Background
Evidence suggests that in the head and neck (H&N) cancer population, early dietetic and speech pathology consultation improves patient outcomes1-3. However, recent data4 indicates that prior to commencing treatment, 28% or fewer of patients are assessed by a dietitian or speech pathologist at Peter MacCallum Cancer Centre.
Aims
To test the feasibility and clinical efficacy of a pre-treatment speech pathology and dietitian specialist clinic for H&N cancer patients. The clinic aims to:
1. Improve patient experience and clinical outcomes.
2. Streamline speech pathology/dietetic H&N services across WCMICS sites.
Method:
This pilot study used a pre-test, post-test quasi experimental design. The study included patients with T2-T4 H&N cancer who were planned to receive radical treatment. Overall 26 participants were recruited. Fourteen patients received usual care (no pre-treatment clinic) and 12 participated in the pre-treatment clinic. Outcome measures were collected at three time points. These included: patient experience, patient clinical outcomes, organisational outcomes and service delivery.
Results:
Patients who participated in the pre-treatment clinic reported being satisfied with the service and had a greater understanding of the possible swallowing, speech/voice and nutritional problems that could develop during (chemo)radiotherapy. The pre-treatment clinic did not impact clinical outcomes for dysphagia or airway management; however, nutritional outcomes (% weight loss and malnutrition prevalence) improved in the intervention group. No difference between groups was seen for unplanned hospital admissions and LOS.
Conclusion:
Overall the pre-treatment was shown to have a positive impact on the patient’s experience and preparedness for treatment. Clinical improvements were seen only for nutritional outcomes. The clinic will likely have the greatest impact on patients receiving definitive (chemo)radiotherapy, where there has been no prior Speech Pathology or Dietitian input provided before commencement of treatment.