xRead - Swallowing Disorders in the Adult Patient (October 2024)

10976817, 2023, 4, Downloaded from https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1002/ohn.302, Wiley Online Library on [08/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

574

Otolaryngology – Head and Neck Surgery 168(4)

pharyn*[tw] OR hypopharyn*[tw] OR laryn*[tw] OR mandible*[tw] OR SCC[tw] OR UADT[tw]) AND ( “ neoplasms ” [mh] OR carcinoma*[tw] OR adenocarci noma*[tw] OR cancer[tw] OR cancers[tw] OR cancerous [tw] OR neoplas*[tw]))) Literature searches yielded 774 articles, with 330 remaining after the titles and abstracts were screened for relevance. These articles were reviewed by the chair and assistant chair and classi fi ed per the Oxford Centre for Evidence ‐ Based Medicine's 2011 levels of evidence. 4 Based on the evidence levels, there were 14, level 1 articles; 37, level 2 articles; 62, level 3 articles; 190, level 4 articles; and 27, level 5 articles. Results A total of 60 statements were generated by the development group for assessment. After 2 iterations of the Delphi survey and the removal of duplicate and similar statements, 48 statements met the standardized de fi nition for consensus ( Tables 1-6 ) and 12 did not ( Table 7 ). The ECS was categorized into topic areas: (1) risk factors, (2) screening, (3) evaluation, (4) prevention, (5) interventions, and (6) surveillance. Risk Factors for Dysphagia Among HNC Patients One statement was created which pertained to factors placing HNC patients at greater risk of developing dysphagia (Table 1). The development group had an extensive discussion and carefully revised this multipart statement which reached a consensus. Screening for Dysphagia in HNC Patients A total of 5 statements concerning appropriate screening for dysphagia among HNC patients were developed, and 3 reached a consensus (Table 2). The development group focused on critical dysphagia screening practices for HNC patients. The consensus was reached regarding the timing of dysphagia screening for HNC patients: It is best performed prior to initiation of cancer therapy. Additionally, the development group agreed on the inclusion of nutri tion screening using validated screening tools and patient ‐ speci fi c characteristics. However, the recom mended application of patient ‐ reported questionnaires

these statements did not reach consensus and were not included in the second survey, while 6 were revised for improved clarity. The second iteration of the survey was used to reassess items for which there was near consensus, or for items for which there were suggestions for signi fi cant alterations in wording that could have affected survey results. All 13 statements included in the second iteration reached consensus and no further Delphi surveys were needed. Literature Review Two systematic literature reviews were performed by an information specialist, using keywords chosen by the development group, to identify current evidence regarding the management of dysphagia. The second review was performed to clarify or expand on topics explored by the group after the fi rst search. The literature searches were conducted in March 2021 and April 2021 and included all relevant publications since 2000 in English from PubMed, EMBASE, Cochrane Database of Systematic Reviews, Web of Science, Agency for Healthcare Research and Quality, ECRI National Guideline Clearinghouse, Canadian Medical Association Infobase, The National Institute for Health and Care Excellence (UK), TRIP Database, National Library of Guidelines (UK), Scottish Intercollegiate Guidelines Network, New Zealand Guidelines Group, Australian National Health and Medical Research Council, Guidelines International Network, Cumulated Index to Nursing and Allied Health Literature, Health Services/Technology Assessment Texts, Proquest Central, Joanna Briggs Institute EBP database, Scopus, Google Scholar, NHS Evidence ENT and Audiology (UK), and BIOSIS. The search strategy was completed using the following search terms: (dysphagia[tab] OR ( “ deglutition disorders ” [mh] OR “ deglutition ” [mh] OR “ energy intake ” [mh] OR eating [mh] OR dysphagia[tw] OR swallow*[tw] OR deglutition [tw] OR eating[tw] OR intake*[tw] OR aspirat*[tw] OR gastrostomy[tw] OR “ g ‐ tube ” [tw]) AND (( “ Head and Neck Neoplasms ” [Mesh]OR “ Squamous Cell Carcinoma of Head and Neck ” [Mesh]) OR ((squamous[tw] OR head [tw] OR neck[tw] OR cervical[tw] OR oral[tw] OR mouth [tw] OR tongue[tw] OR glottis[tw] OR mucous*[tw] OR mucosal[tw] OR nose[tw] OR nasal[tw] OR trachea*[tw] OR esophag*[tw] OR oesophag*[tw] OR aerodigestive [tw] OR nasopharyn*[tw] OR oropharyn*[tw] OR

Table 1. Risk Factors for Dysphagia Among HNC Patients: Statements That Reached Consensus Number Statement

Mean Outliers

1. The presence of any or multiple of the following features predicts an increased risk of developing dysphagia from treatment for HNC a. Patient factors (advanced age, pretreatment malnutrition, pretreatment dysphagia, pretreatment sarcopenia, rural location, alcohol abuse, cranial neuropathies, dementia, feeding tube dependence)

8.82

0

1

b. Tumor factors (recurrence, advanced T and N stage, hypopharyngeal subsite) c. Treatment factors (tracheostomy, chemotherapy + XRT, multimodality treatment)

Abbreviations: HNC, head and neck cancer; N, node; T, tumor; XRT, radiation therapy.