Support services for people who have undergone treatment for head and neck cancer: an approach  to evaluating services

The purpose of this qualitative research was to (1) determine whether support services for people who have undergone treatment for head and neck cancer in Canterbury, New Zealand, align with current national and international guidelines and recommendations for best practice, (2) investigate the views of consumers and health service providers, about current support services and service needs, (3) develop recommendations for a coordinated support service. Interviews with consumers and with service providers, including multidisciplinary team members, were undertaken to collect information about support services for people with head and neck cancer in Canterbury. The analysis was undertaken in two stages. First, information was compared with current guidelines, and second, transcripts of interviews were analysed thematically, using a general inductive approach, to understand any issues arising for both consumers and providers. Comparison with guidelines identified many strengths and a few limitations of the current service compared with international best-practice. A number of other issues arose from the thematic analysis which suggested potential areas for improvement. Recommendations were made to support a best-practice, evidence-based coordinated support service for people with head and neck cancer in Canterbury. The method used to evaluate this service could be used in the evaluation of other intersectoral, multidisciplinary health services.

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Multidisciplinary clinic care improves adherence to best practice in head and neck cancer

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2012.08.010 ◽

2013 ◽

Vol 34 (1) ◽

pp. 57-60 ◽

Cited By ~ 53

Author(s):

Stephen L. Kelly ◽

James E. Jackson ◽

Brigid E. Hickey ◽

Frank G. Szallasi ◽

Craig A. Bond

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Best Practice ◽

Multidisciplinary Clinic

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Support services of head and neck cancer survivors at 3 months post-treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.244 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 244-244

Author(s):

Jean Marie Quispe ◽

Kellie Martens ◽

Jessica Geller ◽

David Raben ◽

Kristin Kilbourn

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Support Groups ◽

Integrative Medicine ◽

Social Worker ◽

Neck Cancer ◽

Support Services ◽

Likert Scale ◽

Post Treatment ◽

Cancer Information

244 Background: Support services offer a multi-disciplinary approach to improve quality of life (QOL) in head and neck cancer (HNC) survivors. This study assessed support services of HNC survivors treated at a University-based cancer center. Methods: HNC survivors (N=115) who completed three-month post-treatment self-report questionnaires were recruited from three radiation oncology clinics. Questionnaires assessed emotional and physical symptoms, QOL, and use and interest in support services. Symptoms were assessed individually on a 5-point Likert scale. Utilization and interest of support services were assessed with yes/no scales while helpfulness of utilization was assessed on a 5-point Likert scale. Spearman correlation analyses were conducted in SPSS v22. Results: Participants’ were mostly male (77%) and Caucasian (79%), with a mean age of 58.71 years (SD=11.05), and 36% had stage III/IV cancer. The majority of participants (93.7%) agreed they received adequate support, yet, interest in classes/education (7.8%), integrative medicine (7.0%) and support groups (6.1%) were endorsed. Surprisingly, interest in these support services was associated with lower ratings of total symptoms: classes/education (r = -.48), integrative medicine (r = -.41) and support groups (r = -.55). More than half of participants utilized at least one support service (67.83%) with the most frequent including: nutritionist/dietitian (55.7%), social worker/navigator (21.0%) and cancer information line (15.7%). Utilization of some services was associated with lower ratings of individual symptoms: social worker/navigator and problems swallowing (r = -.31), fatigue (r = -.27) and pain (r = -.24); and cancer information line and weight loss (r = -.30). Meanwhile, overall helpfulness of support services (M = 2.37, SD = 1.51) was rated between “somewhat” and “quite a bit” helpful. Conclusions: This study suggests a relationship between utilization and interest in support services and symptom ratings. Notably, those who report more physical and emotional symptoms may be less likely to report interest in support services. This may be due to an inability to access support services because of lack of transportation, poor social living conditions, etc.

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Best practice in reducing the suicide risk in head and neck cancer patients: a structured review

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2020.06.035 ◽

2020 ◽

Vol 58 (9) ◽

pp. e6-e15

Author(s):

J.A. Twigg ◽

J.M. Anderson ◽

G. Humphris ◽

I. Nixon ◽

S.N. Rogers ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Suicide Risk ◽

Best Practice

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Measuring concordance with head and neck cancer survivorship algorithms.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21602 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e21602-e21602

Author(s):

Maria Alma Rodriguez ◽

Guadalupe R. Palos ◽

Katherine Ramsey Gilmore ◽

Patricia Chapman ◽

Paula A. Lewis-Patterson

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Best Practice ◽

Professional Communication ◽

Distress Screening ◽

Management Tools ◽

Clinical Action ◽

Chest X Ray ◽

Data Elements

e21602 Background: We developed institutional algorithms for cancer survivors that are site specific. However, little data exists regarding concordance with these clinical management tools. Our aim was to evaluate concordance rates with our Head and Neck (H/N) survivorship algorithms. Methods: We reviewed electronic health records (EHR) of patients seen in the H/N Survivorship Clinic between 9/01/2011 and 8/31/2014. Eligibility included: diagnosis of primary head and neck cancer, ≥ 18 years of age, no active disease, and alive at time of abstraction. Data were collected at baseline (V1) and visits 9-15 months after prior visits (V2 and V3). Data were obtained from tumor registry, a departmental database and the EHR. Twelve data elements were grouped as: 1) lab/diagnostic tests, 2) physical and psychological late effects, and 3) history and physical exams. Concordance rate (%) for each element was defined as a clinical action or recommendation aligned to the standards outlined in the H/N algorithms. Descriptive statistics were used to summarize clinical, demographic, and concordance rates. Results: Included in this analysis were patients with primary H/N malignancies of oropharynx, oral cavity, larynx, and hypopharynx, and who had completed 3 visits (V1-3). 53 patients were evaluable for concordance analyses. Compliance ranged from 55% to 100%, with lowest rates for: CT scans (55.6%), distress screening (75.5%), T4/TSH level (78.4%) and laryngoscopy (79.2%). Highest rates were noted for full physical exam (100%), chest x-ray (97.5%), dental exam (95.9%), and dysphagia evaluation (95.1%). Assessments for lymphedema and xerostomia were similar (91.8%). Conclusions: High compliance ( > 90%) occurred when elements of the algorithm relied on the clinician’s assessment, whereas lower levels of compliance were seen with elements that required orders (CTs and labs), or reliance on others’ actions (i.e. distress screening by nursing). Concordance can be improved using best practice advisories in the EHR to remind providers of orders, and by fostering strong inter-professional communication on the elements of care.

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The PRO-ACTIVE trial protocol: a randomized study comparing the effectiveness of PROphylACTic swallow InterVEntion for patients receiving radiotherapy for head and neck cancer

BMC Cancer ◽

10.1186/s12885-021-08826-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

R. Martino ◽

M. I. Fitch ◽

C. D. Fuller ◽

A. Hope ◽

G. Krisciunas ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Best Practice ◽

Randomized Study ◽

Optimal Timing ◽

Swallowing Therapy ◽

Low Intensity ◽

Link Type ◽

Patient Reported

Abstract Background Swallowing therapy is commonly provided as a treatment to lessen the risk or severity of dysphagia secondary to radiotherapy (RT) for head and neck cancer (HNC); however, best practice is not yet established. This trial will compare the effectiveness of prophylactic (high and low intensity) versus reactive interventions for swallowing in patients with HNC undergoing RT. Methods This multi-site, international randomized clinical trial (RCT) will include 952 adult patients receiving radiotherapy for HNC and who are at high risk for post-RT dysphagia. Participants will be randomized to receive one of three interventions for swallowing during RT: RE-ACTIVE, started promptly if/when dysphagia is identified; PRO-ACTIVE EAT, low intensity prophylactic intervention started before RT commences; or, PRO-ACTIVE EAT+EXERCISE, high intensity prophylactic intervention also started before RT commences. We hypothesize that the PRO-ACTIVE therapies are more effective than late RE-ACTIVE therapy; and, that the more intensive PRO-ACTIVE (EAT + EXERCISE) is superior to the low intensive PRO-ACTIVE (EAT). The primary endpoint of effectiveness is duration of feeding tube dependency one year post radiation therapy, selected as a pragmatic outcome valued equally by diverse stakeholders (e.g., patients, caregivers and clinicians). Secondary outcomes will include objective measures of swallow physiology and function, pneumonia and weight loss, along with various patient-reported swallowing-related outcomes, such as quality of life, symptom burden, and self-efficacy. Discussion Dysphagia is a common and potentially life-threatening chronic toxicity of radiotherapy, and a priority issue for HNC survivors. Yet, the optimal timing and intensity of swallowing therapy provided by a speech-language pathologist is not known. With no clearly preferred strategy, current practice is fraught with substantial variation. The pragmatic PRO-ACTIVE trial aims to specifically address the decisional dilemma of when swallowing therapy should begin (i.e., before or after a swallowing problem develops). The critical impact of this dilemma is heightened by the growing number of young HNC patients in healthcare systems that need to allocate resources most effectively. The results of the PRO-ACTIVE trial will address the global uncertainty regarding best practice for dysphagia management in HNC patients receiving radiotherapy. Trial registration The protocol is registered with the US Patient Centered Outcomes Research Institute, and the PRO-ACTIVE trial was prospectively registered at ClinicalTrials.gov, under the identifier NCT03455608; First posted: Mar 6, 2018; Last verified: Jun 17, 2021. Protocol Version: 1.3 (January 27, 2020).

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