Prophylactic swallowing therapy for patients with head and neck cancer: A three‐arm randomized parallel‐group trial

Abstract

Background: Intensive prophylactic swallowing therapy can mitigate dysphagia in patients with oropharyngeal (OP) SCC, however, presents service challenges. This trial investigated the clinical efficacy of three service models delivering prophylactic swallowing therapy during (chemo)radiotherapy ([C]RT).Methods: Patients (n = 79) with OPSCC receiving (C)RT were were randomized to: (a) clinician-directed face-to-face therapy (n = 26); (b) telepractice therapy via "SwallowIT" (n = 26); or (c) patient self-directed therapy (n = 27).Swallowing, nutritional, and functional status were compared at baseline, 6-weeks, and 3-months post-(C)RT. Patients' perceptions/preferences for service-delivery were collated posttreatment. Results: Service-delivery mode did not affect clinical outcomes, with no significant (P > .05) between-group differences or group-by-time interactions observed for swallowing, nutrition, or functional measures. Therapy adherence declined during (C)RT in all groups. SwallowIT and clinician-directed models were preferred by significantly (P = .002) more patients than patient-directed. Conclusions: SwallowIT provided clinically equivalent outcomes to traditional service models. SwallowIT and clinician-directed therapy were preferred by patients, likely due to higher levels of therapy support.dysphagia, head and neck cancer, prophylactic swallowing therapy, randomized controlled trial, service-delivery, telehealth

Telepractice and Dysphagia Management: The Era of COVID-19 and Beyond

“…Pilot studies [ 66 , 67 ] have confirmed good engagement and high patient satisfaction with these applications. Subsequent randomized trials have confirmed the ability of these asynchronous telepractice applications to yield equivalent therapy adherence and clinical outcomes to in-person clinician-directed therapy, with superior adherence and patient satisfaction [ 68 , 69 ]. Novel research is also currently exploring the capabilities of wearable devices (using SEMG and accelerometry) to assist in monitoring dysphagia function and therapy [ 70 – 72 ].…”

The 3 Bs of cancer care amid the COVID‐19 pandemic crisis: “Be safe, be smart, be kind”—A multidisciplinary approach increasing the use of radiation and embracing telemedicine for head and neck cancer

“…Randomized evidence supports telemedicine for other disease sites, [22][23][24] but HNC telemedicine efforts have largely been limited to swallow therapy, nutrition, quality of life, supportive care, and case conferences. [25][26][27][28][29][30] One study from the Veterans Administration reported that a teleconference HNC preoperative visit spared the average patient 28 hours of travel time and $900 for travel-related costs. 31 Given the lack of data on the feasibility of HNC telemedicine, we report our early experience, which to our knowledge is the first.…”

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

“…Although there is growing literature on telehealth practice across patient populations [12], there was at that time limited research evaluating telehealth for dysphagia management using an existing platform within a patient's home environment. Despite this, there was evidence to endorse the feasibility of using a telehealth approach for dysphagia management in head and neck cancer [13] including studies that provide valid and reliable outcomes for dysphagia management comparable to those obtained in an in-person SLP session [14,15]. A telehealth approach may provide an alternate model to support patients in areas with constraints for intensive in-person cliniciandirected therapy [16].…”