Swallowing is a life-sustaining function that is critical for hydration, nutrition, management of secretions, and consumption of required medications. Swallowing function also contributes to the quality of life through the enjoyment of food and beverage, the social interaction of mealtime, and the shared cultural experience of the cuisine. Safe and efficient swallowing is the result of a series of complex and well-coordinated voluntary and involuntary musculoskeletal actions which are intricately regulated via mucosal sensory receptors, cranial nerves, brainstem centers, and higher cortical controls. Disruption of one or multiple of these components may result in the development of swallowing symptoms, or dysphagia.
Abstract
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.
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.
Original Publication
Otolaryngology-Head and Neck Surgery Volume 168, Issue 4
Authors
Maggie A. Kuhn MD, MAS, M. Boyd Gillespie MD, MSc, Stacey L. Ishman MD, MPH, Lisa E. Ishii MD, MHS, Rebecca Brody PhD, RD, CNSC, Ezra Cohen MD, FRCPSC, FASCO, Shumon I. Dhar MD, Kate Hutcheson PhD, Gina Jefferson MD, Felicia Johnson MD, Anais Rameau MD, MPhil, David Sher MD, MPH, Heather Starmer MA, CCC-SLP, BCS-S, Madeleine Strohl MD, Karen Ulmer MS, RN, CORLN, Vilija Vaitaitis MD, Sultana Begum MPH, Misheelt Batjargal MD, MHA, Nui Dhepyasuwan MEd
