Navigator Engagement Increases the Rate of Speech Language Pathology Evaluations in Head and Neck Cancer Patients

November 2019 Vol 10, No 11
Marilyn Kugler, BSN, RN Navigator
Barrett Cancer Center
UC Health,
Cincinnati, OH
Hope Esslinger, MPT, CCRC
Department of Radiation Oncology, University of Cincinnati,
Cincinnati, OH
Vinita Takiar, MD, PhD
Barrett Cancer Center, UC Health;
Department of Radiation Oncology, University of Cincinnati;
Cincinnati VA Medical Center,
Cincinnati, OH

Background: Head and neck cancer (HNC) care is complex, requiring coordinated care among a variety of providers. Proactive speech-language pathology (SLP) interventions have been proven to improve both patient outcomes and quality of life.1,2 However, these evaluations are often delayed until a patient experiences symptoms. HNC patients undergoing radiation therapy are at high risk for complications related to speech and swallowing. If left untreated, these complications can lead to long-term sequelae, including dysphagia, trismus, feeding tube dependence, and depression. Early SLP intervention allows patients to continue with oral intake and limits feeding tube dependence.3 A dedicated head and neck nurse navigator can facilitate this evaluation and impress upon the patient the need for timely initiation of SLP therapy in order to improve patient compliance, rates of SLP evaluation, and ultimately patient quality of life.

Objective: To determine whether dedicated nurse navigation impacts SLP evaluation rates in head and neck cancer patients.

Methods: The HNC navigation program was initiated at only 1 of the 2 major UC Health hospital facilities (20 miles apart) in early 2015. This study includes all patients that received radiation therapy at either of the 2 UC Health radiation facilities for HNC treatment from 1/2016 to 6/2019. Patients were identified through an institutional database and included all adult patients who received radiation therapy as a portion of their HNC care. At the facility with a dedicated navigator, after it was decided that the patient’s treatment would include radiation therapy, the navigator discussed the importance of evaluation and compliance with SLP-initiated therapies. The navigator then referred the patient to SLP for evaluation and ensured the appointment was completed within 1 week of treatment start. Radiation start dates were compared with initial date of speech language pathology evaluation. Fisher’s exact test was used to compare the proportion of patients referred to SLP at each UC hospital (one with a designated HNC nurse navigator, and one without dedicated navigation). P <0.05 was deemed statistically significant.

Results: Between 2016 and 2019, 424 patients received radiation therapy for treatment of HNC at a single institution. There are 2 hospitals within this system: 273 patients received radiation therapy at the Barrett Cancer Center (BCC), with a dedicated nurse navigator, and 151 patients received treatment at West Chester Radiotherapy (WCR), a UC Health facility without a dedicated navigator. In the setting of a dedicated nurse navigator, an additional 15% of patients were evaluated by SLP. Two hundred forty-two (89%) of BCC patients and 113 (75%) of WCR patients were evaluated by SLP. There were proportionately more SLP evaluations in the presence of a dedicated HNC nurse navigator (Fisher’s exact test, P <.001).

Conclusion: The engagement of a dedicated HNC navigator significantly increases early speech language pathology evaluation for HNC patients undergoing radiation therapy. The effect on outcome is currently being evaluated. The role of timely referral to services which can mitigate treatment-related toxicity should be further explored.

References

  1. Kulbersh BD, Rosenthal EL, McGrew BM, et al. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope. 2006;116:883-886.
  2. Ajmani GS, Nocon CC, Brockstein BE, et al. Association of a proactive swallowing rehabilitation program with feeding tube placement in patients treated for pharyngeal cancer. JAMA Otolaryngol Head Neck Surg. 2018;144:483-488.
  3. Carnaby-Mann G1, Crary MA, Schmalfuss I, Amdur R. "Pharyngocise": randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;83:210-219.
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