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Survey of Usual Practice: Dysphagia Therapy in Head and Neck Cancer Patients

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Abstract

There is no standardized dysphagia therapy for head and neck cancer patients and scant evidence to support any particular protocol, leaving institutions and individual speech-language pathologists (SLPs) to determine their own protocols based on “typical” practices or anecdotal evidence. To gain an understanding of current usual practices, a national internet-based survey was developed and disseminated to SLPs who treat head and neck cancer (HNC) patients. From a random sample of 4,000 ASHA SID13 members, 1,931 fit the inclusion criteria, and 759 complete responses were recorded for a 39.3 % response rate. Results were analyzed by institution type as well as by individual clinical experience. While some interesting trends emerged from the data, a lack of uniformity and consensus regarding best practices was apparent. This is undoubtedly due to a paucity of research adequately addressing the efficacy of any one therapy for dysphagia in the HNC population.

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Acknowledgments

This work was supported in part by a grant from the NIH/NCI (No. RO1CA120950-04).

Conflict of interest

The authors have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Boston University Medical Center, 820 Harrison Ave, FGH Bldg, 4th floor, Boston, MA, 02118, USA

    Gintas P. Krisciunas, William Sokoloff & Susan E. Langmore

  2. CAS Mathematics and Statistics, Boston University, 111 Cummington St, Boston, MA, 02215, USA

    Katherine Stepas

  3. Boston University Sargent College of Health and Rehabilitation Sciences, 635 Commonwealth Ave, Boston, MA, 02215, USA

    Susan E. Langmore

Authors
  1. Gintas P. Krisciunas
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  2. William Sokoloff
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  3. Katherine Stepas
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  4. Susan E. Langmore
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Corresponding author

Correspondence to Gintas P. Krisciunas.

Additional information

This work was done entirely at Boston University Medical Center.

Appendix

Appendix

Survey Questions

  1. 1.

    What kind of clinical setting do you primarily work in?

    1. a.

      Academic teaching hospital

    2. b.

      Stand-alone Specialized Cancer Center

    3. c.

      Urban or Suburban Non-teaching Hospital

    4. d.

      Rural Hospital

    5. e.

      Skilled Nursing Facility or Rehab Center

    6. f.

      Private Practice

    7. g.

      Home Care

  2. 2.

    For HNC patients receiving RT, what is your institution’s policy regarding referrals to SLP?

    1. a.

      Patients are automatically referred to speech pathology before or during RT, even if they do not have a current dysphagia.

    2. b.

      Patients are referred only after they have developed a possible dysphagia.

    3. c.

      There is no institutional policy or referrals are to be made on a case-by-case basis.

  3. 3.

    How do actual referral patterns compare to the institutional policy in Question #2?

    1. a.

      Referral patterns adhere very well to policy

    2. b.

      Referral patterns sometimes adhere to policy

    3. c.

      Referral patterns poorly adhere to policy

    4. d.

      There is no institutional policy or referrals are to be made on a case-by-case basis.

  4. 4.

    At what time do you generally begin to intervene with exercise, stretching, massage, or any other interventions? Please select the best answer.

    1. a.

      Before RT – with all patients

    2. b.

      Before RT – only with patients who are motivated or complaining of difficulty swallowing

    3. c.

      During RT – with all patients

    4. d.

      During RT – only with patients who are motivated or complaining of difficulty swallowing

    5. e.

      In the first 3 months after RT – with all patients

    6. f.

      In the first 3 months after RT – only if the patient has dysphagia

    7. g.

      After 3 months post RT – with all patients

    8. h.

      After 3 months post RT – only if the patient has dysphagia

  5. 5.

    What is your typical treatment protocol for patients you see during RT ? Check all that apply.

    1. a.

      I don’t typically have any treatment protocol for patients during RT

    2. b.

      Compensatory techniques (e.g. Position changes, bolus consistency changes, liquid wash)

    3. c.

      Stretches (e.g. Neck, jaw, tongue)

    4. d.

      Non-swallow Exercise (e.g. Tongue base exercises, laryngeal or pharyngeal exercises, shaker)

    5. e.

      Swallow Maneuver Exercises (e.g. Mendelsohn, Effortful Swallow, Super Supraglottic)

    6. f.

      Other Therapies - can be done by other professionals (e.g. E-stim, massage or other soft tissue manipulation, acupuncture, lymphedema therapy)

  6. 6.

    For those patients in Question #5 who are given a home program during RT, approximately how many days per week do you recommend they perform their stretches or non-swallow/swallowing exercises (not including compensatory techniques)?

    1. a.

      Not recommend at this time.

    2. b.

      2-3 days / week

    3. c.

      4-6 days / week

    4. d.

      7 days / week

  7. 7.

    Approx. how many minutes / day do you recommend these patients perform this home program?

    1. a.

      Not recommend at this time.

    2. b.

      Less than 10 min. per day

    3. c.

      10-20 min. per day

    4. d.

      30 + min. per day

  8. 8.

    For patients with no dysphagia (or clinically insignificant dysphagia) , what is your typical treatment protocol after completion of RT and when acute pain is over? Check all that apply.

    1. a.

      I don’t typically have any treatment protocol for these patients after RT.

    2. b.

      Compensatory techniques (e.g. Position changes, bolus consistency changes, liquid wash)

    3. c.

      Stretches (e.g. Neck, jaw, tongue)

    4. d.

      Non-swallow Exercise (e.g. Tongue base exercises, laryngeal or pharyngeal exercises, shaker)

    5. e.

      Swallow Maneuver Exercises (e.g. Mendelsohn, Effortful Swallow, Super Supraglottic)

    6. f.

      Other Therapies - can be done by other professionals (e.g. E-stim, massage or other soft tissue manipulation, acupuncture, lymphedema therapy)

  9. 9.

    For those patients in Question #8 who are given a home program, approximately how many days per week do you recommend they perform their stretches or non-swallow/swallowing exercises (not including compensatory techniques)?

    1. a.

      Not recommended at this time.

    2. b.

      2-3 days / week

    3. c.

      4-6 days / week

    4. d.

      7 days / week

  10. 10.

    Approx. how many minutes / day do you recommend these patients perform this home program?

    1. a.

      Not recommended at this time.

    2. b.

      Less than 10 min. per day

    3. c.

      10-20 min. per day

    4. d.

      30 + min. per day

  11. 11.

    For patients with dysphagia, what is your typical treatment protocol after completion of RT and when acute pain is over? Check all that apply.

    1. a.

      Compensatory techniques (e.g. Position changes, bolus consistency changes, liquid wash)

    2. b.

      Stretches (e.g. Neck, jaw, tongue)

    3. c.

      Non-swallow Exercise (e.g. Tongue base exercises, laryngeal or pharyngeal exercises, shaker)

    4. d.

      Swallow Maneuver Exercises (e.g. Mendelsohn, Effortful Swallow, Super Supraglottic)

    5. e.

      Other Therapies - can be done by other professionals (e.g. E-stim, massage or other soft tissue manipulation, acupuncture, lymphedema therapy)

  12. 12.

    For those patients in Question #11 who are given a home program, approximately how many days per week do you recommend they perform their stretches or non-swallow/swallowing exercises (not including compensatory techniques)?

    1. a.

      I only recommend compensatory maneuvers

    2. b.

      2-3 days / week

    3. c.

      4-6 days / week

    4. d.

      7 days / week

  13. 13.

    Approx. how many minutes / day do you recommend these patients perform this home program?

    1. a.

      I only recommend compensatory maneuvers

    2. b.

      Less than 10 min. per day

    3. c.

      10-20 min. per day

    4. d.

      30 + min. per day

  14. 14.

    Averaging all your HNC patients with moderate to severe dysphagia, what percentage do you think fully comply with your recommendations? Please select the best answer.

    1. a.

      25% or less

    2. b.

      33%

    3. c.

      50%

    4. d.

      67%

    5. e.

      75% or more

  15. 15.

    Averaging all your HNC patients with mild to no dysphagia, what percentage do you think fully comply with your recommendations? Please select the best answer.

    1. a.

      25% or less

    2. b.

      33 %

    3. c.

      50%

    4. d.

      67%

    5. e.

      75% or more

    6. f.

      I don’t typically have any treatment protocol for these patients

  16. 16.

    At your institution, what is the policy for feeding tube placement in HNC patients who receive RT?

    1. a.

      All patients are recommended to receive feeding tubes prophylactically (before or during the first week of RT).

    2. b.

      Some patients are recommended to receive feeding tubes prophylactically according to specific institutional guidelines. Please specify these guidelines: ______________________

    3. c.

      All patients are recommended to receive feeding tubes only when needed.

  17. 17.

    For patients using a feeding tube during RT, do you generally recommend that they:

    1. a.

      Use the feeding tube as much as possible

    2. b.

      Use the feeding tube conservatively

    3. c.

      Not use the feeding tube unless absolutely necessary

  18. 18.

    What percentage of all your patients are HNC patients? Please select the best answer.

    1. a.

      25% or less

    2. b.

      33%

    3. c.

      50%

    4. d.

      67%

    5. e.

      75% or more

  19. 19.

    How many years have you worked with swallowing disorders in head and neck cancer patients?

    1. a.

      Less than 1 year

    2. b.

      1 to 4 years

    3. c.

      5 to 10 years

    4. d.

      More than 10 years

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Krisciunas, G.P., Sokoloff, W., Stepas, K. et al. Survey of Usual Practice: Dysphagia Therapy in Head and Neck Cancer Patients. Dysphagia 27, 538–549 (2012). https://doi.org/10.1007/s00455-012-9404-2

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