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

Invited Article

Otolaryngology – Head and Neck Surgery 2023, Vol. 168(4) 571 – 592

Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients

© 2023 American Academy of Otolaryngology – Head and Neck Surgery Foundation.

DOI: 10.1002/ohn.302 http://otojournal.org

Maggie A. Kuhn, MD, MAS 1 , M. Boyd Gillespie, MD, MSc 2 , Stacey L. Ishman, MD, MPH 3 , Lisa E. Ishii, MD, MHS 4 , Rebecca Brody, PhD, RD, CNSC 5 , Ezra Cohen, MD, FRCPSC, FASCO 6 , Shumon I. Dhar, MD 7 , Kate Hutcheson, PhD 8 , Gina Jefferson, MD 9 , Felicia Johnson, MD 10 , Anais Rameau, MD, MPhil 11 , David Sher, MD, MPH 7 , Heather Starmer, MA, CCC-SLP, BCS-S 12 , Madeleine Strohl, MD 13 , Karen Ulmer, MS, RN, CORLN 14 , Vilija Vaitaitis, MD 15 , Sultana Begum, MPH 16 , Misheelt Batjargal, MD, MHA 16 , and Nui Dhepyasuwan, MEd 16

warranted to address additional controversies related to dysphagia in HNC patients.

Abstract Objective. To develop an expert consensus statement (ECS) on the management of dysphagia in head and neck cancer (HNC) patients to address controversies and offer oppor tunities for quality improvement. Dysphagia in HNC was de fi ned as swallowing impairment in patients with cancers of the nasal cavity, paranasal sinuses, nasopharynx, oral cavity, oropharynx, larynx, or hypopharynx. Methods. Development group members with expertise in dysphagia followed established guidelines for developing ECS. A professional search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements targeted at providers mana ging dysphagia in adult HNC populations. The development group prioritized topics where there was signi fi cant practice variation and topics that would improve the quality of HNC patient care if consensus were possible. Results. The development group identi fi ed 60 candidate consensus statements, based on 75 initial proposed topics and questions, that focused on addressing the following high yield topics: (1) risk factors, (2) screening, (3) evaluation, (4) prevention, (5) interventions, and (6) surveillance. After 2 iterations of the Delphi survey and the removal of duplicative statements, 48 statements met the standardized de fi nition for consensus; 12 statements were designated as no consensus. Conclusion. Expert consensus was achieved for 48 state ments pertaining to risk factors, screening, evaluation, prevention, intervention, and surveillance for dysphagia in HNC patients. Clinicians can use these statements to improve quality of care, inform policy and protocols, and appreciate areas where there is no consensus. Future research, ideally randomized controlled trials, is

1 Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA 2 Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA 3 Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA 4 Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University Medical Institute, Cockeysville, Maryland, USA 5 Department of Clinical and Preventive Nutrition Sciences, Rutgers University, West Linn, Oregon, USA 6 Moores Cancer Center at UC San Diego Health, La Jolla, California, USA 7 UT Southwestern Medical Center, Dallas, Texas, USA 8 Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Center, Houston, Texas, USA 9 Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Surgical Oncology/Microvascular Reconstruction, University of Mississippi Medical Center, Jackson, Mississippi, USA 10 ENT Ozarks, Springdale, Arkansas, USA 11 Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York City, New York, USA 12 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA 13 Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA 14 Milton J Dance, Jr Head and Neck Cancer at GBMC, Baltimore, Maryland, USA 15 Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Charleston, South Carolina, USA 16 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA Corresponding Author: Maggie A. Kuhn, MD, MAS, Department of Otolaryngology – Head and Neck Surgery, University of California Davis, 2521 Stockton Boulevard Suite 7200, Sacramento, CA 95817-2207, USA. Email: makuhn@ucdavis.edu