Eat All Through Radiation Therapy (EAT‐RT): Structured therapy model to facilitate continued oral intake through head and neck radiotherapy—User acceptance and content validation

Abstract

Background To develop and examine user acceptance and content validity of a structured program to facilitate safe but challenging oral intake during radiotherapy (RT) delivered by a speech language pathologist (SLP)—the Eat‐All Through Radiation Therapy (EAT‐RT) program. Methods EAT‐RT was developed through expert consensus of SLPs at the Princess Margaret Cancer Centre (Canada) and M D Anderson Cancer Center using a conceptual framework of a diet hierarchy and a mealtime routine. EAT‐RT was refined by practicing SLPs, and then disseminated for a 4‐week clinical pilot at seven sites who were subsequently invited to participate in an online survey. Results Twelve SLPs from six sites piloted EAT‐RT therapy with a median of eight patients (IQR: 2‐15) before and/or during RT. All SLPs reported EAT‐RT added value to their practice, harmonized well with exercises, and its content was helpful; 11 (92%) reported EAT‐RT facilitated patient understanding and indicated the desire to continue using EAT‐RT. Conclusion The EAT‐RT program was accepted by North American SLPs. The findings support the content and value of EAT‐RT to facilitate oral intake in patients with head and neck cancer throughout RT.

Exploring patient experiences with a telehealth approach for the PRO-ACTIVE trial intervention in head and neck cancer patients

“…PRO-ACTIVE is a large multi-site, 3-arm, pragmatic randomized controlled trial, evaluating the effectiveness of prophylactic swallowing therapy for head and neck cancer patients undergoing radiation therapy [9]. In the PRO-ACTIVE trial, patients are randomized to receive one of three behavioural swallowing interventions: a low intensity face-to-face swallowing therapy with an SLP that starts before radiation therapy, continues bi-weekly during radiotherapy and includes a clinical swallowing assessment, education on symptom management, and a structured program (EAT-RT) to facilitate safe but challenging oral intake [10]; a high intensity swallowing therapy that is similar to the EAT-RT program but with the addition of swallowing exercises conducted in between meals; and, a control group who is offered the high intensity therapy late during radiotherapy but only to patients who develop swallowing issues while receiving radiation therapy. The PRO-ACTIVE trial launched in late 2018 with the aim to recruit 952 patients in five-years across seven institutions in Canada and the United States.…”

Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients

“…It is critical for the dysphagia specialist to work closely with the MDT to ensure optimal management of treatment toxicities to support a patient's ability to continue per os intake. For example, the Eat All Through Radiation Therapy program was developed to provide a framework for clinician‐supported oral intake targeting swallowing preservation 83 . Consistent with this literature, the development group agreed that HNC patients have improved swallowing outcomes if encouraged to continue eating and drinking, guided by a dysphagia specialist, throughout cancer treatment (Table 4; Statement 24).…”

Clinical Practices in Head and Neck Cancer: A Speech-Language Pathologist Practice Pattern Survey

“…8,26,27 These data have supported the creation of a structured oral intake model, EAT-RT, which includes a visual model aimed at promoting ongoing oral intake and assisting patients in potential diet changes during the period of RT. 28 One component not included in prior research was the use of a maintenance swallow exercise program upon discharge from SLP services. Nearly all respondents indicated recommendations for maintenance programs comprised of mainly swallow-based exercises, non-swallow exercises, and stretches with varied frequency and intensity.…”