Dysphagia following treatment for head and neck cancer is one of the most significant morbidities impacting quality of life. Despite the value of prophylactic exercises to mitigate the impact of ...radiation on long-term swallowing function, adherence to treatment is limited. The purpose of this investigation was to explore the feasibility of a mobile health application to support patient adherence to swallowing therapy during radiation-based treatment. 36 patients undergoing radiation therapy were provided with the Vibrent™ mobile application as an adjunct to standard swallowing therapy. The application included exercise videos, written instructions, reminders, exercise logging, and educational content. 80% of participants used the app during treatment and logged an average of 102 exercise sessions over the course of treatment. 25% of participants logged at least two exercise sessions per day over the 7-week treatment period, and 53% recorded at least one session per day. Exit interviews regarding the patient experience with the Vibrent™ mobile application were largely positive, but also provided actionable strategies to improve future versions of the application. The Vibrent™ mobile application appears to be a tool that can be feasibly integrated into existing patient care practices and may assist patients in adhering to treatment recommendations and facilitate communication between patients and providers between encounters.
Objective
To examine associations between speech‐language pathology (SLP) care and pretreatment variables, short‐term and long‐term swallowing and airway impairment, and survival in elderly patients ...treated for oropharyngeal squamous cell cancer (SCCA).
Study Design
Retrospective analysis of Surveillance, Epidemiology, and End Results‐Medicare data.
Methods
We evaluated longitudinal data from 666 patients diagnosed with oropharyngeal SCCA from 2004 to 2007 using cross‐tabulations, multivariate logistic regression, and survival analysis.
Results
SLP care was documented in 25% of patients. High‐volume hospital care (odds ratio (OR) = 3.2 1.0–10.0) and dysphagia during treatment (OR = 13.0 3.6–47.1) were the only significant predictors of SLP care during the initial treatment period. SLP care was significantly more likely during the first year (OR = 5.3 3.1–9.1) and second year (OR = 4.5 2.4–8.2) following initial treatment. Subsequent dysphagia (OR = 32.5 16.9–62.4), stricture (OR = 2.2 1.2–4.0), gastrostomy (OR = 1.7 1.1–2.7), and tracheostomy tube use (OR = 2.4 1.2–4.8) were significantly associated with long‐term SLP care. After controlling for patient, tumor, and treatment‐related variables, SLP care was associated with significant relative attenuation of the OR for dysphagia (93%), stricture (35%), weight loss (8%), and airway obstruction (34%). Survival analysis, controlling for all other variables, demonstrated improved survival for patients under SLP care (hazard ratio = 0.73 0.57–0.95).
Conclusion
SLP care is underutilized in elderly oropharyngeal SCCA patients and largely utilized after the onset of impaired airway and swallowing function, but is associated with improved outcomes. These data suggest a need for treatment guidelines that incorporate the routine use of SLP care in this population during the initial treatment period and beyond.
Level of Evidence
2c. Laryngoscope, 128:1403–1411, 2018
Oral Cancer Carole Fakhry, Karen T. Pitman, Ana P. Kiess
2020
eBook
A state-of-the-art guide on oral cancer management from distinguished experts! Oral Cancer: Evaluation, Therapy, and Rehabilitation edited by prominent Johns Hopkins clinicians and educators Carole ...Fakhry, Karen Pitman, Ana Kiess, and David Eisele provides a comprehensive, state-of-the-art review on the diagnosis and management of oral cancer. This unique resource fills a void in the literature by exploring surgical and reconstructive issues specific to each subsite of the oral cavity. Important pre- and post-treatment evaluations by dental, speech language pathology, and the oncologic care team are reviewed. The comprehensive book is divided into 10 sections, each focused on different facets of the patients' trajectory. The text starts with epidemiology of oral cavity cancer and discussion of patient populations at increased risk of oral cavity cancer. The book details pre-cancers, multidisciplinary diagnostic evaluations, treatment, post-treatment, recurrent and metastatic oral cancer, and palliative care, concluding with future directions such as chemoprevention. A full spectrum of oral neoplasms are covered in depth, including different types of squamous cell cancer, primary malignancies of the mandible, and sublingual and minor salivary gland malignancies. Key Features * All oral cavity subsites are approached from both an ablative and reconstructive standpoint, with dedicated chapters focused on specific oral cancer reconstructive techniques * Discussion of oncologic considerations encompassing radiation and medical oncology including definitive radiation therapy, brachytherapy, adjuvant radiation therapy, and adjuvant chemotherapy/novel therapeutics * Clinical pearls cover complications of both surgery and radiation therapy, as well as psychological and dental implications of therapy * High-quality illustrations, photographs, and videos further elucidate impacted anatomy and techniques Residents and clinicians in otolaryngology-head and neck surgery, oral and maxillofacial surgery, head and neck reconstructive surgery, medical oncology, and radiation oncology will benefit from reading this excellent resource. Dentists who wish to further their knowledge about oral cancers will also find it an invaluable reference.
Shares personal experience interning at New York City's Lesbian, Gay, Bisexual, & Transgender Community Center beginning with her initial contact with the Center, through her interview, & to her time ...in the Youth Enrichment Services (YES) program. Focus is on the fact that she is heterosexual & the implications for working with LGBTQ youth as well as for how others assessed her sexual orientation when she discussed her placement. After discussing her process of coming out as a straight person, some remarks are offered on how the YES program runs. She acknowledges the personal & professional growth she enjoyed from the experience. J. Zendejas
