Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Purpose: Head and neck cancer (HNC) patients commonly experience dysphagia across the disease trajectory due to tumor involvement of swallow musculature and treatment sequelae. This pilot program aims to address disparities in access to nutritional supplies and educational resources for low-income individuals with HNC and dysphagia.
Methods: Patients with HNC were followed by a speech-language pathologist (SLP) before, during, or after cancer treatment from June 2023 to March 2024. Those who expressed concern about affording dysphagia supplies, such as nutritional shakes or thickeners, were referred to a collaborating food bank sponsored by an institutional grant. Referrals were valid for three months, with the SLP determining weekly supply amount based on clinical needs. The food bank staff was trained to use a screening tool that identified individuals at risk for swallowing dysfunction, allowing access to the program for the community at-large. This group also received educational handouts on SLP services and general dysphagia management strategies. Patient demographics, clinical information (food security, medical diagnoses, feeding tube status), and dysphagia symptoms were collected through referral records and dysphagia screening forms.
Results: A total of 13 patients were referred to the food bank, with 8 from the cancer center and 5 from the community. Community patients were older on average (84.6 years) compared to cancer center patients (63.6 years). Among cancer center referrals, 87.5% had a diagnosis of HNC, while the community group showed 60% neurological and 20% respiratory etiology of dysphagia. Feeding tubes were present in 25% of cancer center patients, while none in the community group. Notably, 80% of cancer center patients identified as black, indigenous and people of color (BIPOC), with 62.5% reporting low food security, defined as limited and/or low-quality options for food to eat. All community patients followed through on picking up supplies, compared to 62.5% of cancer center patients; those who did not ultimately obtain supplies also reported the lowest food security defined as missing or skipping meals because of other expenses or needing to ration food. Dysphagia symptoms in the community included >5% unexplained weight loss (100%), prolonged mealtimes (80%), frequent choking (60%), and recurrent pneumonia (40%). Cancer center patients required approximately 152 shakes each, while community patients averaged 29 shakes.
Conclusions: The findings underscore the substantial nutritional needs of HNC patients with dysphagia and the barriers they face in accessing necessary supplies. The program demonstrated the effectiveness of collaboration with local food banks to address this issue, although budget constraints limited the quantity of nutritional supplies and patient referrals. Additionally, logistical challenges in supply distribution affected compliance, particularly among cancer center patients. Findings will inform future initiatives and sustainable partnerships for supporting vulnerable populations struggling with dysphagia and food insecurity .