Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP...
-
Upload
mercy-jackson -
Category
Documents
-
view
219 -
download
2
Transcript of Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP...
![Page 1: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/1.jpg)
Head and Neck Cancer Survivors:Dysphagia and Quality of Life
Jocelen Gudgeon, M.A. CCC-SLPSpeech-Language Pathologist
Department of Otolaryngology-Head & Neck Surgery
University of Iowa Hospitals and Clinics
![Page 2: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/2.jpg)
Dysphagia and Quality of Life
Goals1. Discuss importance of swallowing exercises
for individuals going through radiation
2. Discuss the role of telemedicine dysphagia therapy
![Page 3: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/3.jpg)
Head and Neck Cancer (HNC)
• Prevalence– 5th most common cancer worldwide– 3% of all malignancies in US
• Incidence– 53,000 new cases in US each year– 11,500 deaths in US per year
Stenson, 2013
![Page 4: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/4.jpg)
Dysphagia: Any disruption in transport of food/liquid from the oral cavity
to the stomach
• Choking• Coughing• Gagging• Throat Clearing• Unintentional weight loss• Need for multiple swallows
• Wet or gurgly vocal quality• Sensation of food sticking in
throat• Food or liquids coming out of
tracheostomy• History of respiratory
infections or pneumonia
Signs and Symptoms
![Page 5: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/5.jpg)
Causes:
Tumor Treatment
Surgery Radiation (+/- Chemo)
Dysphagia in HNC Survivors
+/-
+/-
![Page 6: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/6.jpg)
• Incidence of post-treatment dysphagia ranges from 50% to 60%
• Review of 416 HNC cases treated at UIHC revealed that 45.9% had dysphagia
Shune et al., 2012; Langendijk et al., 2009; Jensen et al., 2007; Eisbruch et al., 2007; Platteaux et al., 2010
![Page 7: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/7.jpg)
Our experience has shown that all individuals undergoing radiation for HNC experience at least some
degree of dysphagia.
![Page 8: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/8.jpg)
Common Side Effects of Radiation
Mucositis
Taste changes
Thick secretions
Pain with swallowing
![Page 9: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/9.jpg)
Efforts to Increase Swallowing-Related Quality of Life
Provide Dysphagia InterventionDuring Radiation
andAfter Radiation
![Page 10: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/10.jpg)
Intervention During Radiation (XRT)
• Complete swallowing assessment
• Implement prophylactic swallowing exercise program
• Provide recommendations to minimize impact of side effects on oral intake
Carbaby-Mann et al., 2012; Carroll, et al., 2008; Kulbersh et al. 2006
![Page 11: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/11.jpg)
Bottom Line:
MOVE IT OR LOSE IT!Do exercises as much as can be
tolerated
KEEP SWALLOWING SOMETHING!
Water sips at a minimumGillespie et al., 2004
![Page 12: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/12.jpg)
Intervention After XRT
• Re-assess swallowing function– Provide oral intake recommendations
• Recommend intensive swallowing therapy
![Page 13: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/13.jpg)
Challenges to Obtaining Post-XRT Swallowing Therapy
• Difficult to return to hospital on regular basis to receive therapy
• Access to Speech-Language Pathologist – May not be available locally– May not have expertise in working with HNC
population
![Page 14: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/14.jpg)
Telemedicine Approach to Dysphagia Therapy
Studied the feasibility of providing off-site therapy using video-chat software
Four subjects were enrolled• Completed at least one face-to-face session• Received two telemedicine sessions per week
for eight weeksKarnell et al., Submitted 2013
![Page 15: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/15.jpg)
![Page 16: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/16.jpg)
Patient and clinician ratings collected via questionnaires regarding:
1. Technical quality
2. Satisfaction with use of telemedicine approach
3. Equivalency of telemedicine approach to traditional on-site therapy
![Page 17: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/17.jpg)
Results:
• Each participant said the telemedicine approach was satisfactory
• Each participant rated the telemedicine approach to be equivalent to or better than traditional face-to-face therapy
• Challenging area: Technical feasibility–Reliability of Internet connection
![Page 18: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/18.jpg)
Additional Study Findings
Resource conservation
• Travel expenses and time savings
![Page 19: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/19.jpg)
Patients saved an average 2,934 miles of travel
Des Moines
WaterlooDubuque
Burlington
UIHC
![Page 20: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/20.jpg)
Therapy expenses
• None had insurance to pay for therapy at a local facility
• All had IowaCare– Therapy only obtainable at UIHC or Broadlawns in
Des Moines
Resource Conservation
![Page 21: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/21.jpg)
Therapy Outcomes?
Study targeted feasibility not efficacy
Telemedicine approach facilitated more frequent therapy sessions
General consensus: – Two sessions/week increased compliance
with swallowing exercises
“Squeaky wheel gets the grease”
![Page 22: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/22.jpg)
Communication
Allowed communication despite loss of voice• Patient with trach used the text box to type her
responsesTelemedParticipant 2: The tongue curls are the easiest it seems. The tongue hold hurts little on right side and tongue pull hurts both sides. But closer to meds the less it hurts
![Page 23: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/23.jpg)
CommunicationFacilitated communication with other healthcare team members
• Encouraged to call RN/physician with concerns
• Facilitated contact with dietitian
![Page 24: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/24.jpg)
Provide Support and Encouragement
TelemedParticipant 2: I tend to push it if it doesn't hurt at first then it hurts. Just a couple and stop would be betterTelemedParticipant 2: The I get to scared to do themTelemedParticipant 2: I am not scared of the swab anymoreTelemedParticipant 2: Dr encouraged me to try the self breathing more. and Dr Wehbe encouraged the swallowing
![Page 25: Head and Neck Cancer Survivors: Dysphagia and Quality of Life Jocelen Gudgeon, M.A. CCC-SLP Speech-Language Pathologist Department of Otolaryngology-Head.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649d8e5503460f94a7709f/html5/thumbnails/25.jpg)