Background
The FACE‐Q H&N is a patient reported outcome measure covering multiple constructs for patients with head and neck tumors. Additional testing is needed to determine suitability in assessing ...speech‐ and swallowing‐related quality of life and function.
Methods
FACE‐Q H&N, The M. D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI) scores were collected from two patient cohorts who had undergone jaw reconstruction. Construct validity was assessed using convergent validity testing and known groups testing to assess discriminant validity.
Results
A priori hypotheses testing demonstrated strong correlations (ρ > 0.6, p < 0.05) between FACE‐Q H&N eating and drinking, swallowing and eating distress scales with MDADI subscales, and between FACE‐Q H&N speech function and distress scales and the SHI. Known groups testing demonstrated all instruments could delineate outcomes among patients who had radiation, advanced tumors, and tracheostomy.
Conclusion
The FACE‐Q H&N may be an alternative for the SHI and MDADI in this patient cohort.
Background
Transoral robotic surgery (TORS) is a minimally invasive approach for the treatment of oropharyngeal cancer. The effects on swallowing and speech need to be comprehensively evaluated to ...understand the associated morbidity.
Methods
A prospective cohort of 21 patients was recruited to undergo pre‐TORS and post‐TORS swallowing and communication assessment. Fiberoptic endoscopic evaluation of swallowing (FEES) was used in the first postoperative week.
Results
Sixteen participants (76.2%) had penetration‐aspiration scores ≥3 or higher, seven (33.3%) aspirated on thin liquids, three (14.3%) did so silently. Prolonged recovery trajectory occurred for the majority of the cohort, particularly if TORS was followed by adjuvant radiotherapy. Swallowing and communication scores were significantly worse in base of tongue primary tumors and with advanced age.
Conclusion
Early FEES demonstrates a significant decline in swallowing function, including increased secretion load, pharyngeal residue, laryngeal penetration, and aspiration. Silent aspiration occurred in 14% and thus highlights the necessity for instrumental assessment to ascertain aspiration risk.
To compare and analyse satisfaction and costs of telehealth services for patients receiving allied health services at a quaternary oncology hospital.
Cross-sectional design survey distributed to ...patients who had received outpatient allied health (psych-oncology, dietetics, speech pathology) telehealth services from March November 2020. Responses regarding satisfaction and barriers relating to telehealth were examined, and costs calculated.
A total of 156 surveys were distributed, 124 were completed and included in the analysis. The majority of respondents (56%) were female patients, with a median age of 57 years. Survey results revealed that 89% of respondents would access allied health consultations using telehealth again, of whom 14.5% indicated that they preferred telehealth to a face-to-face appointment. Common barriers to service delivery were internet connection, inability to perform physical examination via telehealth, and patient unfamiliarity with technology. Levels of satisfaction were high, with 92.7% of respondents either satisfied or very satisfied with the allied health telehealth service offered. Only 1.5% of the participants were dissatisfied on account of unfamiliarity with the technology and preference for face-to-face contact with their clinician.To attend a face-to-face allied health consultation 90% of respondents would have to drive to the hospital, with cost of petrol and parking per trip calculated to be an average of $ 51.25.
Allied health service delivered via telehealth was met with high rates of satisfaction and resulted in lower patient costs.
Long-term health-related quality of life (HRQOL) and functional outcomes following mandibular and maxillary reconstruction are lacking. To determine these outcomes, a cross-sectional study of ...patients with a history of cancer who underwent jaw reconstruction was undertaken. Participants were identified from a database of jaw reconstruction procedures at the Chris O’Brien Lifehouse (Sydney, Australia). Eligible patients had at least one month follow-up, were aged ≥18 years at surgery, and had history of malignancy. HRQOL was measured using the FACE-Q Head and Neck Cancer Module (FACE-Q H&N). Functional outcomes were measured using the FACE-Q H&N, MD Anderson Dysphagia Inventory (MDADI) and Speech Handicap Index (SHI). Ninety-seven questionnaires were completed (62% response rate). Mean age of respondents was 63.7 years, 61% were male, and 64% underwent radiotherapy. Treatment with radiotherapy was associated with worse outcomes across 10/14 FACE-Q H&N scales, three MDADI subscales and one composite score, and the SHI. Mean differences in scores between irradiated and non-irradiated patients exceeded clinically meaningful differences for the MDADI and SHI. Issues with oral competence, saliva, speaking, and swallowing worsened with increasing time since surgery. Younger patients reported greater concerns with appearance, smiling, speaking, and cancer worry. Women reported greater concerns regarding appearance and associated distress. History of radiotherapy substantially impacts HRQOL and function after jaw reconstruction. Age at surgery and gender were also predictors of outcomes and associated distress. Pre-treatment counselling of patients requiring jaw reconstruction may lead to improved survivorship for patients with head and neck cancer.
Background
In response to the pathophysiology and expected trajectory of dysphagia that arises following treatment for head and neck cancer (HNC), an intensive and progressive approach to dysphagia ...is warranted. This pilot study evaluates the recovery of swallowing function following the implementation of an exercise‐based approach to dysphagia rehabilitation.
Methods
Consecutive recruitment was carried out prospectively at a quaternary referral centre. Participants were aged 18 years and older and had completed treatment for HNC. Dysphagia was assessed pre and post a 10‐week rehabilitation program using videofluoroscopy swallow study (VFSS) and clinician‐and patient‐reported outcomes.
Results
Ten participants were recruited over a 6‐month period, all of whom had oropharyngeal dysphagia confirmed on VFSS. At the conclusion of the 10‐week intervention period, DIGEST (Dynamic Imaging Grade of Swallowing Toxicity) scores improved significantly for both safety and efficiency components. Four of seven participants who had a percutaneous endoscopic gastrostomy tube at baseline were no longer reliant on it for their nutrition, hydration or medication at the completion of the therapeutic period. While four participants continued to aspirate on thin fluids, none developed aspiration pneumonia.
Conclusion
Oropharyngeal dysphagia as a consequence of HNC treatment is challenging to rehabilitate; however, in selected patients, it is responsive to intensive and individualized rehabilitation programs.
This study describes the novel trismus device combined with an intensive trismus rehabilitation program for patients with head and neck cancer.
Oral competence refers to the maintenance of lip closure with sufficient strength to prevent anterior spillage of saliva, food and fluid, and to clearly articulate labial sounds. Despite facial nerve ...paralysis having an impact on eating, drinking and communicating, little research has been done in this area.
Studies examining oral competence associated with a diagnosis of facial nerve paralysis were considered using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement checklists and evaluated for their risk of bias using the RevMan Risk of Bias Tool.
44 articles were examined. There was an over-representation of case-series and cohort studies. All studies carried a high risk of bias due to lack of (a) validated outcome measures, (b) comparison group and (c) blinding or randomised assessors and participants. Studies primarily examined facial nerve intervention for the purpose of restoring smiling or facial aesthetics rather than oral competence.
Whilst oral competence is often compromised after a facial nerve paralysis, it is inconsistently measured, managed and described. Further studies are required to examine the (a) incidence, (b) severity and (c) impact on quality of life relating to oral incompetence using validated measures at consistent time intervals.
Abstract Understanding the barriers and facilitators for prophylactic swallowing and trismus exercises for patients undergoing radiation to the head and neck may help exercise adherence. The analysis ...reviews all published reports of exercise adherence with a critical appraisal following PRISMA guidelines. A total of 137 potential papers were identified; 20 studies met the inclusion criteria. The most commonly reported facilitators for swallowing and trismus exercises were regular clinician contact and online resources to reinforce instructions, set goals, and manage radiation toxicities. Social support and perceived benefit from exercises were also reported to be of help. The most common barriers to exercise were radiation toxicities, anxiety, feeling overwhelmed with information, and not understanding the reason for the exercises. Understanding facilitators and barriers to adherence is critical when designing exercise interventions for patients undergoing radiation for head and neck cancer.
Head and neck cancer treatment often leads to trismus, a condition characterized by limited mouth opening. Exercise-based therapy is the most common intervention but there are no clear guidelines as ...to the optimal exercise regimen. Restorabite™ is a portable and force-regulated trismus device designed to enhance exercise adherence. This study explores the adherence to exercises using Restorabite™ in head and neck cancer patients with trismus and identifies facilitators and barriers to exercise therapy.
Mixed-methods, prospective cohort study undertaken at a quaternary oncology hospital, in Sydney Australia involving participants diagnosed with head and neck cancer diagnosed with trismus (maximal incisal opening under 35 mm). Patients underwent a 10-week individualized trismus program using Restorabite™ with weekly speech pathology reviews. Exercise adherence was tracked through categorized descriptors. Data were collected prospectively at baseline, during 10 weeks of therapy with Restorabite™, and at 6- and 12-month post-trismus exercise. Participants described facilitators of trismus therapy, and barriers to completing the prescribed exercises. Clinical documentation of these responses was then analyzed using content analysis.
One-hundred and thirty-five participants were recruited. During the intervention 69% (n = 93) exercised as recommended, 24% (n = 32) exercised less, and 7% (n = 10) exercised more than recommended. At 6 months post-intervention, 55.5% (n = 75) exercised as recommended, 38.5% (n = 52) exercised less, and 4% (n = 6) exercised more. At 12 months, 36% (n = 49) exercised as recommended, 48% (n = 62) exercised less, and 11% (n = 15) exercised more. MIO increased from a mean of 18.6 mm at baseline, to 30.1 mm at the end of the 10-week intervention. This was maintained at 6 and 12 months (31.7 and 32.1 mm, respectively). Adherence to the exercise program was associated with greater improvement in maximum interincisal opening (p < 0.001). Facilitators of adherence included intrinsic motivation, device portability, perceived functional change, and external support tools. Barriers included cancer treatment toxicities, competing priorities, and health challenges. Positive outcomes included functional improvements, while negative outcomes included increased pain.
Seventy-six percent of patients prescribed Restorabite™ performed trismus exercises at or more than the recommended frequency. Facilitators and barriers identified provide insights into factors influencing adherence. Future research should involve comparative studies that compare the adherence and effectiveness of different exercise programs.
Background
Patients treated for head and neck cancer are at high risk of developing head and neck lymphedema (HNL). We describe outcomes of HNL management at an Australian institution from 2018 to ...2020.
Methods
Electronic records from Chris O'Brien Lifehouse were retrospectively reviewed from January 1, 2018 to December 31, 2020. Objective changes in HNL were assessed using The M. D. Anderson Cancer Center (MDACC) HNL rating scale and Assessment of Lymphedema of the Head and Neck (ALOHA).
Results
Among the 100 patients referred for management of HNL, surgery was the most frequent treatment modality (80%; 70% with neck dissection) and 69% underwent radiotherapy. Manual lymphatic drainage (MLD) was most often prescribed (96%), followed by self‐MLD (93%). Small but significant improvements in ALOHA measurements were observed for 50 patients (50%). Only 5/29 (17%) patients had post‐treatment improvements on the MDACC scale.
Conclusions
Standardized, prospective measurement of treatment approaches and outcomes is needed to further evaluate the service.
