Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients

Maggie A Kuhn¹, M Boyd Gillespie², Stacey L Ishman³, Lisa E Ishii⁴, Rebecca Brody⁵, Ezra Cohen⁶, Shumon I Dhar⁷, Kate Hutcheson⁸, Gina Jefferson⁹, Felicia Johnson¹⁰, Anais Rameau¹¹, David Sher⁷, Heather Starmer¹², Madeleine Strohl¹³, Karen Ulmer¹⁴, Vilija Vaitaitis¹⁵, Sultana Begum¹⁶, Misheelt Batjargal¹⁶, Nui Dhepyasuwan¹⁶

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA.
² Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
³ Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁴ Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University Medical Institute, Cockeysville, Maryland, USA.
⁵ Department of Clinical and Preventive Nutrition Sciences, Rutgers University, West Linn, Oregon, USA.
⁶ Moores Cancer Center at UC San Diego Health, La Jolla, California, USA.
⁷ UT Southwestern Medical Center, Dallas, Texas, USA.
⁸ Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Center, Houston, Texas, USA.
⁹ Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Surgical Oncology/Microvascular Reconstruction, University of Mississippi Medical Center, Jackson, Mississippi, USA.
¹⁰ ENT Ozarks, Springdale, Arkansas, USA.
¹¹ Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York City, New York, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA.
¹³ Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA.
¹⁴ Milton J Dance, Jr Head and Neck Cancer at GBMC, Baltimore, Maryland, USA.
¹⁵ Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Charleston, South Carolina, USA.
¹⁶ American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA.

PMID: 36965195
DOI: 10.1002/ohn.302

Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients

Maggie A Kuhn et al. Otolaryngol Head Neck Surg. 2023 Apr.

. 2023 Apr;168(4):571-592.

doi: 10.1002/ohn.302.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA.
² Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
³ Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁴ Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University Medical Institute, Cockeysville, Maryland, USA.
⁵ Department of Clinical and Preventive Nutrition Sciences, Rutgers University, West Linn, Oregon, USA.
⁶ Moores Cancer Center at UC San Diego Health, La Jolla, California, USA.
⁷ UT Southwestern Medical Center, Dallas, Texas, USA.
⁸ Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Center, Houston, Texas, USA.
⁹ Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Surgical Oncology/Microvascular Reconstruction, University of Mississippi Medical Center, Jackson, Mississippi, USA.
¹⁰ ENT Ozarks, Springdale, Arkansas, USA.
¹¹ Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York City, New York, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA.
¹³ Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA.
¹⁴ Milton J Dance, Jr Head and Neck Cancer at GBMC, Baltimore, Maryland, USA.
¹⁵ Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Charleston, South Carolina, USA.
¹⁶ American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA.

PMID: 36965195
DOI: 10.1002/ohn.302

Abstract

Objective: To develop an expert consensus statement (ECS) on the management of dysphagia in head and neck cancer (HNC) patients to address controversies and offer opportunities for quality improvement. Dysphagia in HNC was defined as swallowing impairment in patients with cancers of the nasal cavity, paranasal sinuses, nasopharynx, oral cavity, oropharynx, larynx, or hypopharynx.

Methods: Development group members with expertise in dysphagia followed established guidelines for developing ECS. A professional search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements targeted at providers managing dysphagia in adult HNC populations. The development group prioritized topics where there was significant practice variation and topics that would improve the quality of HNC patient care if consensus were possible.

Results: The development group identified 60 candidate consensus statements, based on 75 initial proposed topics and questions, that focused on addressing the following high yield topics: (1) risk factors, (2) screening, (3) evaluation, (4) prevention, (5) interventions, and (6) surveillance. After 2 iterations of the Delphi survey and the removal of duplicative statements, 48 statements met the standardized definition for consensus; 12 statements were designated as no consensus.

Conclusion: Expert consensus was achieved for 48 statements pertaining to risk factors, screening, evaluation, prevention, intervention, and surveillance for dysphagia in HNC patients. Clinicians can use these statements to improve quality of care, inform policy and protocols, and appreciate areas where there is no consensus. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to dysphagia in HNC patients.

Keywords: dysphagia; head and neck cancer; laryngeal cancer; nasopharyngeal cancer; oral cavity cancer; oropharyngeal cancer; radiation; swallowing.

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References

1. Raber-durlacher JE, Brennan MT, Verdonck-de Leeuw IM, et al. Swallowing dysfunction in cancer patients. Supp Care Cancer. 2012;20(3):433-443.
1. Hutcheson KA, Nurgalieva Z, Zhao H, et al. Two-year prevalence of dysphagia and related outcomes in head and neck cancer survivors: an updated SEER-Medicare analysis. Head Neck. 2019;41(2):479-487.
1. Govender R, Smith CH, Taylor SA, Barratt H, Gardner B. Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises. BMC Cancer. 2017;17(1):43.
1. Miller KD, Nogueira L, Mariotto AB, et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin. 2019;69(5):363-385.
1. McDermott JD, Bowles DW. Epidemiology of head and neck squamous cell carcinomas: impact on staging and prevention strategies. Curr Treat Options Oncol. 2019;20(5):43.

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Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients

Affiliations

Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous