Evaluation of a speech pathology service delivery model for patients at low dysphagia risk during radiotherapy for HNC

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Moroney, Laura B
Ward, Elizabeth C
Helios, Jennifer
Crombie, Jane
Burns, Clare L
Blake, Claire
Comans, Tracy
Chua, Benjamin
Kenny, Lizbeth
Hughes, Brett GM
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2020
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Abstract

Purpose: There are no evidence-based guidelines informing which patients with head and neck cancer (HNC) require regular speech pathology (SP) support during radiation treatment (RT). Hence, some services use a “one-size-fits-all” model, potentially over-servicing those patients at low risk for dysphagia. This study evaluated the clinical safety and efficiency of an interdisciplinary service model for patients identified prospectively as “low risk” for dysphagia during RT. Methods: A prospective cohort of 65 patients with HNCs of the skin, thyroid, parotid, nose, and salivary glands, receiving curative RT, were managed on a low-risk pathway. Patients with baseline dysphagia (functional oral intake score ≤ 5) were excluded. The model involved dietitians conducting dysphagia screening at weeks 3, 5, and 6/7 within scheduled appointments. Patients at risk of dysphagia were referred to SP for assessment, then management if required. To validate the model, SP assessed swallow status/toxicities at week 5/6/7 during RT and confirmed dysphagia status at weeks 2 and 6 post RT. Results: Most (89.3%) patients did not require dysphagia support from SP services. Of the 18 patients identified on screening, only 7 (10.7%) had sufficient issues to return to SP care. Week 5/6/7 SP review confirmed low levels of toxicity. No post-treatment dysphagia was observed. There was an incremental benefit of A$15.02 for SP staff costs and a recovery of 5.31 appointments per patient. Conclusion: The pathway is a safe and effective service model to manage patients with HNC at low risk for dysphagia during RT, avoiding unnecessary SP appointments for the patient and service.

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Supportive Care in Cancer

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This publication has been entered into Griffith Research Online as an Advanced Online Version.

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Subject

Biomedical and clinical sciences

Psychology

Dysphagia

Head and neck cancer

Radiation treatment

Service delivery

Speech pathology

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Moroney, LB; Ward, EC; Helios, J; Crombie, J; Burns, CL; Blake, C; Comans, T; Chua, B; Kenny, L; Hughes, BGM, Evaluation of a speech pathology service delivery model for patients at low dysphagia risk during radiotherapy for HNC, Supportive Care in Cancer, 2019

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