Development of a Dysphagia Pathway Program for Head and Neck Cancer in a Rural Patient Population

Abstract

Purpose: The purpose of this study is to discuss the feasibility of developing, and the challenges of implementing, a structured dysphagia program in a rural patient population with preliminary data. Method: The Dysphagia Pathway Program (DPP) is a standardized, prophylactic swallow therapy program for head and neck cancer patients initiated in 2019 as a multidisciplinary approach at Penn State Hershey Medical Center. An interrupted time series study was conducted comparing the swallow and nutritional status of patients pre- and postimplementation of the DPP. Data were analyzed using the chi-square test and linear mixed-effects models to determine statistical significance for categorical and continuous variables, respectively. Results: The DPP group included 52 patients, and the pre-implementation group included 109 patients. A higher percentage of patients in the DPP group tolerated a by mouth (PO)-only diet at the last day of treatment time point ( p < .001). The DPP group showed similar changes in body mass index and albumin over time but had lower rates of gastrostomy tube placements ( p = .002) compared to the pre-implementation group. The average adherence to speech and swallow therapy in the DPP group decreased over time. Conclusions: Although we encountered many obstacles in the development of the DPP, we found prophylactic swallow therapy to be feasible to implement and beneficial in our rural patient population. In this pilot study, our results demonstrated that prophylactic swallow therapy shows a favorable trend in swallowing and nutritional status. Future improvements include improving documentation of swallowing outcomes, patient adherence, and utilizing telehealth.