Adherence to a Prophylactic Swallowing Therapy Program During (Chemo) Radiotherapy: Impact of Service-Delivery Model and Patient Factors

Abstract

Intensive, prophylactic swallowing therapy programs have been developed to improve dysphagia outcomes for patients with head/neck cancer (HNC) receiving (chemo)radiotherapy ([C]RT). Across studies, variable therapy adherence rates have been reported. Preliminary research suggests that service-delivery mode and demographic factors may influence adherence. This study examined patient adherence to a prophylactic swallowing therapy protocol across three service-delivery models: (1) clinician-directed face-to-face therapy, (2) technology-assisted therapy using the telepractice application, SwallowIT and (3) independent patient-directed therapy. The secondary aim explored the impact of patient factors on adherence. Patients with oropharyngeal HNC receiving definitive (C)RT were randomised to receive the Pharyngocise exercise protocol via clinician-directed (n = 26), patient-directed (n = 27) or SwallowIT-assisted (n = 26) models. Adherence was calculated as the percentage of prescribed exercise completed. Multiple patient factors were recorded at baseline. Adherence across the 6 weeks in all groups was low (27%), and declined from week 4 of (C)RT. The clinician-directed model yielded significantly (p = 0.014) better adherence than patient-directed therapy in weeks 1-3. There was also a trend for higher adherence in the SwallowIT group compared to patient-directed in weeks 1-3 (p = 0.064). Multivariable linear modelling identified active smoking at baseline (p < 0.001) and concomitant chemotherapy (p = 0.040) as significant negative predictors of adherence, with baseline reduced motivation trending towards significance. Although (C)RT-related toxicities will impact adherence, adopting service-delivery models with greater structure/support and providing extra assistance to patients with known risk factors may help optimise therapy adherence to prophylactic therapy programs. Telepractice may provide an alternate model to support adherence where service constraints limit intensive clinician-directed therapy.

Management of dysphagia in the patient with head and neck cancer during COVID‐19 pandemic: Practical strategy

“…There is a paucity of evidence on the benefits of telehealth in dysphagia therapy, but there is some suggestion of improved treatment adherence in patients receiving telehealth in comparison with patient-lead home treatment. 25 In addition to telehealth, other technologydriven options such as mobile applications may play a role when available. 26,27 Swallowing therapists should strive to adapt their virtual visits to provide the highest level of care possible.…”

Effects of Prophylactic Swallowing Exercises on Dysphagia and Quality of Life in Patients with Head and Neck Cancer Receiving (Chemo) Radiotherapy. The Redyor Study: Protocol for a Randomized Clinical Trial.

“…Patients were only referred when they presented with obvious swallow deficits or the consequent malnourishment, weight loss, changes in voice characteristics, etc., often months or years post-CRT (12). The greater the delay, the worse is the patient's detrimental muscle disuse and swallow dysfunction (13,14).…”

“…In recent years, there has been a growing interest in swallowing interventions. Potential benefits of prophylactic exercises conducted during (15)(16)(17), soon after (18), or before the CRT intervention (19) have been described, and improvements in functional swallow outcomes and quality of life parameters after respiratory therapy (RT) intervention have been reported (14). Nevertheless, supportive care for earlier dysphagia management in rehabilitation departments continues to play a secondary role in HNC diagnosis in most health systems (9,12).…”

Optimising nutrition support in patients with head and neck cancer

“…Other studies have shown no difference in outcomes with feeding tube selection and suggest a reactive approach may be more favourable to reduce duration of feeding tube use (Kramer et al, 2014;Sheth, Sharp, & Walters, 2013). Whilst there are concerns that gastrostomy placement may result in gastrostomy dependency and increased dysphagia post-treatment (Corry et al, 2008;Ward et al, 2016), other studies have not supported this finding (Crombie et al, 2015;Prestwich et al, 2014).…”

“…Dedicated research assistant time to allow for daily contact with the patient is one option or smartphone app technology could be considered as this has been successful at improving self-monitoring in weight loss trials (Carter, Burley, Nykjaer, & Cade, 2013;Wharton, Johnston, Cunningham, & Sterner, 2014) and so perhaps may be effective at self-monitoring intake. Other studies have also reviewed service delivery models (Wall, Ward, Cartmill, Hill, & Porceddu, 2016), and utilised a novel telepractice application (Wall, Ward, Cartmill, Hill, & Porceddu, 2017) to improve adherence to prophylactic swallowing exercises which could also be methods to apply to improving dietary adherence.…”