The Gold
Coast University Hospital commenced radiation therapy for head & neck cancer
patients in 2014. A senior Speech Pathologist and Dietitian were
recruited to develop and provide a new outpatient-based service pathway to
support patients in the pre-treatment, on-treatment and post-treatment phases.
The COSA’ Evidence-based practice guidelines for the nutritional management of
adult patients with head and neck cancer1’ were key in the development and
implementation of a patient-focused service.
Pre-treatment:
Consistent with guidelines,
all patients are screened for malnutrition as well as swallowing dysfunction at
baseline at the Head & Neck multidisciplinary clinic. All patients referred
for radiation are also referred to the Dietitian & Speech Pathologist for
comprehensive assessment. Patients referred for definitive chemo-radiotherapy
are seen in an innovative interdisciplinary clinic consultation with the
Radiation Oncologist, Dietitian, Speech Pathologist and Cancer Care
Co-ordinator. This clinic was designed to improve efficiency and promote
team-based care. Decisions surrounding indication for prophylactic gastrostomy
tube insertion and instrumental swallowing assessments are made at this time.
All radiation head and neck cancer patients are referred to the Allied
Health led pre-treatment education group session.
On-treatment:
Patients are scheduled for
minimum weekly 30 minute review appointments at the combined Dietitian &
Speech Pathology Clinic. Standardised parameters monitored include CTCAE
symptom gradings, swallowing outcomes measures (i.e. FOIS, RBHOMS), weight,
nutritional intake and fortnightly PG-SGA. Appointments are aligned around treatment
times resulting in a >90% attendance rate. All patients on treatment are
presented at the weekly Dietitian & Speech Pathology led head and neck
cancer case-conference attended by medical, nursing and allied health staff.
Post-treatment:
Patients are scheduled for
minimum fortnightly Speech Pathology & Dietitian reviews for 6 weeks
following treatment. Patients are then seen at routine intervals of 2, 4, 8 and
12 months post treatment or more frequently if clinically indicated.