xRead - Swallowing Disorders in the Adult Patient (October 2024)
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Kuhn et al.
Table 5. Interventions for Dysphagia in HNC Patients: Statements That Reached Consensus Number Statement
Mean Outliers
12 The inability to safely maintain adequate oral nutrition is an indication of enteral feeding in HNC patients. 8.36 1 16 Patient and family education about oral care helps decrease the adverse effects of dysphagia associated with HNC. 7.27 0 23 Oral intake is encouraged in HNC patients judged by a dysphagia specialist to be low risk for the consequences of aspiration. 8.09 0 25 Identi fi cation of appropriate textures and liquids for safe consumption of oral intake is bene fi cial for HNC patients with dysphagia. 8.18 1 26 Pretreatment feeding tubes are most appropriate for HNC patients with baseline swallowing impairment and/ or malnutrition. 7.18 2 30 NPO status is not universally required for aspirating HNC patients. 7.73 0 40 Swallowing therapy is most effective when initiated by the start of HNC treatment. 7.00 1 41 Essential to counseling for HNC patients and caregivers are aspiration precautions and (self) Heimlich. 7.36 0 42 Comprehensive education for HNC patients and their caregivers includes instructions for which medications may be crushed or administrated via feeding tube. 7.73 1 43 Self-assessment of nutrition and hydration status is an important component of HNC patient and caregiver education. 7.64 1 44 Consistent, daily oral care (including cleaning the tongue, palate, and teeth) reduces bacterial load and the risk of developing aspiration pneumonia due to swallowing impairment in HNC patients. 7.09 1 47 HNC patients' ability to maintain weight and hydration via PO diet are key considerations prior to discontinuation of enteral feeding devices. 8.55 1 48 Devices can be used to augment the intensity of behavioral swallowing therapies in HNC patients. 7.09 0 49 Device-facilitated therapies are more effective when evidence-supported devices are selected based on dysphagia pathophysiology. 7.18 1 52 Lymphedema therapy contributes to improved swallowing in HNC patients with lymphedema. 7.4 1 53 Pharyngoesophageal dilation is bene fi cial in HNC survivors who report dysphagia and have identi fi ed stenosis. 8.27 0 54 Surgical interventions that curtail intractable aspiration improve the pulmonary health of HNC patients with refractory aspiration pneumonia. 7.27 0 55 Functional total laryngectomy for intractable aspiration offers improved quality of life for HNC patients when pulmonary infections persist despite NPO status, in the setting of concurrent tracheostomy dependence and nonfunctional voice. 8.00 0
Abbreviation: HNC, head and neck cancer; NPO, nil per os; PO, per os.
Table 6. Surveillance of Dysphagia in HNC Patients: Statements That Reached Consensus Number Statement
Mean Outliers
17 New-onset dysphagia in disease-free HNC survivors requires a work-up to exclude disease recurrence or new primary tumor. 8.36 1 56 Patients with dysphagia after HNC treatment experience improved nutrition status and health outcomes when followed by a multidisciplinary team. 8.00 0 57 Life-long monitoring for dysphagia signs and symptoms is important for HNC survivors. 8.18 0 58 Obtaining dysphagia-related patient-reported outcomes are an important component of ongoing HNC care. 7.82 1 59 The speci fi c cadence and method of screening for dysphagia in HNC survivors are dictated by individualized factors (tumor site, cancer stage, treatment history, and prior functional de fi cits). 7.00 0 60 Dysphagia surveillance in HNC survivors includes measures of health (for instance, nutritional status, weight, and lung function). 7.55 1
Abbreviation: HNC, head and neck cancer.
Screening for Dysphagia in HNC Patients Assessment of dysphagia risk at the time of HNC diagnosis establishes a functional “ start point ” andmay identify a subset of patients who could most bene fi t
from a dysphagia prehabilitation program. On this basis, there was a strong consensus that SLP consulta tion is optimal prior to HNC treatment (Table 2; Statement 14). Owing to discordance between
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