Adherence to Swallow Exercises during (Chemo)Radiotherapy for Head and Neck Cancer

Abstract

<h3>Purpose/Objective(s)</h3> Patients undergoing curative (chemo)radiotherapy ((C)RT) for head and neck cancer (HNC) who experience or are at risk of developing dysphagia are often provided with pre-treatment swallow exercises (SE), in line with consensus opinion for best practice. Evidence of SE efficacy is limited, with adherence cited as a confounding factor. We evaluated SE adherence in our patient group with the aim of proposing opportunities for improvement. <h3>Materials/Methods</h3> A 16 item questionnaire was developed with input from patients, speech and language therapists (SLTs) and oncologists, including quantitative and qualitative questions covering demographics, patient reported swallow function, understanding of and confidence with SE, frequency of completion, and resources that could improve adherence. The questionnaire was offered in paper or electronic format (Civica Software) to patients who completed (C)RT over a 3-month period. All patients had received swallow exercises as per our standard protocol with advice to complete them 7-10 times per day, supported by a written leaflet and regular SLT review during treatment. <h3>Results</h3> Of 39 patients who completed (C)RT, 90% (n=35) completed the questionnaire; 51% (n=18) treated with primary (C)RT and 46% (n=16) post-operative (C)RT. Swallowing difficulties were reported by 31% (n=11) pre-(C) RT, rising to 71% (n=25) at end of treatment. Almost all (94%, n=33) stated they understood the rationale for SE. Frequency of completion was variable (Table 1). Treatment toxicities were reported as barriers to adherence by 51% (n=18). Over a third of patients (37%, n=13) felt only somewhat, slightly or not at all confident they were completing SE correctly. Regarding resources that would improve adherence, a leaflet with written instructions and pictures or diagrams was selected most frequently (46%, n=16), a website/app with videos was also popular (29%, n=10). 80% (n=28) planned to continue SE after treatment. 83% (n=29) rated their overall experience of SE and advice as either good or very good. <h3>Conclusion</h3> A questionnaire offers a simple way to obtain a snapshot view of current experience, and our high response rate suggests results are reliable. Our findings suggest that our current recommendation of SE completion 7-10 times per day is not achievable for most patients; a change in recommendation to 3-5 times per day is supported by recent evidence and encourages self-efficacy. At least a third of patients lacked confidence in completing SE, and we are focusing on this by developing new pictorial, online and video resources. Our survey indicated high overall satisfaction with our current service despite variable adherence. Future work will evaluate the impact of service improvements on patient outcomes.