Enhancing swallowing function and quality-adjusted survival of Head-and-Neck cancer patients receiving radiotherapy through a pre-habilitation program

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Authors (including presenting author) :
Lam YL (1), Ip KM (1), Wong SY (1), TMH Speech Therapist Team (1), TMH Clinical Oncology Team (2)
Affiliation :
(1)Speech Therapy Department, Tuen Mun Hospital, (2)Department of Clinical Oncology, Tuen Mun Hospital
Introduction :
Radiation Therapy is the most common treatment modality for Head-and-Neck cancer patients in Hong Kong. However, over 75% of patients suffer from acute swallowing toxicities and >90% of patients develop chronic progressive decline of swallowing functions over the years. These swallowing impairments compromise patients’ nutritional status, physical activity and quality of life. Internationally, a “pre-habilitation” model is advocated over the usual care model with early involvement of Speech Therapist in the early treatment planning, patient/family education, baseline function assessment and interventions (NICE guideline, 2014; Australian Government and Cancer Council, 2017). Prophylactic swallowing exercises are also promoted to reduce fibrosis, and thus preventing patient’s long-term swallowing decline.
Objectives :
The program aims to improve Head-and-Neck cancer patients’ swallowing status and quality of life through early education, proactive rehabilitation, close monitoring, timely recommendation and survivorship scheme.
Methodology :
In January 2014, we initiated collaboration with Clinical Oncology to discuss about the scope, aim, referral criteria and workflow of the project. The program was locally named as “HOPE program” (Head-and-neck Oropharyngeal dysphagia Prevention and Education program). From June 2014 to July 2018, the program gradually expanded to cover all Head-and-Neck cancer patients planning to receive radical radiotherapy. All referred patients would receive pre-treatment individual consultation session with Speech Therapist, then swallowing review in subacute phase (post-RT 1 month and post-RT 6 month), and yearly review in survivorship period (post-RT > 1year). Education materials (including pamphlets, booklets and DVDs) were provided in pre-habilitation phase to assist the education of prophylactic swallowing exercises.
Result & Outcome :
Up to October 2018, totally 347 patients Head-and-neck cancer patients were recruited in HOPE program (81% patients were having nasopharyngeal cancer). All of the patients received first speech therapist consultation before (or shortly after) the start of radiation therapy and were encouraged to carry out prophylactic swallowing exercises. Patient’s performance in Functional Oral Intake Scale (FOIS), Maximum Incisor Opening (MIO) and University of Washington Quality of Life (UW-QOL) did not show significant decline in post-RT 1 month and post-RT 6 months when compared to pre-RT level. These outcomes are better than literature control groups and it may show that HOPE program is beneficial in enhancing head-and-neck patients swallowing outcomes after radiotherapy. In Patient satisfaction survey (n=82), over 90% of the patients agreed that the pre-treatment consultation help them to understand more about the possible radiotherapy swallowing side-effects and the prophylactic swallowing exercises are beneficial to them. Future follow-up will be carried out to HOPE program patients to investigate the long-term swallowing outcome.

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