMC5536729 DOI: 10.5195/ijt.2016.6203] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Understanding end-user populations is required in designing telepractice applications. This study explored computer literacy and health locus of control in head/neck cancer (HNC) patients to inform suitability for telerehabilitation. Sixty individuals with oropharygneal cancer were recruited. Computer literacy was examined using a 10-question survey. The Multidimensional Health Locus of Control Scale Form C (MHLC-C) examined perceptions of health “control”. Participants were mostly middle-aged males, from high socioeconomic backgrounds. Only 10% were non-computer users. Of the computers users, 91% reported daily use, 66% used multiple devices and over 75% rated themselves as “confident” users. More than half were open to using technology for health-related activities. High internal scores (MHLC-C) signified a belief that own behaviour influenced health status. HNC patients have high computer literacy and an internal health locus of control, both are positive factors to support telepractice models of care. This may include asynchronous models requiring heightened capacity for self-management.
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Affiliation(s)
- Bena Cartmill
- CENTRE FOR FUNCTIONING AND HEALTH RESEARCH, QUEENSLAND HEALTH, AUSTRALIA.,SCHOOL OF HEALTH AND REHABILITATION SCIENCES, THE UNIVERSITY OF QUEENSLAND, AUSTRALIA.,SPEECH PATHOLOGY DEPARTMENT, PRINCESS ALEXANDRA HOSPITAL, QUEENSLAND HEALTH, AUSTRALIA
| | - Laurelie R Wall
- CENTRE FOR FUNCTIONING AND HEALTH RESEARCH, QUEENSLAND HEALTH, AUSTRALIA.,SCHOOL OF HEALTH AND REHABILITATION SCIENCES, THE UNIVERSITY OF QUEENSLAND, AUSTRALIA.,CENTRE FOR RESEARCH EXCELLENCE IN TELEHEALTH, THE UNIVERSITY OF QUEENSLAND, AUSTRALIA
| | - Elizabeth C Ward
- CENTRE FOR FUNCTIONING AND HEALTH RESEARCH, QUEENSLAND HEALTH, AUSTRALIA.,SCHOOL OF HEALTH AND REHABILITATION SCIENCES, THE UNIVERSITY OF QUEENSLAND, AUSTRALIA.,CENTRE FOR RESEARCH EXCELLENCE IN TELEHEALTH, THE UNIVERSITY OF QUEENSLAND, AUSTRALIA
| | - Anne J Hill
- SCHOOL OF HEALTH AND REHABILITATION SCIENCES, THE UNIVERSITY OF QUEENSLAND, AUSTRALIA.,CENTRE FOR RESEARCH EXCELLENCE IN TELEHEALTH, THE UNIVERSITY OF QUEENSLAND, AUSTRALIA
| | - Sandro V Porceddu
- RADIATION ONCOLOGY DEPARTMENT, PRINCESS ALEXANDRA HOSPITAL, QUEENSLAND HEALTH, AUSTRALIA.,SCHOOL OF MEDICINE, THE UNIVERSITY OF QUEENSLAND, AUSTRALIA
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Adherence to a Prophylactic Swallowing Therapy Program During (Chemo) Radiotherapy: Impact of Service-Delivery Model and Patient Factors. Dysphagia 2016; 32:279-292. [DOI: 10.1007/s00455-016-9757-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/26/2016] [Indexed: 11/25/2022]
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32
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Barnhart MK, Ward EC, Cartmill B, Robinson RA, Simms VA, Chandler SJ, Wurth ET, Smee RI. Pretreatment factors associated with functional oral intake and feeding tube use at 1 and 6 months post-radiotherapy (+/- chemotherapy) for head and neck cancer. EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF OTO-RHINO-LARYNGOLOGICAL SOCIETIES (EUFOS) : AFFILIATED WITH THE GERMAN SOCIETY FOR OTO-RHINO-LARYNGOLOGY - HEAD AND NECK SURGERY 2016. [PMID: 27498203 DOI: 10.1007/s00405-016-4241-9.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
A proportion of patients with head and neck cancer (HNC) experience significant swallowing difficulty during and post-radiotherapy/chemoradiotherapy (RT/CRT). Identifying patients during the pretreatment period who are anticipated to have compromised oral intake would allow for early and accurate patient education, and prioritisation of their management. Ascertaining a clear set of pretreatment predictors from the literature is challenging due to heterogeneity in study designs and patient cohorts, with minimal prospective data available (especially at 1-month post-treatment). The objectives of this study were to investigate which pretreatment factors predicted compromised oral intake and feeding tube use at 1 and 6 months post-RT/CRT. Prospective data were collected on 80 consecutive HNC patients receiving RT/CRT from 2011 to 2014. The primary outcome was to identify predictors of a modified diet at 1 and 6 months post-RT/CRT. Secondary outcomes were to identify predictors of feeding tube use at these time intervals, and <6 vs. >6 week duration of feeding tube use. Multivariate analysis revealed bilateral neck radiotherapy treatment was a strong predictor of modified diets at 1 month (p < 0.001), and T-stages T3/T4 a predictor of modified diets at 6 months (p = 0.03). Patients treated with concurrent CRT (p = 0.02) and bilateral neck treatment (p = 0.02) predicted feeding tube use at 1 month, and concurrent CRT predicted feeding tube use for >6 weeks (p = 0.04). Therefore, patients receiving bilateral neck treatment and/or CRT are at greatest risk of requiring modified diets and feeding tube use early post-treatment, and should be prioritised for intervention and ongoing support.
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Affiliation(s)
- Molly K Barnhart
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia. .,The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD, 4072, Australia.
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD, 4072, Australia.,Centre for Functioning and Health Research, Queensland Health, Buranda, QLD, 4102, Australia
| | - Bena Cartmill
- Centre for Functioning and Health Research, Queensland Health, Buranda, QLD, 4102, Australia.,Speech Pathology, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Rachelle A Robinson
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia
| | - Virginia A Simms
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia
| | - Sophie J Chandler
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia
| | - Elea T Wurth
- Simba Analytics, Melbourne, VIC, 3000, Australia
| | - Robert I Smee
- Comprehensive Cancer Centre, POWH, Randwick, NSW, 2031, Australia.,The Clinical Teaching School, University New South Wales, Kensington, NSW, Australia.,Acting Dir, Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, 2340, Australia
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33
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Barnhart MK, Ward EC, Cartmill B, Robinson RA, Simms VA, Chandler SJ, Wurth ET, Smee RI. Pretreatment factors associated with functional oral intake and feeding tube use at 1 and 6 months post-radiotherapy (+/− chemotherapy) for head and neck cancer. Eur Arch Otorhinolaryngol 2016; 274:507-516. [DOI: 10.1007/s00405-016-4241-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022]
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34
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Wells M, King E, Toft K, MacAulay F, Patterson J, Dougall N, Hulbert-Williams N, Boa S, Slaven E, Cowie J, McGarva J, Niblock PG, Philp J, Roe J. Development and feasibility of a Swallowing intervention Package (SiP) for patients receiving radiotherapy treatment for head and neck cancer-the SiP study protocol. Pilot Feasibility Stud 2016; 2:40. [PMID: 27965858 PMCID: PMC5153906 DOI: 10.1186/s40814-016-0079-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/07/2016] [Indexed: 01/27/2023] Open
Abstract
Background Head and neck cancer (HNC) is the sixth most common cancer worldwide, and the functional, psychological and social consequences of HNC cancer and its treatment can be severe and chronic. Dysphagia (swallowing problems) affects up to two thirds of patients undergoing combined chemoradiotherapy. Recent reviews suggest that prophylactic swallowing exercises may improve a range of short- and long-term outcomes; however, the importance of psychological and behavioural factors on adherence to swallowing exercises has not been adequately studied. This study aims to develop and test the feasibility of a Swallowing intervention Package (SiP) designed in partnership with patients, speech and language therapists (SLTs) and other members of the head and neck multi-disciplinary team (MDT), for patients undergoing chemoradiotherapy (CRT) or radiotherapy (RT) for head and neck cancer. Methods/design This feasibility study uses quantitative and qualitative research methods, within a quasi-experimental design, to assess whether patients will tolerate and adhere to the SiP intervention, which aspects of the intervention can be implemented and which cannot, whether treatment fidelity can be achieved across different contexts, whether study processes and outcome measures will be feasible and acceptable and to what extent the intervention is likely to have an impact on swallowing dysfunction and quality of life. Patients are being recruited from five sites in Scotland and England (three interventions and two usual care). The SLT based in the relevant intervention centre teaches the exercise programme and provides supporting materials. A combination of patient-reported outcome measures (PROMs), adherence measures and clinical swallowing assessments are used prior to intervention (baseline), at the end of treatment, 3 and 6 months post-treatment. Discussion This collaborative study has taken a unique approach to the development of a patient-centred and evidence-based swallowing intervention. The introduction of an e-SiP app provides an exploration of the use of technology in delivering this intervention. The study provides an opportunity to examine the feasibility of delivering and participating in a supported swallowing intervention across several different NHS sites and will provide the evidence needed to refine intervention and study processes for a future trial. Trial registration NCRI portfolio, 18192 & 20259
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Affiliation(s)
- Mary Wells
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Emma King
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | | | | | | | - Nadine Dougall
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | | | | | | | - Julie Cowie
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | | | | | | | - Justin Roe
- The Royal Marsden NHS Foundation Trust, London, UK
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35
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Wall LR, Ward EC, Cartmill B, Hill AJ, Porceddu SV. Examining user perceptions of SwallowIT: A pilot study of a new telepractice application for delivering intensive swallowing therapy to head and neck cancer patients. J Telemed Telecare 2016; 23:53-59. [DOI: 10.1177/1357633x15617887] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Consumer feedback and end-user perceptions provide important information regarding the clinical acceptability of new telepractice systems. This pilot investigation aimed to evaluate end-user perceptions of a new asynchronous telepractice application, ‘ SwallowIT’, designed to support patients to remotely complete intensive swallowing therapy during curative chemoradiotherapy (CRT) treatment for head and neck cancer (HNC). Insights were sought from 15 patients with oropharyngeal cancer who used SwallowIT to complete supported home swallowing therapy. Perceptions were evaluated via structured questionnaires, completed following initial orientation to SwallowIT and on completion of CRT. Semi-structured phone interviews were conducted ≥3 months post-treatment. The majority of patients reported positive initial perceptions towards SwallowIT for comfort (87%), confidence (87%), motivation (73%) and support (87%). No statistically significant change in perceptions was observed from baseline to end of CRT ( p > 0.05). Thematic analysis of interviews revealed four main themes: the ease of use of SwallowIT, motivating factors, circumstances which made therapy difficult, and personal preferences for service-delivery models. These preliminary findings demonstrate that SwallowIT was well-perceived by the current group of HNC consumers and suggest that SwallowIT may be well-accepted as an alternate service-delivery model for delivering intensive swallowing therapy during CRT.
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Affiliation(s)
- Laurelie R Wall
- Centre for Functioning and Health Research, Queensland Health, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
- Centre for Research Excellence in Telehealth, The University of Queensland, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Queensland Health, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Bena Cartmill
- Centre for Functioning and Health Research, Queensland Health, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Australia
| | - Anne J Hill
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
- Centre for Research Excellence in Telehealth, The University of Queensland, Australia
| | - Sandro V Porceddu
- Radiation Oncology Department, Princess Alexandra Hospital, Queensland Health, Australia
- School of Medicine, The University of Queensland, Australia
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Follow-up and Survivorship in Head and Neck Cancer. Clin Oncol (R Coll Radiol) 2016; 28:451-8. [DOI: 10.1016/j.clon.2016.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 02/23/2016] [Accepted: 03/03/2016] [Indexed: 12/14/2022]
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Research into the prevention and rehabilitation of dysphagia in head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2016; 24:208-14. [DOI: 10.1097/moo.0000000000000260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Goldsmith TA, Roe JWG. Human papilloma virus-related oropharyngeal cancer: opportunities and challenges in dysphagia management. Curr Opin Otolaryngol Head Neck Surg 2016; 23:185-90. [PMID: 25943965 DOI: 10.1097/moo.0000000000000154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Human papilloma virus (HPV) has emerged as the most common cause of oropharyngeal cancer (OPC) compared with traditional causes of excess alcohol and tobacco use. In this article, we will discuss HPV-related OPC and the challenges and opportunities presented in dysphagia management relative to efforts to de-escalate treatment and improve outcomes. RECENT FINDINGS It is becoming increasingly apparent that patients with HPV-positive disease appear to respond favourably to chemoradiation. Targeted chemoradiation is associated with severe early and late toxicities related to swallow function. Research is in progress to ascertain the benefit of treatment de-escalation with a particular focus on swallowing outcomes. Patients are younger and, with the improved outcomes reported in the literature, surviving longer with the consequences of their treatment. Given the changing demographic of this patient group, there are a number of opportunities to optimize swallowing outcomes, and this should be underpinned by detailed swallowing evaluation and counselling prior to treatment. A number of strategies have been suggested to improve swallowing outcomes; however, persisting and late-onset swallowing effects continue to be a risk. Transoral surgery is evolving as an option for the treatment of HPV-positive disease; however, more studies are required to understand functional outcomes. SUMMARY Clinical trials are now underway to ascertain the effectiveness of tailored treatments for HPV-positive OPC with a focus on swallowing outcomes. It is encouraging that studies are now including detailed, multidimensional swallowing evaluation. Until such time as longitudinal data are available, patients should be treated by speech-language pathologists based on existing radiation treatment protocols and in the knowledge that patients may experience significant late swallowing difficulties.
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Affiliation(s)
- Tessa A Goldsmith
- aDepartment of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA bSpeech and Language Therapy Department, The Royal Marsden NHS Foundation Trust, London, UK
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Evaluation of a weekly speech pathology/dietetic service model for providing supportive care intervention to head and neck cancer patients and their carers during (chemo)radiotherapy. Support Care Cancer 2015; 24:1227-34. [DOI: 10.1007/s00520-015-2912-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/16/2015] [Indexed: 11/25/2022]
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Brown TE, Crombie J, Spurgin AL, Tripcony L, Keller J, Hughes BGM, Dickie G, Kenny LM, Hodge RA. Improving guideline sensitivity and specificity for the identification of proactive gastrostomy placement in patients with head and neck cancer. Head Neck 2015; 38 Suppl 1:E1163-71. [DOI: 10.1002/hed.24184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 03/02/2015] [Accepted: 07/03/2015] [Indexed: 01/28/2023] Open
Affiliation(s)
- Teresa E. Brown
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Jane Crombie
- Department of Speech Pathology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Ann-Louise Spurgin
- Department of Speech Pathology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Lee Tripcony
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Jacqui Keller
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Brett G. M. Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine, University of Queensland; Queensland Australia
| | - Graeme Dickie
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Lizbeth Moira Kenny
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Robert A. Hodge
- Department of ENT/Head and Neck Surgery; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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van den Berg MGA, Kalf JG, Hendriks JCM, Takes RP, van Herpen CML, Wanten GJA, Drenth JPH, Kaanders JHAM, Merkx MAW. Normalcy of food intake in patients with head and neck cancer supported by combined dietary counseling and swallowing therapy: A randomized clinical trial. Head Neck 2015; 38 Suppl 1:E198-206. [PMID: 25533021 DOI: 10.1002/hed.23970] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Manon G. A. van den Berg
- Department of Gastroenterology and Hepatology - Dietetics and Intestinal Failure; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Johanna G. Kalf
- Nijmegen Centre of Evidence-Based Practice Department of Rehabilitation/Speech and Language Pathology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Jan C. M. Hendriks
- Department for Health Evidence; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Robert P. Takes
- Department of Otolaryngology and Head and Neck Surgery; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Carla M. L. van Herpen
- Department of Medical Oncology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Geert J. A. Wanten
- Department of Gastroenterology and Hepatology - Dietetics and Intestinal Failure; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Joost P. H. Drenth
- Department of Gastroenterology and Hepatology; Radboud University Medical Centre; Nijmegen The Netherlands
| | | | - Matthias A. W. Merkx
- Department of Oral and Maxillofacial Surgery; Radboud University Medical Centre; Nijmegen The Netherlands
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Nund R, Ward E, Scarinci N, Cartmill B. The Value of Qualitative Research in Dysphagia in the Head and Neck Cancer Population: What Can We Learn From the Survivors' Perspective? ACTA ACUST UNITED AC 2015. [DOI: 10.1044/sasd24.3.99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dysphagia is a common acute and long-term side effect of curative, non-surgical treatment for head and neck cancer (HNC). Despite what is known about dysphagia associated with HNC treatment in terms of its prevalence, severity, physiological characteristics, and the associated effects on quality of life (QoL), our understanding of the key factors which impact on HNC survivors is only just emerging. Whilst quantitative research studies have demonstrated that most people experience dysphagia in the early post-treatment period, and that many people continue to have ongoing swallowing issues for months and years following treatment, emerging qualitative research in this field has provided insights into the extent to which the presence of dysphagia impacts on the everyday lives of people with HNC. By exploring issues from the perspectives of people living with dysphagia, qualitative research has highlighted those factors that have the greatest impact on oral intake, raised issues for service provision, and highlighted the need for additional professional involvement and better long term supportive care.
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Affiliation(s)
- Rebecca Nund
- School of Health and Rehabilitation Sciences, The University of QueenslandBrisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health ServiceBrisbane, Queensland, Australia
| | - Elizabeth Ward
- School of Health and Rehabilitation Sciences, The University of QueenslandBrisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health ServiceBrisbane, Queensland, Australia
| | - Nerina Scarinci
- School of Health and Rehabilitation Sciences, The University of QueenslandBrisbane, Queensland, Australia
| | - Bena Cartmill
- Centre for Functioning and Health Research, Metro South Hospital and Health ServiceBrisbane, Queensland, Australia
- Department of Speech Pathology, Princess Alexandra HospitalBrisbane, Queensland, Australia
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Wall LR, Ward EC, Cartmill B, Hill AJ. Physiological changes to the swallowing mechanism following (chemo)radiotherapy for head and neck cancer: a systematic review. Dysphagia 2014; 28:481-493. [PMID: 24078216 DOI: 10.1007/s00455-013-9491-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/28/2013] [Indexed: 02/06/2023]
Abstract
Emerging research suggests that preventative swallowing rehabilitation, undertaken before or during (chemo)radiotherapy ([C]RT), can significantly improve early swallowing outcomes for head and neck cancer (HNC) patients. However, these treatment protocols are highly variable. Determining specific physiological swallowing parameters that are most likely to be impacted post-(C)RT would assist in refining clear targets for preventative rehabilitation. Therefore, this systematic review (1) examined the frequency and prevalence of physiological swallowing deficits observed post-(C)RT for HNC, and (2) determined the patterns of prevalence of these key physiological deficits over time post-treatment. Online databases were searched for relevant papers published between January 1998 and March 2013. A total of 153 papers were identified and appraised for methodological quality and suitability based on exclusionary criteria. Ultimately, 19 publications met the study’s inclusion criteria. Collation of reported prevalence of physiological swallowing deficits revealed reduced laryngeal excursion, base-of-tongue (BOT) dysfunction, reduced pharyngeal contraction, and impaired epiglottic movement as most frequently reported. BOT dysfunction and impaired epiglottic movement showed a collective prevalence of over 75 % in the majority of patient cohorts, whilst reduced laryngeal elevation and pharyngeal contraction had a prevalence of over 50 %. Subanalysis suggested a trend that the prevalence of these key deficits is dynamic although persistent over time. These findings can be used by clinicians to inform preventative intervention and support the use of specific, evidence-based therapy tasks explicitly selected to target the highly prevalent deficits post-(C)RT for HNC.
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Study of the medial group retropharyngeal node metastasis from nasopharyngeal carcinoma based on 3100 newly diagnosed cases. Oral Oncol 2014; 50:1109-13. [PMID: 25200523 DOI: 10.1016/j.oraloncology.2014.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE Patterns of metastases to the medial retropharyngeal lymph nodes (RPLN) from nasopharyngeal carcinoma (NPC) have gain little attention. Since the incidence of dysphagia was closely related to whether the medial RPLN was irradiated, we carried out a prospective study to explore the patterns of the medial RPLN involvement. METHODS AND MATERIALS Previously untreated NPC patients were required to receive MRI scan. MRI scanning sequences included pre-contrast T1WI, T2WI, and post-contrast T1WI with fat suppression. All images were evaluated by the multi-disciplinary treatment group of NPC. RESULTS 3100 cases of NPC entered this study. 2679 (86.4%) cases had involved lymph nodes. The detailed distribution were: 2341 (87.4%) in level IIb, 1798 (67.1%) in level IIa, 1184 (44.2%) in level III, 350 (14.1%) in level IV, 995 (37.1%) in level V, 115(4.3%) in level Ib, 2012 (75.1%) in the retropharyngeal area. But only 6 (0.2%) were located at the medial group, accompanied with the lateral RPLN and other node metastasis. Only one medial RPLN can be identified in a patient, whereas the number of the lateral RPLNs per affected side varied between one and four. The average size of the medial and lateral RPLNs was 8±4 mm (range, 4-17 mm) and 16±9 mm (range, 5-53 mm), respectively. CONCLUSIONS ① Involvement of the retropharyngeal nodes were mainly located at the lateral group, the medial RPLN was rarely seen. ② Metastasis to the medial RPLN was always accompanied with other node metastasis. ③ Only one medial RPLN can be identified in a patient, whereas the enlarged lateral RPLNs per affected side could be multiple. ④ The average size of the medial RPLN was smaller than the lateral RPLNs.
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Current assessment and treatment strategies of dysphagia in head and neck cancer patients. Curr Opin Support Palliat Care 2014; 8:152-63. [DOI: 10.1097/spc.0000000000000050] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nund RL, Ward EC, Scarinci NA, Cartmill B, Kuipers P, Porceddu SV. Survivors' experiences of dysphagia-related services following head and neck cancer: implications for clinical practice. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2014; 49:354-363. [PMID: 24734913 DOI: 10.1111/1460-6984.12071] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND It is known that people with dysphagia experience a number of negative consequences as a result of their swallowing difficulties following head and neck cancer management (HNC). However their perceptions and experiences of adjusting to dysphagia in the post-treatment phase, and the services received to assist this process, has not been studied. AIMS To explore the lived experience of people with dysphagia following non-surgical treatment for HNC and examine their perceptions of service needs. METHODS & PROCEDURES A demographically diverse group of 24 people who had received radiotherapy for HNC in the past five years, and experienced dysphagia as a result of treatment, were recruited using maximum variation sampling. Each participant took part in a semi-structured, in-depth interview, where they reflected on their adjustment to, and recovery from dysphagia following treatment for HNC, as well as the dysphagia-related services they received during their treatment. Thematic analysis was used to analyse the transcripts and to identify key themes that emerged from the data. RESULTS The main integrative theme was the desire for ongoing access to dysphagia-related services in order to adequately manage dysphagia. Within this integrative theme were five additional themes including: (1) entering the unknown: life after treatment for HNC; (2) making practical adjustments to live with dysphagia; (3) making emotional adjustments to live with dysphagia; (4) accessing support outside the hospital services; and (5) perceptions of dysphagia-related services. CONCLUSIONS & IMPLICATIONS The interviews revealed the need for both greater access to services and a desire for services which address the multitude of issues faced by people with dysphagia following HNC in the post-treatment period. Speech and language therapists managing this caseload need to ensure post-treatment services are available and address not only the physical but also the emotional and psychosocial changes impacting people with dysphagia in order to assist them to adjust to, and live successfully with dysphagia. Further research should be conducted to support the development of innovative services and to highlight dysphagia-related survivorship issues to governing bodies/policy makers.
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Affiliation(s)
- Rebecca L Nund
- Division of Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Queensland, Australia; Centre for Functioning and Health Research, Metro South Health Services District, Queensland Health, Brisbane, Queensland, Australia
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Epstein JB, Güneri P, Barasch A. Appropriate and necessary oral care for people with cancer: guidance to obtain the right oral and dental care at the right time. Support Care Cancer 2014; 22:1981-8. [PMID: 24676676 DOI: 10.1007/s00520-014-2228-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/21/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The identification of experienced and knowledgeable dental specialists to provide appropriate oral care for cancer patients, as well as the integration of this care within general oncology management, may be a challenge. This paper discusses the general and additional requirements for dental care providers to support the cancer patient and provide prevention and/or treatment for oral complications of cancer therapy. METHODS We performed a literature review of specific issues regarding the oral cavity and adjacent structures in the cancer patient, including detection and early diagnosis of oral malignancy. We incorporated the systemic effects of cancer and its therapy that affect oral disease and treatment. We present a summary of how to seek expert dental care for cancer patients and for referral from the dental and medical community. RESULTS Due to the complexity conferred by the disease and its treatment, cancer patients require educated, experienced dentists for treatment and/or prevention of oral-related morbidity. Correct diagnosis and evidence-based prophylactic and therapeutic oral care can significantly improve patient quality of life and reduce morbidity and healthcare costs. CONCLUSIONS The knowledge and expertise of dental professionals regarding prevention/treatment of complications and secondary malignant lesions in cancer patients are critical. Integration of oral care with the oncology care and in survivors requires effective communication between dental and medical providers beginning ideally at diagnosis. These clinicians may be identified at the cancer center, nearby hospital dental programs, and, less commonly, in the community.
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Affiliation(s)
- Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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A Survey of Variables Used by Speech-Language Pathologists to Assess Function and Predict Functional Recovery in Oral Cancer Patients. Dysphagia 2014; 29:376-86. [PMID: 24609610 DOI: 10.1007/s00455-014-9520-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 02/07/2014] [Indexed: 10/25/2022]
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Cnossen IC, van Uden-Kraan CF, Rinkel RNPM, Aalders IJ, de Goede CJT, de Bree R, Doornaert P, Rietveld DHF, Langendijk JA, Witte BI, Leemans CR, Verdonck-de Leeuw IM. Multimodal guided self-help exercise program to prevent speech, swallowing, and shoulder problems among head and neck cancer patients: a feasibility study. J Med Internet Res 2014; 16:e74. [PMID: 24610383 PMCID: PMC3961811 DOI: 10.2196/jmir.2990] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 01/12/2014] [Accepted: 01/18/2014] [Indexed: 12/22/2022] Open
Abstract
Background During a 6-week course of (chemo)radiation many head and neck cancer patients have to endure radiotherapy-induced toxicity, negatively affecting patients’ quality of life. Pretreatment counseling combined with self-help exercises could be provided to inform patients and possibly prevent them from having speech, swallowing, and shoulder problems during and after treatment. Objective Our goal was to investigate the feasibility of a multimodal guided self-help exercise program entitled Head Matters during (chemo)radiation in head and neck cancer patients. Methods Head and neck cancer patients treated with primary (chemo)radiation or after surgery were asked to perform Head Matters at home. This prophylactic exercise program, offered in three different formats, aims to reduce the risk of developing speech, swallowing, shoulder problems, and a stiff neck. Weekly coaching was provided by a speech and swallowing therapist. Patients filled out a diary to keep track of their exercise activity. To gain insight into possible barriers and facilitators to exercise adherence, reports of weekly coaching sessions were analyzed by 2 coders independently. Results Of 41 eligible patients, 34 patients were willing to participate (83% uptake). Of participating patients, 21 patients completed the program (64% adherence rate). The majority of participants (58%) had a moderate to high level of exercise performance. Exercise performance level was not significantly associated with age (P=.50), gender (P=.42), tumor subsite (P=1.00) or tumor stage (P=.20), treatment modality (P=.72), or Head Matters format (Web-based or paper) (P=1.00). Based on patients’ diaries and weekly coaching sessions, patients’ perceived barriers to exercise were a decreased physical condition, treatment-related barriers, emotional problems, lack of motivation, social barriers, and technical problems. Patients’ perceived facilitators included an increased physical condition, feeling motivated, and social and technical facilitators. Conclusions Head Matters, a multimodal guided self-help exercise program is feasible for head and neck cancer patients undergoing (chemo)radiation. Several barriers (decreased physical condition, treatment-related barriers) and facilitators (increased physical condition, feeling motivated) were identified providing directions for future studies. The next step is conducting a study investigating the (cost-)effectiveness of Head Matters on speech, swallowing, shoulder function, and quality of life.
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Affiliation(s)
- Ingrid C Cnossen
- VU University Medical Center, Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, Netherlands
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