A pre-treatment speech pathology/dietitian specialist clinic for head and neck cancer patients receiving (chemo)radiotherapy

Ms Jane Harrowfield1, Ms Megan Watson1, Dr Jacqui Frowen1

1Peter Maccallum Cancer Centre, Melbourne, Australia

Aim:

To test the feasibility and clinical efficacy of a pre-treatment speech pathology and dietitian specialist clinic for head and neck cancer patients. The clinic aims to: 1) Improve patient experience and clinical outcomes and 2) Streamline speech pathology/dietetic services between hospitals sharing patient management.

Method:

This pilot study used a pre-test, post-test quasi -experimental design. The study included 26 patients with head and neck cancer who were planned to receive radiotherapy (with or without chemotherapy). Fourteen patients received usual care and 12 participated in the pre-treatment clinic along with usual care. Outcome measures were collected pre treatment, at the beginning and at the end of treatment. Outcomes included: patient experience, patient clinical outcomes, organisational outcomes and service delivery.

Results:

Patients who participated in the pre-treatment clinic had a greater understanding of the possible swallowing, speech/voice and nutritional problems that could develop during (chemo)radiotherapy.  This result was statistically significant. The pre-treatment clinic did not impact clinical outcomes for dysphagia or airway management; however, nutritional outcomes showed a trend towards less weight loss and a lower malnutrition prevalence for those patients who participated in the clinic.  No difference between groups was seen for unplanned hospital admissions and length of stay. Episodes of care were not increased for dietetics but were higher for speech pathology. This means for dietetics, additional resources are not required and the clinic is cost-neutral.

Significance of the findings to allied health:

This clinic demonstrated the advantages of providing a pre-treatment multidisciplinary clinic in the setting of head and neck cancer, particularly for dietetic management. This pilot study could provide a template for allied health teams who want to work collaboratively, allowing for improved clinical outcomes while minimising the need for additional resources.