Routine Use of Swallowing Outcome Measures Following Head and Neck Cancer in a Multidisciplinary Clinic Setting

Abstract

Introduction Chemoradiotherapy treatment for head and neck cancer (HNC) can have a major impact on swallowing function and health-related quality of life.The use of outcome measures in early detection of patients with swallowing problems provides the opportunity for targeting speech and language therapy (SLT) interventions to aid adaption and promote better clinical outcomes. Objective The purpose of the present study was to assess relationships between four outcomes measures over time, in a cohort of HNC patients, treated by (chemo-)radiotherapy. Methods Data were collected at 3 months and 12 months, on 49 consecutive patients with primary squamous cell cancer of the oropharynx, nasopharynx or hypopharynx stage T1–4, N0–2b, M0 disease. Results Out of 49 eligible patients, 45 completed assessment at 3 months and 20 at 12 months. The 3-month outcomes gave a strong indication of performance at 1 year. There were several strong correlations found between measures. The strongest was between the 3-month Performance Status Scale for Head and Neck Cancer (PSSHN) and the 12-month PSSHN (rs = 0.761, n = 17), the 12-month PSSHN and the 12-month Functional Oral Intake Scale (FOIS) (rs = 0.823, n = 20), and the 12-month University of Washington Head and Neck Quality of Life (UWQoL) swallow and the 12-month Water Swallow Test (WST) capacity (rs = 0.759, n = 17). Conclusion The UW-QoL swallow item and WST are easy to incorporate into routine care and should be used as part of a standard assessment of swallow outcome. These measures can serve to help screen patients for dysfunction and focus allocation of resources for those who would benefit from more comprehensive assessment and intervention by SLT.

Evaluation of the head and neck cancer patient concerns inventory in a cohort of patients attending routine multidisciplinary speech and language therapy/dietitian follow up clinics

“…Consecutive patients helped to reduce non-responder bias and 94% participated. Only 3 of the 94 refused to use the PCI on 5 occasions and this seemed to be an issue of personal preference rather Energy levels [25] Salivation [22] Energy levels [33] Appetite [37] Taste [25] Appetite [19] Coughing [28] Weight [34] Mucus [25] PEG tube [17] Weight [28] Taste [31] Salivation [23] Mucus [17] Speech/voice being understood [27] Coughing [29] Dental health/teeth [20] Coughing [16] Taste [27] Speech/voice being understood [29] Fear of cancer coming back [20] Speech/voice being understood [16] Dental health/teeth [24] Dental health/teeth [26] Weight [20] Taste [14] Salivation [24] Fear of cancer coming back [25] Speech/voice being understood [18] Sleeping [14] Fear of cancer coming back [21] Salivation [25] Sore mouth [18] Mood [13] PEG tube [21] PEG tube [23] Pain in head and neck [14] Dental health/teeth [12] Cancer treatment [21] Sore mouth [23] Coughing [11] Fear of cancer coming back [12] Sore mouth [21] Cancer treatment [20] PEG tube [11] Weight [12] Sleeping…”

“…The timing post treatment was variable and some of the patients completed it multiple times. However, this was just a question of the 28% [26] 28% [26] 27% [25] 27% [25] Gender Female 30 60% [18] 57% [17] 47% [14] 37% [11] 43% [13] 37% [11] 33% [10] 27% [8] 27% [8] 33% [10] 23% [7] Male 64…”

“…42% [27] 44% [28] 31% [20] 33% [21] 33% [21] 28% [18] 28% [18] 23% [15] 28% [ 45% [20] 39% [17] 34% [15] 39% [17] 34% [15] 39% [17] 27% [12] 34% [15] 27% [12] 32% [14] ≥65 50…”

“…48% [24] 48% [24] 32% [16] 34% [17] 28% [14] 28% [14] 22% [11] 26% [13] 22% [11] P value 74% [14] 32% [6] 37% [7] 26% [5] 16% [3] 5% [1]…”

“…However, it covers several treatment issues relating to SLT and Diet interventions, with the PCI-HN items chewing/eating, swallowing, speech/voice/being understood, being among the ten most common issues raised by patients (13,14). It also incorporates several wider issues commonly reported by patients following treatment, such as dry mouth and taste after (chemo-) radiotherapy which have been found to be symptom drivers of oral intake (15)(16)(17). Fatigue is also an important issue as it can contribute to low mood, which compounds swallowing problems, and can, in turn, affect appetite, nutrition and weight loss (18).…”