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Objective The Patterson Edema scale was developed in 2007 to address the lack of a reliable, sensitive scale to measure laryngeal and pharyngeal oedema in patients with head and neck cancer. The objective of this study was to revise the existing Patterson scale to improve its reliability and utility. Design Prospective investigation. Setting Academic medical center. Participants Speech‐Language Pathologists, Otolaryngologists, and Radiation Oncologists. Main outcome measures Ratings using the Revised Patterson Edema Scale. Methods A consensus group reviewed existing literature regarding the performance of the original Patterson scale and revised the existing scale in regard to items to be included and descriptors for each severity level. The scale was then utilised by 18 speech language pathologists from the US and UK with >2 years‐experience working with dysphagia and dysphonia with endoscopy. Each SLP rated a total of eight parameters (epiglottis, vallecula, pharyngoepiglottic folds, aryepiglottic folds, arytenoids, false vocal folds, true vocal folds and pyriform sinuses) using the Revised Patterson Edema Scale. Feedback was solicited from raters regarding areas where clarity was lacking for further scale revision. Scale revisions were completed and additional ratings were completed by otolaryngologists, radiation oncologists and less experienced SLP providers to establish reliability across disciplines. Quadratic weighted Kappa values were obtained to establish interrater reliability. Results Feedback received from raters included suggestions for clarification of how to rate unilateral oedema, use of a standard task battery to visualise and rate structures consistently, and clarification of true vocal fold oedema rating parameters. Overall interrater reliability was established using quadratic weighted Kappa with good agreement noted for the epiglottis, vallecula, arytenoids and false vocal folds; moderate agreement noted for aryepiglottic folds, pharyngoepiglottic folds and pyriform sinuses; and fair agreement noted for true vocal folds. Conclusions The Revised Patterson Edema Scale demonstrates moderate‐substantial interrater reliability for most parameters across multiple disciplines and experience levels, with the exception of the true vocal folds where agreement was fair. We believe the Revised Patterson Oedema Scale provides a reliable tool for clinicians and researchers to rate oedema in the supraglottic larynx and pharynx following treatment for head and neck cancer.

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.

Objective: To investigate associations between markers of social functioning (trouble with social eating and social contact), depression and health-related quality of life (QOL) among head and neck cancer survivors.Methods: This cross-sectional analysis included individuals with oral cavity, oropharynx, larynx, salivary gland and thyroid cancers from Head and Neck 5000 alive at 12 months. Trouble with social eating and social contact were measured using items from EORTC QLQ-H&N35 and QOL using EORTC QLQ-C30; responses were converted into a score of 0-100, with a higher score equalling more trouble or better QOL. A HADS subscale score of ≥8 was considered significant depression.Associations between tertiles of trouble with social eating and social contact and depression and QoL were assessed using multivariable logistic and linear regression (with robust errors), respectively.Results: Of 2561 survivors, 23% reported significant depression. The median QOL score was 75.0 (interquartile range 58.3-83.3).

Background The 100 ml water swallow test (WST) is a validated swallow assessment used in head and neck cancer (HNC). We aimed to determine the level of agreement when completing the 100 ml WST via clinician‐graded video‐testing or patient self‐testing compared to standard face‐to‐face assessment (FTF). Methods Convenience sampling from four UK centers. Inclusion criteria: patients with HNC treated with any modality prior to, or within 5 years of treatment. Participants were recruited to complete the 100 ml WST by video‐testing or self‐testing and compared with FTF. Results Sixty‐three patients were recruited; 1 was unable to perform the task; 30 in video‐testing; and 32 in self‐testing. There was no difference in swallow capacity (p = 0.424) and volume (p = 0.363) for the video‐testing or the self‐testing swallow capacity (p = 0.777) and volume (p = 0.445). Conclusions This study demonstrates that video‐testing and self‐testing are reliable methods of completing the 100 ml WST for this sample of patients with HNC.