Safety and acceptability of a modified swallowing impairment screening assessment via nasendoscopy following head and neck cancer treatment: a feasibility study

Abstract

ABSTRACT Swallowing impairment is a prevalent sequalae of head and neck cancer and its treatment and if left unmanaged can have negative impacts on health and quality of life and place an increased burden on the health care system. Treatment side effects of head and neck cancer, such as radiotherapy acute toxicities, can affect clinicians’ ability to accurately assess swallowing safety. Therefore, swallowing impairment following head and neck cancer warrants routine objective screening to determine physiological changes and prompt referrals for management. Flexible Endoscopic Evaluation of Swallow (FEES) accurately detects swallowing impairment, however lengthy procedures may be burdensome, especially for those suffering from treatment toxicities. This study aimed to evaluate the feasibility of a modified FEES screening protocol for people with head and neck cancer. Participants were recruited as part of a larger study examining head and neck lymphoedema and underwent a modified FEES protocol. Direct comparisons to a historical cohort who underwent a full FEES protocol as per the study facility’s usual practice, were completed. Feasibility was measured through safety, acceptability and time efficiency indicators and results were analysed descriptively. In total, nine procedures using the modified FEES protocol were conducted between August 2019 and February 2020 and these were compared to nine matched procedures using a full FEES protocol. Comparisons suggest that the modified protocol was more time efficient than the full protocol, with comparable safety levels and tolerance between cohorts. The modified FEES protocol demonstrated feasibility as a screening procedure, warranting further investigation in a larger trial setting.