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

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Kuhn et al.

Table 2. Screening for Dysphagia in HNC Patients: Statements That Reached Consensus Number Statement

Mean Outliers

2

Dysphagia screening for newly diagnosed HNC patients guides preventative and supportive interventions when performed prior to cancer treatment. 7.09 1

7

A validated clinician nutrition screening tool is useful in assessing nutritional risk in HNC patients. SLP consultation is optimal prior to treatment in HNC patients who are at risk for dysphagia.

7.18 8.55

0 0

14

Abbreviations: HNC, head and neck cancer; SLP, speech-language pathologists.

Table 3. Evaluation of Dysphagia in HNC Patients: Statements That Reached Consensus Number Statement

Mean Outliers

8

A comprehensive nutritional assessment of HNC patients with dysphagia includes anthropometric measurements, biochemical measurements, and individualized nutrition requirements.

7.91

0

9 Bedside swallow assessment by an SLP is useful in evaluating swallowing safety following tracheostomy. 7.36 0 In HNC patients who fail dysphagia screening, instrumental swallow evaluation provides insight into the nature of swallowing impairment. 7.55 1 11 Instrumental evaluation procedures (endoscopy or fl uoroscopy) are useful swallowing evaluation methods for HNC patients after radiotherapy. 8.55 0 13 Pretreatment instrumental swallowing evaluation establishes baseline swallowing function and impairment in HNC patients who report symptoms of dysphagia or who are at risk of developing dysphagia during treatment. 8.09 0 18 FEES affords the bene fi t of direct visualization of the swallowing mechanism at the point of care for HNC patients. 8.00 0 19 Video fl uoroscopy provides functional imaging of the oral cavity and upper esophagus in HNC patients. 8.00 0 20 Perform swallowing evaluation prior to oral diet initiation in HNC patients with tracheostomy. 7.18 0 21 Video fl uoroscopic assessment of swallowing is bene fi cial following total laryngectomy to evaluate for the postsurgical leak. 7.27 1 10

Abbreviations: FEES, fl exible endoscopic evaluation of swallowing; HNC, head and neck cancer; SLP, speech-language pathologists.

and symptom ‐ driven assessments for screening dys phagia in HNC patients did not reach a consensus.

prevention topics agreed upon by the development team included the involvement of appropriate specialists (eg, RDN and SLPs) as members of the multidisciplinary team (MDT), RDNs, prophylactic swallowing therapy, feeding tube use, and pain management. Statements regarding the bene fi ts of contemporary chemoradiation strategies such as intensity ‐ modulated radiotherapy (IMRT) were also agreed upon by the development group. Prevention ‐ related statements not reaching con sensus included the role of prophylactic feeding tubes, chemotherapy regimens, and HNC patient/caregiver education in in fl uencing swallowing outcomes. Interventions for Dysphagia in HNC Patients The development team reviewed 22 statements relating to interventions for dysphagia in HNC patients; of these, a consensus was reached on 18 (Table 5). Statements with agreement among the development group covered a spectrum of interventions. These included diet allocation, patient/caregiver education, oral care, feeding tube use and discontinuation, behavioral swallowing and lymphe dema therapy, and surgical procedures. The development group agreed that interventions require the participation of an MDT approach for optimal dysphagia

Evaluation of Dysphagia in HNC Patients The development group created 9 statements on the theme of dysphagia evaluation in HNC patients. All 9 statements reached consensus (Table 3). Discussions involved the timing and choice of instrumental evaluation procedures among HNC patients. The statements support fl exible endoscopic evaluation of swallowing (FEES) or video fl uoroscopic swallow study (VFSS) for positive dysphagia screening in HNC patients and following radiotherapy. SLP assessment and instrumental swallow evaluation are useful before cancer treatment in HNC patients with dysphagia or those at high dysphagia risk. Furthermore, consensus statements support evaluation by an RDN to improve nutrition outcomes in HNC patients with or at risk for dysphagia. Prevention of Dysphagia Among HNC Patients Fourteen statements relating to the prevention of dysphagia among HNC patients were developed. Of these, 11 reached a consensus. ( Table 4 ). Important