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Swallowing Outcomes in Head & Neck Cancer

Swallowing Outcomes in Head & Neck Cancer. Jo Patterson Macmillan Speech & Language Therapist/Research Fellow. Swallowing Outcomes. Critique assessments Collector’s perspective Patient rated outcomes Clinical scales Clinical indicators. Patient reported outcomes. SWAL-QOL / SWAL-CARE

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Swallowing Outcomes in Head & Neck Cancer

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  1. Swallowing Outcomes in Head & Neck Cancer Jo Patterson Macmillan Speech & Language Therapist/Research Fellow

  2. Swallowing Outcomes • Critique assessments • Collector’s perspective • Patient rated outcomes • Clinical scales • Clinical indicators

  3. Patient reported outcomes • SWAL-QOL / SWAL-CARE • M.D.Anderson Dysphagia Inventory

  4. SWAL-QOL (McHorney 2002) • Devised from patient focus group (N=549, 14.5% head & neck cancer) • Good correlation with UWQOL (Lovell 2005) • Moderately related to pathophysiology

  5. Measurement tool • SWAL-QOL 2002 (44 items, 11 domains) general burden* (fatigue) food selection* (sleep) eating duration (communication) eating desire fear of eating mental health* social function* symptom frequency

  6. Data Sample • N=65 (49 males; 16 females) • Age 32-80y mean 60y • Oral (31) oropharyngeal (30) NPC (4) • T1-2 (35) T3-4 (30) • Surgery (10) surgery & radiotherapy (36) chemoradiotherapy (13) radiotherapy (6) • 35 completed pre & post SWAL-QOL • Analysed using ANOVA

  7. Pre-treatment

  8. 6 months post treatment

  9. Collector’s perspective • Author’s report 14 mins to complete – much longer needed • Difficult to analyse – many components • Good sections – includes symptoms • Not to be done cross-sectional

  10. M.D. Anderson Dysphagia Inventory (Chen 2001) • 20 items (sub-groups emotion, physical, function) • Devised from professionals (SALTs & Surgeons) • Good reliability • Correlates with UWQOL • No association with aspiration (Gillespie 2005) • Used as outcome for swallowing exercises (Kulbersh 2006)

  11. MDADI pre & post CRT Demographics Total = 116

  12. Comparison pre & post

  13. Collector’s perspective • 10 mins to complete • ‘no opinion’ poses difficulties • Difficult to use on someone without swallowing difficulties • Difficult to use on NBM patients • One item complex double negative

  14. Quality of Life Questionnaires • University of Washington QOL Scales • DAHNO • Correlates with VFSS, HADS, MDADI, SWAL-QOL, TOMS • Short, quick to complete • Wide research base • Difficult to find out how it was devised • Reproducible, reliable & valid • Originally intended for surgical group • Additions of taste, saliva, mood, anxiety • Speech & saliva difficult for people to answer

  15. Pre-treatment priorities

  16. Clinical Scales • Performance Status Scales (List ’90) • Therapy Outcome Measures (TOMS) • FIGS

  17. Performance Status Scales (List 1990) • Developed by surgeons, oncologists & SALTs • Purpose; research & clinical • Normalcy of diet, eating in public, communication • Rated by ‘health professionals’ • High reliability • Correlates with QOL • Included in DAHNO dataset

  18. Diet scale pre vs. 3 months post Chemoradiotherapy

  19. Collectors perspective • Quick • Can be done by other staff • Some diets difficult to grade • Can give false positive results • Gradations ?equal • Large literature base for comparison • ?swallowing outcome

  20. Therapy Outcome Measures(Enderby ’77) 10 core patients specific scales • ‘Laryngectomy’ only scale specific to H&NC • Scales on voice, dysarthria, phonology & dysphagia • Pilot study Radford et al 2003 • Correlates with UWQOL scales • ?modification for H&NC

  21. Functional Intraoral Glasgow Scale (FIGS)(Goldie 2006) • Originated Canniesburn Hospital • 3 scales – chew, swallow & speech • Total score of all 3 items

  22. Clinical Indicators • Aspiration / penetration • Residue • Swallowing efficiency • Feeding tube dependency

  23. Aspiration / Penetration • H&NC literature focuses on aspiration • Penetration / aspiration scale (Rosenbek) • Increases reliability of findings • One score • Requires instrumental assessment • ?meaningful to clinical picture / patient

  24. % Aspiration Post CRT % aspiration

  25. % Aspiration pneumonia

  26. Swallowing Efficiency • Residue • Oropharyngeal swallowing efficiency • Water swallow test

  27. Mean time to swallow 100mLs water pre-treatment

  28. Tube feeding

  29. DAHNO • Was the patient seen for pre treatment SALT assessment? • PSS Normalcy of Diet • Weight • Type & timing of nutritional support

  30. Summary • Choice of measures • One-dimensional, cross-sectional misleading • Needs to be longitudinal, set time points • Simple / collectable • What questions to ask of the data • It will require dedicated time • ?interventions • DAHNO

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