Purpose of review Enhanced recovery after surgery (ERAS) is well documented in a number of surgical specialities. However, it remains an emerging concept in surgical head and neck cancer care. The purpose of this review is to appraise the current evidence investigating enhanced recovery in head and neck cancer, and explore areas for future clinical research. Recent findings There were three key themes in enhanced recovery from the current head and neck cancer literature: early oral feeding, fistula closure and service delivery. This evidence is emerging and the quality of papers remains variable which makes it difficult to draw robust clinical recommendations. However, there are some encouraging clinical findings with regards to early oral feeding protocols and suturing of the trachea-stoma. Summary There is limited literature in enhanced recovery in head and neck cancer, with questionable quality of the papers reviewed. As such, there is no consensus for a standardized enhanced recovery pathway which demonstrates effective service delivery and positive patient outcomes. It is clear that implementation of enhanced recovery pathways is complex and requires patient and clinician buy in. Future research should focus on co-design of a methodologically sound enhanced recovery pathway with evaluation of its implementation.
Dysphagia is a common and frequently undetected complication of many neurological disorders and of sarcopoenia in ageing persons. Spontaneous swallowing frequency (SSF) has been mooted as a possible tool to classify dysphagia risk. We conducted a review of the literature to describe SSF in both the healthy population and in disease-specific populations, in order to consider its utility as a screening tool to identify dysphagia. We searched Medline, Embase, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials databases. Metadata were extracted, collated and analysed to give quantitative insight. Three hundred and twelve articles were retrieved, with 19 meeting inclusion and quality criteria. Heterogeneity between studies was high (I2 = 99%). Mean SSF in healthy younger sub-groups was 0.98/min [CI: 0.67; 1.42]. In the Parkinson’s sub-group, mean SSF was 0.59/min [0.40; 0.87]. Mean SSF in healthy older, higher risk and dysphagic populations were similar (0.21/min [0.09; 0.52], 0.26/min [0.10; 0.72] and 0.30/min [0.16; 0.54], respectively). SSF is a novel, non-invasive clinical variable which warrants further exploration as to its potential to identify persons at risk of dysphagia. Larger, well-conducted studies are needed to develop objective, standardised methods for detecting SSF, and develop normative values in healthy populations.
BackgroundDysphagia is a common, and frequently undetected, complication of many neurological disorders and of sarcopoenia in ageing persons. However it is difficult to detect dysphagia clinically until the point of visible aspiration, and there are relatively few trained speech and language therapists, whose time and remit are limited to those with obvious disorders. Reduction in spontaneous swallowing frequency (SSF) has been mooted as a possible proxy for dysphagia. We therefore conducted a systematic review of the literature to describe SSF in both the healthy population, and in disease specific populations, in order to assess its utility as a screening tool to identify dysphagia.MethodsWe searched Medline, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials databases. Metadata were extracted, collated, and analysed via a random effects model to give quantitative insight.ResultsThree hundred and twelve articles were retrieved, with 19 meeting inclusion and quality criteria. Heterogeneity between studies was high (I2 = 98%), in part, due to the variety of methods for swallow identification reported. The mean SSF in Healthy younger groups was 0.98/min [CI: 0.78; 1.23]. In the Parkinson’s groups mean SSF was 0.59/min [0.41; 0.85]. Mean SSF in Healthy older, Higher risk and Dysphagic populations were similar (0.21/min [0.12; 0.37], 0.26/min [0.14; 0.85]), (0.27/min [0.17; 0.43] respectively).ConclusionsSSF is a novel, non-invasive clinical variable which warrants further explorations as to its potential to identify persons at risk of dysphagia. Larger, well-conducted studies are needed to develop objective, standardised methods for detecting SSF, and develop normative values in healthy populations.
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