The health care experiences of people with head and neck cancer: A scoping review.

BACKGROUND: Understanding health care experience in head and neck cancer (HNC) is becoming increasingly important due to changes in the disease profile, survivorship, and a greater appreciation of patient health care experience as an important outcome measure. People with HNC encounter many different types of health care professionals and health care touchpoints. METHOD: Through systematic database searching, this scoping review of qualitative English-language studies describes the self-reported care experiences of those with HNC across the health care continuum, and describes the current state of the literature. RESULTS: Overall, the 95 studies identified were heterogeneous and investigated a broad range of topics. Trends across studies showed research centered on hospital-based care, conducted in developed countries, with more studies on feeding than other aspects of care. Generic qualitative research frameworks, with individual interviews, were the preferred method of data collection. CONCLUSION: Despite identifying many studies, there are significant gaps in our understanding of the HNC patient experience.

Exploring the Interplay Between Radiotherapy Dose and Physiological Changes in the Swallowing Mechanism in Patients Undergoing (Chemo)radiotherapy for Oropharynx Cancer.

This study explored associative relationships between radiotherapy dose volumes delivered to the dysphagia aspiration risk structures (DARS) and swallowing physiological disturbance at 3 months post treatment in a homogenous cohort of patients who received (chemo)radiotherapy ((C)RT) for oropharyngeal head and neck cancer (HNC). Participants(n = 53) were a subgroup of patients previously recruited as part of a prospective randomised trial, and had undergone physiological swallowing assessment using videofluroscopic swallowing study (VFSS) at 3 months post (C)RT. The extended oral cavity (EOC), supraglottic larynx (SGL), glottic larynx (GL), cricopharyngeal inlet (CI), and pharyngeal constrictor muscles (PCM) were contoured as per international consensus guidelines and dose volume histograms (DVHs) were generated for each structure. Each DVH was analysed to reveal mean, maximum and partial radiotherapy doses of V40, V50 and V60 for each structure. Physiological swallowing function on VFSS was rated using the Modified Barium Swallow Impairment Profile (MBSImP). A binary logistic regression model was used to establish associative relationships between radiotherapy dose to the DARS and physiological changes within the swallowing mechanism. Structures that received the largest volumes of radiotherapy dose were the PCM and SGL. Significant relationships were found between the proportion of the EOC, SGL, GL and PCMs that received radiotherapy doses > 40 Gy, > 50 Gy and > 60 Gy and the likelihood of a moderate-severe physiological swallowing impairment (on the MBSImP). Whilst the current study was exploratory in nature, these preliminary findings provide novel evidence to suggest structure-specific associative relationships between radiotherapy dose and impacts to corresponding swallow physiology in patients with oropharyngeal HNC.

Using dosimetric information to guide dysphagia management in patients with head and neck cancer: Clinicians' knowledge and experiences.

Purpose: The use of dosimetric information to guide the management of dysphagia related to head and neck cancer (HNC) treatment is an emerging area of practice. In order to better meet the needs of people with dysphagia in HNC, it is important to explore how clinicians use this information to guide practice and also to identify factors that influence/discourage the use of dosimetric information.Method: A descriptive qualitative method was chosen and purposeful sampling with additional snowball sampling were used to recruit clinicians working within Australian cancer centres. To facilitate participation, clinicians were offered either a focus group or individual interview as a means to collect their perspectives. A total of 20 clinicians with varying years of clinical experience (range 2.5 - 29 years) were recruited. Eight participants took part in a focus group and 12 elected to participate in an individual interview. Content analysis was used to analyse transcripts.Result: Three main themes emerged from the transcripts: (1) clinician factors such as experience, confidence and knowledge and (2) clinical service factors such as staffing levels, clinical management pathways and system access influence use of dosimetric information; (3) patient factors such as demographics, surgical history and education needs influence dysphagia management plans.Conclusion: Speech-language pathologists' (SLPs') use of dosimetric information within HNC settings to direct patient management is emerging and varies between clinicians and workplaces. Given that dosimetric information potentially enables specialised dysphagia management planning for patients during their radiotherapy treatment, further education and training for speech-language pathologists in this area should be prioritised.

A prospective study monitoring carer distress during (chemo)radiotherapy for head and neck cancer via an electronic platform.

INTRODUCTION: Research has shown that electronic platforms can assist data capture of patient-reported outcome measures (PROMs) to guide clinical care. In comparison, routine collection of carer-reported outcome measures (CROMs) to support the patient-carer dyad during cancer treatment has had limited attention. The current study utilised a novel electronic CROM (eCROM) system, ScreenIT Carer, to monitor the prevalence and nature of distress in carers of patients undergoing (chemo)radiotherapy ((C)RT) for head/neck cancer (HNC), and explore factors associated with carer distress. METHODS: Carers completed ScreenIT Carer weekly when attending patients' (C)RT treatment sessions from planning to 2 weeks post-treatment. ScreenIT Carer included the Distress Thermometer (DT) and Problem List, and a purpose-built Mealtime-Specific DT and Problem list. Data were first examined descriptively, then associations between demographic/treatment-related factors and distress severity were analysed using mixed-effects general linear modelling. RESULTS: 135 carers provided 434 ScreenIT Carer entries during the study period (mean entries = three/carer; yielding average adherence rate of 41% (range 11-100%)). A high prevalence of general (59%) and mealtime-specific distress (46%) was reported by carers. Nature of distress was multifactorial, with emotional problems and the patients' physical condition/symptoms common contributing factors. Based on multivariate analysis, tumour site, geographical location of residence and time during (C)RT when ScreenIT Carer was completed were significant predictors of carer distress severity. CONCLUSIONS: Carer distress is prevalent and multifactorial during (C)RT. This study highlights the feasibility of utilising eCROM platforms such as ScreenIT Carer, to monitor carer wellbeing and guide supportive care services as part of a holistic care pathway.

Practices, knowledge and inter-professional relationships between speech pathologists and radiation therapists managing patients with head and neck cancer.

INTRODUCTION: This study examined knowledge and practices of speech pathologists (SPs) and radiation therapists (RTs) regarding plan optimisation for head and neck cancer (HNC) patients, and the potential impacts on swallowing function. The secondary aim was to explore the level of interaction occurring between these professional groups within cancer centres. METHODS: Two electronic surveys, with matched questions for SPs and RTs, explored: service/institutional demographics; clinician awareness, practices regarding plan optimisation to swallowing structures and; relationships and interactions between SPs and RTs in the management of HNC patients. Participant recruitment occurred through specialist professional networks with additional snowball sampling. Data were analysed with descriptive statistics and thematic analysis. RESULTS: A total of 32 SPs and 41 RTs completed surveys. All SPs and 50% of RTs were aware of dose-dysphagia relationships, though SPs rarely used dosimetric information to inform patient management. Only 33% of RTs indicated that their centres actively constrain dose to swallowing structures, reporting that staffing skill mixtures and lack of prescription by the treating RO were restrictive factors. Both SPs and RTs acknowledged the importance of collaborating with colleagues (SPs/RTs) and felt they could assist their colleagues in devising patient management plans, though current collaboration/interaction was minimal. CONCLUSIONS: Levels of awareness were found to be higher in SP group. Despite high levels of awareness, limited use of swallowing structure dose constraints and hence dosimetric information specific to swallowing was rarely used to optimise/guide multidisciplinary HNC acute care. Opportunities for enhanced collaboration between SPs and RTs should be considered.

Perspectives on optimizing radiotherapy dose to the dysphagia/aspiration-related structures for patients with head and neck cancer.

PURPOSE OF REVIEW: The purpose of this study is to provide an overview on the methodologies, outcomes and clinical implications of studies that have investigated swallowing outcomes after head and neck cancer (HNC) treatment when reducing radiotherapy dose to specific dysphagia/aspiration-related structures (DARS). RECENT FINDINGS: Overall, there is limited recent evidence, with a lack of high-quality studies, which examine the outcomes of DARS-optimized radiotherapy treatment. Large variations exist in the methodology of these studies in regards to which DARS are delineated and how swallowing outcomes are measured. Consequently, there is a wide range of dose limits recommended to a variety of DARS structures. Despite these limitations, there appears to be a general consensus that optimizing dose to the DARS will result in some reduction of dysphagia after radiotherapy without compromising on treatment to the tumour. SUMMARY: More rigorous study must be completed to determine the true extent of clinical benefit from this practice. Institutions must take into consideration the limitations of the evidence as well as logistical costs of implementing this technique into practice. However, optimizing dose to the DARS appears to be a well-tolerated practice that may have substantial positive benefits for patients' swallowing function and quality of life after HNC treatment.

Dysphagia optimized radiotherapy to reduce swallowing dysfunction severity in patients undergoing treatment for head and neck cancer: A systematized scoping review.

This study involved a systematized scoping review to coalesce current evidence on dysphagia outcomes achieved through active sparing of the swallowing structures in patients receiving radiotherapy for head and neck cancer. Eligible publications between 2007 and 2017 were reviewed and synthesized regarding participant demographics, treatment regimens, swallowing structures chosen for optimization, dosimetric constraints, and dysphagia measures. Nine prospective cohort studies were included. Key structures routinely spared included pharyngeal constrictor muscles (PCMs), glottic larynx (GL), supraglottic larynx (SGL), and esophageal inlet muscle. Shorter enteral feeding times and reductions in Common Terminology Criteria for Adverse Event (CTCAE) grade 3 dysphagia toxicity were observed when dose to the larynx (GL and SGL) and PCMs was constrained to < 50 and < 60 Gy, respectively. Emerging evidence supports "active" sparing of the swallowing structures at the time of radiotherapy planning to reduce dysphagia severity, with no compromise to planning target volumes and locoregional control rates.