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

Otolaryngology-Head and Neck Surgery

Kuhn, M. A., Gillespie, M. B., et al. (2023).

Otolaryngology-Head and Neck Surgery, 168(4), 571-592.

<div>This guideline provides recommendations for managing dysphagia in adults with head and neck cancer (HNC).&nbsp;</div>

American Academy of Otolaryngology‐Head and Neck Surgery Foundation Guidelines Task Force

<div>The following statements regarding dysphagia screening for HNC patients reached consensus:</div> <div> <ul> <li>"Dysphagia screening for newly diagnosed HNC patients guides preventative and supportive interventions when performed prior to cancer treatment" (p. 575).</li> <li>"SLP consultation is optimal prior to treatment in HNC patients who are at risk for dysphagia" (p. 575).</li> </ul> </div>

<div>The following statements regarding dysphagia evaluation for HNC patients reached consensus:</div> <div> <ul> <li>"Bedside swallow assessment by an SLP is useful in evaluating swallowing safety following tracheostomy" (p. 575).</li> <li>"In HNC patients who fail dysphagia screening, instrumental swallow evaluation provides insight into the nature of swallowing impairment" (p. 575).</li> <li>"Instrumental evaluation procedures (endoscopy or fluoroscopy) are useful swallowing evaluation methods for&nbsp;HNC patients after radiotherapy" (p. 575).</li> <li>"Pretreatment instrumental swallowing evaluation establishes baseline swallowing function and impairment in&nbsp;HNC patients who report symptoms of dysphagia or who are at risk of developing dysphagia during treatment" (p. 575).</li> <li>"FEES [flexible endoscopic evaluation of swallowing] affords the benefit of direct visualization of the swallowing mechanism at the point of care for HNC&nbsp;patients" (p. 575).</li> <li>"Videofluoroscopy provides functional imaging of the oral cavity and upper esophagus in HNC patients" (p. 575).</li> <li>"Perform swallowing evaluation prior to oral diet initiation in HNC patients with tracheostomy" (p. 575).</li> <li>"Videofluoroscopic assessment of swallowing is beneficial following total laryngectomy to evaluate for the&nbsp;postsurgical leak" (p. 575).</li> </ul> </div>

<div>The following recommendations regarding dysphagia prevention for HNC patients reached consensus:</div> <div> <ul> <li>"HNC patients have improved swallowing outcomes if encouraged to continue eating and drinking, guided by a dysphagia specialist, throughout cancer treatment" (p. 576).</li> <li>"A multidisciplinary team with members from head and neck surgery, radiation oncology, medical oncology, speech-language pathology, nutrition, and nursing is preferred to provide comprehensive care for HNC patients and minimize dysphagia associated with treatment" (p. 576).</li> <li>"Prophylactic swallowing exercises benefit HNC patients undergoing radiation therapy by optimizing functional status and quality of life" (p. 576).</li> </ul> </div>

<div>The following recommendations regarding dysphagia intervention for HNC patients reached consensus:</div> <div> <ul> <li>"Patient and family education about oral care helps decrease the adverse effects of dysphagia associated&nbsp;with HNC" (p. 577).</li> <li>"Oral intake is encouraged in HNC patients judged by a dysphagia specialist to be low risk for the consequences&nbsp;of aspiration" (p. 577).</li> <li>"Identification of appropriate textures and liquids for safe consumption of oral intake is beneficial for HNC&nbsp;patients with dysphagia" (p. 577).</li> <li>"NPO [nil per os] status is not universally required for aspirating HNC patients" (p. 577).</li> <li>"Swallowing therapy is most effective when initiated by the start of HNC treatment" (p. 577).</li> <li>"Essential to counseling for HNC patients and caregivers are aspiration precautions and (self) Heimlich" (p. 577).</li> <li>"Consistent, daily oral care (including cleaning the tongue, palate, and teeth) reduces bacterial load and the risk&nbsp;of developing aspiration pneumonia due to swallowing impairment in HNC patients" (p. 577).</li> <li>"Devices can be used to augment the intensity of behavioral swallowing therapies in HNC patients" (p. 577).</li> <li>"Device-facilitated therapies are more effective when evidence-supported devices are selected based on&nbsp;dysphagia pathophysiology" (p. 577).</li> </ul> </div>

<div>The following recommendations regarding dysphagia surveillance for HNC patients reached consensus:</div> <div> <ul> <li>"Patients with dysphagia after HNC treatment experience improved nutrition status and health outcomes when followed by a multidisciplinary team" (p. 577).</li> <li>"Life-long monitoring for dysphagia signs and symptoms is important for HNC survivors" (p. 577).</li> <li>"Obtaining dysphagia-related patient-reported outcomes are an important component of ongoing HNC care" (p. 577).</li> <li>"The specific cadence and method of screening for dysphagia in HNC survivors are dictated by individualized factors (tumor site, cancer stage, treatment history, and prior functional deficits)" (p. 577).</li> </ul> </div>

<div>The following statements regarding dysphagia management for HNC patients did not reach consensus:</div> <div> <ul> <li>"Symptom-driven dysphagia evaluation in HNC patients (such as for dehydration, malnutrition, coughing, or choking) is useful to establish impairments to the swallowing mechanism" (p. 578).</li> <li>"Patient-reported questionnaires are good screening tools for dysphagia in head and neck patients" (p. 578).</li> <li>"Comprehensive screening for dysphagia in HNC patients includes clinician-reported outcome measures" (p. 578).</li> <li>"HNC patient and caregiver education on the signs and symptoms of swallowing impairment helps preserve swallowing function" (p. 578).</li> </ul> </div>