Anticipation of the Impact of Human Papillomavirus on Clinical Decision Making for the Head and Neck Cancer Patient

Objective: Clinical practices of speech-language pathologists (SLP) treating head and neck cancer (HNC) patients range widely despite literature trending toward best practices. This survey study was designed to identify current patterns and assess for gaps in clinical implementation of research evidence. Method: A web-based survey was distributed to SLPs via listserv and social media outlets. Descriptive statistics and group calculations were completed to identify trends and associations in responses. Results: Of 152 received surveys, the majority of respondents were hospital-based (86%) and had greater than 5 years of experience (65%). There was group consensus for the use of prophylactic exercise programs (95%), recommendations for SLP intervention during HNC treatment (75%), and use of maintenance programs post-treatment (97%). Conversely, no group consensus was observed for use of pre-treatment swallow evaluations, frequency of service provision, and content of therapy sessions. Variation in clinical decision making was noted in use of prophylactic feeding tubes and number of patients taking nothing by mouth during treatment. No associations were found between years of experience and decision-making practices, nor were any associations found between practice setting and clinical decision making. Conclusion: Despite the growing body of literature outlining evidence-based treatment practices for HNC patients, clinical practice patterns among SLPs continue to vary widely resulting in inconsistent patient care across practice settings. As compared to prior similar data, increased alignment with best practices was observed relative to early referrals, implementation of prophylactic intervention programs, and intervention with the SLP during the period of HNC treatment.

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Leveraging patient‐reported outcomes data to inform oncology clinical decision making: Introducing the FACE‐Q Head and Neck Cancer Module

Cancer ◽

10.1002/cncr.31900 ◽

2018 ◽

Vol 125 (6) ◽

pp. 863-872 ◽

Cited By ~ 5

Author(s):

Jennifer R. Cracchiolo ◽

Anne F. Klassen ◽

Danny A. Young‐Afat ◽

Claudia R. Albornoz ◽

Stefan J. Cano ◽

...

Keyword(s):

Decision Making ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Patient Reported Outcomes ◽

Clinical Decision Making ◽

Clinical Decision ◽

Cancer Module ◽

Patient Reported ◽

The Face

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Clinical Decision Making with Head and Neck Cancer Patients with Dysphagia

Seminars in Speech and Language ◽

10.1055/s-0039-1688979 ◽

2019 ◽

Vol 40 (03) ◽

pp. 213-226

Author(s):

Heather Starmer ◽

Jeffrey Edwards

Keyword(s):

Decision Making ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Clinical Decision Making ◽

Clinical Decision ◽

Surgical Removal ◽

Epidemiologic Factors ◽

Cancer Management ◽

Nonsurgical Patient

AbstractDysphagia is a common challenge faced by patients with head and neck cancer. Management of these patients is quite distinct from many other dysphagia etiologies due to the nature of surgical removal of organs critical to swallowing, the ability to provide preventative therapies, and the variable risk for complications related to dysphagia. Thus, clinicians providing care to the head and neck cancer population need to understand these differences when employing clinical decision making. In addition, changes in the demographics of head and neck cancer, related predominantly to the epidemic of oropharyngeal cancer associated with the human papillomavirus, have further transformed both the types of patients and the types of treatments offered. These epidemiologic factors further complicate the decision-making process for clinicians. This article provides a framework for decision making in the surgical and nonsurgical patient with head and neck cancer.

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The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers

International Journal of Particle Therapy ◽

10.14338/ijpt-20-00006.1 ◽

2020 ◽

Vol 7 (1) ◽

pp. 41-53

Author(s):

Jaden D. Evans ◽

Riley H. Harper ◽

Molly Petersen ◽

William S. Harmsen ◽

Aman Anand ◽

...

Keyword(s):

Decision Making ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Clinical Decision Making ◽

Cox Model ◽

Clinical Decision ◽

Concurrent Chemotherapy ◽

Cumulative Probability ◽

Kaplan Meier

Abstract Purpose To understand how verification computed tomography-quality assurance (CT-QA) scans influenced clinical decision-making to replan patients with head and neck cancer and identify predictors for replanning to guide intensity-modulated proton therapy (IMPT) clinical practice. Patients and Methods We performed a quality-improvement study by prospectively collecting data on 160 consecutive patients with head and neck cancer treated using spot-scanning IMPT who underwent weekly verification CT-QA scans. Kaplan-Meier estimates were used to determine the cumulative probability of a replan by week. Predictors for replanning were determined with univariate (UVA) and multivariate (MVA) Cox model hazard ratios (HRs). Logistic regression was used to determine odds ratios (ORs). P < .05 was considered statistically significant. Results Of the 160 patients, 79 (49.4%) had verification CT-QA scans, which prompted a replan. The cumulative probability of a replan by week 1 was 13.7% (95% confidence interval [CI], 8.82-18.9), week 2, 25.0% (95% CI, 18.0-31.4), week 3, 33.1% (95% CI, 25.4-40.0), week 4, 45.6% (95% CI, 37.3-52.8), and week 5 and 6, 49.4% (95% CI, 41.0-56.6). Predictors for replanning were sinonasal disease site (UVA: HR, 1.82, P = .04; MVA: HR, 3.64, P = .03), advanced stage disease (UVA: HR, 4.68, P < .01; MVA: HR, 3.10, P < .05), dose > 60 Gy equivalent (GyE; relative biologic effectiveness, 1.1) (UVA: HR, 1.99, P < .01; MVA: HR, 2.20, P < .01), primary disease (UVA: HR, 2.00 versus recurrent, P = .01; MVA: HR, 2.46, P = .01), concurrent chemotherapy (UVA: HR, 2.05, P < .01; MVA: not statistically significant [NS]), definitive intent treatment (UVA: HR, 1.70 versus adjuvant, P < .02; MVA: NS), bilateral neck treatment (UVA: HR, 2.07, P = .03; MVA: NS), and greater number of beams (5 beam UVA: HR, 5.55 versus 1 or 2 beams, P < .02; MVA: NS). Maximal weight change from baseline was associated with higher odds of a replan (≥3 kg: OR, 1.97, P = .04; ≥ 5 kg: OR, 2.13, P = .02). Conclusions Weekly verification CT-QA scans frequently influenced clinical decision-making to replan. Additional studies that evaluate the practice of monitoring IMPT-treated patients with weekly CT-QA scans and whether that improves clinical outcomes are warranted.

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