Laura B Moroney1,2, Elizabeth C Ward3,4, Jennifer Helios5, Jane Crombie5, Clare L Burns5,3, Claire Blake5, Tracy Comans6, Benjamin Chua5,7, Lizbeth Kenny5,7, Brett G M Hughes5,7. 1. Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia. laura.moroney@outlook.com. 2. School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia. laura.moroney@outlook.com. 3. School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia. 4. Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia. 5. Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia. 6. The Centre for Health Services Research, The University of Queensland, Brisbane, Australia. 7. School of Medicine, The University of Queensland, Brisbane, Australia.
Abstract
PURPOSE: There are no evidence-based guidelines informing which patients with head and neck cancer (HNC) require regular speech pathology (SP) support during radiation treatment (RT). Hence, some services use a "one-size-fits-all" model, potentially over-servicing those patients at low risk for dysphagia. This study evaluated the clinical safety and efficiency of an interdisciplinary service model for patients identified prospectively as "low risk" for dysphagia during RT. METHODS: A prospective cohort of 65 patients with HNCs of the skin, thyroid, parotid, nose, and salivary glands, receiving curative RT, were managed on a low-risk pathway. Patients with baseline dysphagia (functional oral intake score ≤ 5) were excluded. The model involved dietitians conducting dysphagia screening at weeks 3, 5, and 6/7 within scheduled appointments. Patients at risk of dysphagia were referred to SP for assessment, then management if required. To validate the model, SP assessed swallow status/toxicities at week 5/6/7 during RT and confirmed dysphagia status at weeks 2 and 6 post RT. RESULTS: Most (89.3%) patients did not require dysphagia support from SP services. Of the 18 patients identified on screening, only 7 (10.7%) had sufficient issues to return to SP care. Week 5/6/7 SP review confirmed low levels of toxicity. No post-treatment dysphagia was observed. There was an incremental benefit of A$15.02 for SP staff costs and a recovery of 5.31 appointments per patient. CONCLUSION: The pathway is a safe and effective service model to manage patients with HNC at low risk for dysphagia during RT, avoiding unnecessary SP appointments for the patient and service.
PURPOSE: There are no evidence-based guidelines informing which patients with head and neck cancer (HNC) require regular speech pathology (SP) support during radiation treatment (RT). Hence, some services use a "one-size-fits-all" model, potentially over-servicing those patients at low risk for dysphagia. This study evaluated the clinical safety and efficiency of an interdisciplinary service model for patients identified prospectively as "low risk" for dysphagia during RT. METHODS: A prospective cohort of 65 patients with HNCs of the skin, thyroid, parotid, nose, and salivary glands, receiving curative RT, were managed on a low-risk pathway. Patients with baseline dysphagia (functional oral intake score ≤ 5) were excluded. The model involved dietitians conducting dysphagia screening at weeks 3, 5, and 6/7 within scheduled appointments. Patients at risk of dysphagia were referred to SP for assessment, then management if required. To validate the model, SP assessed swallow status/toxicities at week 5/6/7 during RT and confirmed dysphagia status at weeks 2 and 6 post RT. RESULTS: Most (89.3%) patients did not require dysphagia support from SP services. Of the 18 patients identified on screening, only 7 (10.7%) had sufficient issues to return to SP care. Week 5/6/7 SP review confirmed low levels of toxicity. No post-treatment dysphagia was observed. There was an incremental benefit of A$15.02 for SP staff costs and a recovery of 5.31 appointments per patient. CONCLUSION: The pathway is a safe and effective service model to manage patients with HNC at low risk for dysphagia during RT, avoiding unnecessary SP appointments for the patient and service.
Entities:
Keywords:
Dysphagia; Head and neck cancer; Radiation treatment; Service delivery; Speech pathology; Toxicity
Authors: Laura B Moroney; Jennifer Helios; Elizabeth C Ward; Jane Crombie; Anita Pelecanos; Clare L Burns; Ann-Louise Spurgin; Claire Blake; Lizbeth Kenny; Benjamin Chua; Brett G M Hughes Journal: Head Neck Date: 2018-05-13 Impact factor: 3.147
Authors: Peter C Belafsky; Debbie A Mouadeb; Catherine J Rees; Jan C Pryor; Gregory N Postma; Jacqueline Allen; Rebecca J Leonard Journal: Ann Otol Rhinol Laryngol Date: 2008-12 Impact factor: 1.547
Authors: Laurelie R Wall; Bena Cartmill; Elizabeth C Ward; Anne J Hill; Elizabeth Isenring; Sandro V Porceddu Journal: Support Care Cancer Date: 2015-08-25 Impact factor: 3.603
Authors: Adegboyega K Lawal; Thomas Rotter; Leigh Kinsman; Andreas Machotta; Ulrich Ronellenfitsch; Shannon D Scott; Donna Goodridge; Christopher Plishka; Gary Groot Journal: BMC Med Date: 2016-02-23 Impact factor: 8.775