Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Purpose/Objectives: In July 2020, we initiated a pilot program establishing a multidisciplinary clinic (MDC) combining otolaryngology and radiation oncology appointments for patients diagnosed with head and neck cancer. We have previously reported initial findings from our first two years of MDC demonstrating substantially improved treatment package times (TPTs) for our MDC patients receiving adjuvant therapy compared to patients receiving care through the conventional clinic and satellite locations at our institution. Due to the improvements in care coordination we observed with TPTs, we hypothesized that we would similarly observe improvements with swallow therapy and function after head and neck radiotherapy. Here, we present additional follow-up data examining compliance with speech language pathology (SLP) therapy and post-treatment swallow outcomes for patients treated in our MDC compared to our conventional and satellite clinic locations.
Materials/Methods: We conducted a retrospective review of patients with head and neck cancer who received treatment at our institution between 7/31/2020 - 7/31/2022. Patients were included if they received either definitive or adjuvant radiotherapy and had post-treatment follow-up available including documentation of post-treatment swallow function. Patient demographics, tumor characteristics and treatment details along with various measurements of swallow function were collected and stratified by clinic type (MDC, conventional and satellite locations).
Results: A total of 232 patients were included in the analysis. Oral cavity and oropharynx tumors were the most commonly treated primary site for patients in all clinics. There was no statistical difference in the rate of bilateral neck irradiation (69% vs 58% vs 63%, p=0.3) or delivery of concurrent chemotherapy (60% vs 52% vs 48%, p=0.5) for the MDC, conventional and satellite clinic patients, respectively.
MDC patients were more likely to have had baseline video swallow studies than their conventional clinic and satellite clinic counterparts (85% vs 63% vs 26%, p<0.01). They were also more likely to attend SLP clinic visits during radiotherapy (90% vs 74% vs 61%, p<0.01) and within 3 months post-treatment (98% vs 75% vs 59%, p<0.01). While patients in MDC had higher rates of feeding tube (FT) placement (52% vs 34% vs 41%, p=0.02), there was no difference in PEG dependence at 3 months. MDC patients were statistically more likely to be tolerating a regular diet at 6 months post-treatment than their conventional or satellite clinic counterparts (83% vs 71% vs 70%, p<0.01).
Conclusion: Our study reinforces the benefits of comprehensive care in MDC, demonstrating functional outcome improvements in addition to previously demonstrated improvements in treatment times. Patients treated in MDC had significantly improved access to baseline swallow studies and SLP support during as well as following completion of radiation therapy compared to patients in conventional or satellite clinics. Despite higher rates of feeding tube placement, the patients in MDC had statistically increased likelihood of regular diet at 6 months posttreatment. These findings further underscore the importance of multidisciplinary care in optimizing head and neck cancer care especially focused on quality of life outcomes.