Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: The case management (CM) team provides comprehensive support for laryngectomy patients through advocacy, access, awareness, and adherence. The use of a Heat and Moisture Exchanger (HME) provides significant health benefits for laryngectomy patients, including improved pulmonary health, better humidification for the lungs, and overall enhancement in quality of life.2 Despite these known benefits, achieving adherence to prescribed daily HME use remains a challenge for many patients.
The "HME Awareness Pilot Program" focused on patients who utilized fewer than their prescribed number of HMEs daily (1.9 HMEs or fewer). Therefore, these patients were not meeting the prescribed goal of two HMEs per day to achieve optimal pulmonary health1
Methods: The program sought to enroll patients in a 30-day pilot using two HMEs per day, while tracking patient-reported outcome measures, including which HME they used both day and night, hours of wear, coughing and forced expectoration, frequency of stoma cleaning, hours of sleep, and nighttime coughing. Patients also received education on the importance of two HMEs per day use as well as general HME use education. Patients completed a baseline questionnaire. Data collection occurred through phone calls, email, and USPS mail. This data was shared with the CM team. The CM team attempted to communicate with patients weekly. After 30 days, patients completed a post-pilot questionnaire.
Results: 29 patients?were enrolled and completed the pilot program. 72% (21) of patients commit to utilizing two HMEs/day, with higher humidity at night. 55% (16) of patients report improved sleep. 31% (9) of patients reported an increase in ease of breathing. 55% (16) of patients reported less mucus. 62% (18) of patients reported less coughing. We were pleased to see that 82% (24) of those that took part in the pilot program experienced positive change in any tracking measure.
Conclusion: The pilot demonstrated positive outcomes of tailored patient education as well as effects patient use of two HMEs per day, particularly in reduced coughing, less mucus production, and improved sleep quality. This pilot study showed promising outcomes for future research related to patient education surrounding the benefit of HME adherence. Additionally, the individualized support provided by the CM team was well-received by patients, reinforcing the value of continued personalized support and education.
References
1 Ward?EC,?Hancock?K,?Boxall?J, et al.?Post-laryngectomy pulmonary and related symptom changes following adoption of an optimal day-and-night heat and moisture exchanger (HME) regimen.?Head & Neck.?2023;?45(4):?939-951. doi:10.1002/hed.27323
2 Longobardi, Y., J. Galli, T. Di Cesare, et al. (2022). "Optimizing Pulmonary Outcomes After Total Laryngectomy: Crossover Study on New Heat and Moisture Exchangers." Otolaryngol Head Neck Surg: 1945998221086200.
3 Munoz, A., M. Small, R. Wood et al. (2018). "The impacts of morning, daytime, and nighttime symptoms on disease burden in real-world patients with COPD." Int J Chron Obstruct Pulmon Dis 13: 1557-1568.
4 Parrilla, C., A. Minni, H. Bogaardt, et al. (2015). "Pulmonary Rehabilitation After Total Laryngectomy: A Multicenter Time-Series Clinical Trial Evaluating the Provox XtraHME in HME-Naive Patients." Ann. Otol. Rhinol Laryngol 124(9): 706-713.