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Messing BP, Ward EC, Lazarus C, Ryniak K, Maloney J, Thompson CB, Kramer E. Longitudinal comparisons of a whole-mouth taste test to clinician-rated and patient-reported outcomes of dysgeusia postradiotherapy in patients with head and neck cancer and associations with oral intake. Head Neck 2021; 43:2159-2177. [PMID: 33856086 DOI: 10.1002/hed.26690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/25/2021] [Accepted: 03/16/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND After head and neck cancer (HNC) treatment, dysgeusia may be a barrier to oral intake. In this exploratory study, we prospectively examined taste perception, clinician-rated (CRO) and patient-reported (PRO) taste changes and their effect on oral intake postradiotherapy. METHODS Twenty-eight patients were assessed at baseline, treatment weeks 2 and 4, and 1, 3, and 6 months post-treatment using a whole-mouth taste test and associated CRO and subjective PRO measures. RESULTS Greater taste impairment was reflected by subjective than by a whole-mouth taste test. The most significant and consistent decline occurred mid-treatment. The Chemotherapy-Induced Taste Alteration Scale (PRO) discomfort subscale correlated significantly with maintaining an oral diet, percent of oral intake, and appetite level from mid-treatment to 6 months post-treatment. CONCLUSIONS PRO results indicated ongoing oral intake issues. Whole-mouth taste tests may fail to fully reflect functional taste-loss. Dysgeusia prevention and treatment methods are needed to improve patient outcomes.
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Affiliation(s)
- Barbara Pisano Messing
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Head & Neck Surgery, Johns Hopkins Voice Center at GBMC, Baltimore, Maryland, USA.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Government, Brisbane, Queensland, Australia
| | - Cathy Lazarus
- Department of Otolaryngology - Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, Thyroid Head and Neck Research Center, Thyroid Head and Neck Cancer (THANC) Foundation, Mount Sinai Beth, Israel
| | - Keri Ryniak
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Head & Neck Surgery, Johns Hopkins Voice Center at GBMC, Baltimore, Maryland, USA
| | - Jessica Maloney
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Head & Neck Surgery, Johns Hopkins Voice Center at GBMC, Baltimore, Maryland, USA
| | - Carol B Thompson
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Kramer
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Head & Neck Surgery, Johns Hopkins Voice Center at GBMC, Baltimore, Maryland, USA
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Messing BP, Ward EC, Lazarus C, Ryniak K, Kim M, Silinonte J, Gold D, Thompson CB, Pitman KT, Blanco R, Sobel R, Harrer K, Ulmer K, Neuner G, Patel K, Tang M, Lee G. Establishing a Multidisciplinary Head and Neck Clinical Pathway: An Implementation Evaluation and Audit of Dysphagia-Related Services and Outcomes. Dysphagia 2018; 34:89-104. [PMID: 29922848 PMCID: PMC6349813 DOI: 10.1007/s00455-018-9917-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/02/2018] [Indexed: 11/28/2022]
Abstract
Head and neck cancer (HNC) guidelines recommend regular multidisciplinary team (MDT) monitoring and early intervention to optimize dysphagia outcomes; however, many factors affect the ability to achieve these goals. The aims of this study were to explore the barriers/facilitators to establishing and sustaining a MDT HNC care pathway and to examine the dysphagia-related speech-language pathology (SLP) and dietetic components of the pathway. Using the Consolidated Framework for Implementation Research (CFIR), a mixed methods study design was used to evaluate an established MDT HNC pathway. Ten MDT members provided perceptions of facilitators/barriers to implementing and sustaining the pathway. Patients attending the SLP and dietetic components of the pathway who commenced treatment between 2013 and 2014 (n = 63) were audited for attendance, outcome data collected per visit, and swallowing outcomes to 24-month post-treatment. Dysphagia outcomes were compared to a published cohort who had received intensive prophylactic dysphagia management. Multiple CFIR constructs were identified as critical to implementing and sustaining the pathway. Complexity was a barrier. Patient attendance was excellent during treatment, with low rates of non-compliance (< 15%) to 24 months. Collection of clinician/patient outcome tools was good during treatment, but lower post-treatment. Dysphagia outcomes were good and comparable to prior published data. The pathway provided patients with access to regular supportive care and provided staff opportunities to provide early and ongoing dysphagia monitoring and management. However, implementing and sustaining a HNC pathway is complex, requiring significant staff resources, financial investment, and perseverance. Regular audits are necessary to monitor the quality of the pathway.
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Affiliation(s)
- Barbara Pisano Messing
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA. .,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia. .,Greater Baltimore Medical Center, The Milton J. Dance, Jr. Head & Neck Center, 6569 N. Charles Street, PPW Suite 401, Baltimore, MD, 21204, USA.
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Government, Brisbane, QLD, Australia
| | - Cathy Lazarus
- Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, Thyroid Head and Neck Research Center, Thyroid Head and Neck Cancer (THANC) Foundation, Mount Sinai Beth Israel, New York, NY, USA
| | - Keri Ryniak
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Melissa Kim
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Jessica Silinonte
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Dorothy Gold
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Carol B Thompson
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen T Pitman
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ray Blanco
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Ryan Sobel
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Karen Harrer
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Karen Ulmer
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Geoffrey Neuner
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Kruti Patel
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Mei Tang
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Gregory Lee
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
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Blanco RG, Fakhry C, Ha PK, Ryniak K, Messing B, Califano JA, Saunders JR. Transoral Robotic Surgery Experience in 44 Cases. J Laparoendosc Adv Surg Tech A 2013; 23:900-7. [DOI: 10.1089/lap.2013.0261] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Ray G.F. Blanco
- Johns Hopkins Head and Neck Surgery, Milton J. Dance, Jr. Head and Neck Center, Baltimore, Maryland
- Head and Neck Surgery, Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Carole Fakhry
- Johns Hopkins Head and Neck Surgery, Milton J. Dance, Jr. Head and Neck Center, Baltimore, Maryland
- Head and Neck Surgery, Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick K. Ha
- Johns Hopkins Head and Neck Surgery, Milton J. Dance, Jr. Head and Neck Center, Baltimore, Maryland
- Head and Neck Surgery, Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Keri Ryniak
- Johns Hopkins Head and Neck Surgery, Milton J. Dance, Jr. Head and Neck Center, Baltimore, Maryland
| | - Barbara Messing
- Johns Hopkins Head and Neck Surgery, Milton J. Dance, Jr. Head and Neck Center, Baltimore, Maryland
| | - Joseph A. Califano
- Johns Hopkins Head and Neck Surgery, Milton J. Dance, Jr. Head and Neck Center, Baltimore, Maryland
- Head and Neck Surgery, Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John R. Saunders
- Johns Hopkins Head and Neck Surgery, Milton J. Dance, Jr. Head and Neck Center, Baltimore, Maryland
- Head and Neck Surgery, Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland
- Greater Baltimore Medical Center, Baltimore, Maryland
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Messing BP, Ryniak K, Shellenberger J, Hieber B, Ulmer K, Gold D, Harrer K, Kim M, Valasek L, Silinonte J. Multidisciplinary Care of the Head and Neck Cancer Patient. ACTA ACUST UNITED AC 2012. [DOI: 10.1044/vvd22.1.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
When a patient is diagnosed with head and neck cancer, there is a tremendous physical, social, and emotional burden placed on the patient and his or her family. The complex nature of the diagnostic and treatment-planning process, along with the intensity of this life-altering event, requires an integrated, multidisciplinary team approach. Clinicians representing the disciplines of surgery, medical oncology, radiation oncology, speech-language pathology, nursing, nutrition, social work, and other health professionals must work together to meet the entire spectrum of the patient's needs before, during, and after treatment. The purpose of this article is to share the integrated approach that enables the oncology team of professionals at our center to address the needs of our patients. We will present a clinical pathway that focuses on medical, functional, psychosocial, and nutritional requirements that ensure optimal outcomes.
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Affiliation(s)
- Barbara P. Messing
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Keri Ryniak
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Jaclyn Shellenberger
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Bethany Hieber
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Karen Ulmer
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Dorothy Gold
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Karen Harrer
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Melissa Kim
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Lisa Valasek
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Jessica Silinonte
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
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