Feasibility of assessing patient health benefits and incurred costs resulting from early dysphagia intervention during and immediately after chemoradiotherapy for head-and-neck cancer

  • R. Martino University of Toronto
  • J. Ringash Princess Margaret Cancer Centre, University Health Network; University of Toronto
  • L. Durkin University of Toronto; University Health Network
  • E. Greco University of Toronto
  • S. Hui Huang University Health Network
  • W. Xu Princess Margaret Cancer Centre, University Health Network
  • C.J. Longo McMaster University
Keywords: Head-and-neck cancer, dysphagia interventions, patient costs, lost income, quality of life

Abstract

Background

Resource limitations affect the intensity of speech–language pathology (slp) dysphagia interventions for patients with head-and-neck cancer (hnc). The objective of the present study was to assess the feasibility of a prospective clinical trial that would evaluate the effects on health and patient costs of early slp dysphagia interventionfor hnc patients planned for curative concurrent chemoradiotherapy (ccrt).

Methods

Patients with hnc planned for curative ccrt were consecutively recruited and received dysphagia-specific intervention before, during, and for 3 months after treatment. Swallowing function, body mass index, health-related quality of life (qol), and out-of-pocket costs were measured before ccrt, at weeks 2 and 5 during ccrt, and at 1 and 3 months after ccrt. Actuarial percutaneous endoscopic gastrostomy (peg) removal rates and body mass index in the study patients and in a time-, age-, and disease-matched cohort were compared.

Results

The study enrolled 21 patients (mean age: 54 years; 19 men). The study was feasible, having a 95% accrual rate, 10% attrition, and near completion of all outcomes. Compared with the control cohort, patients receiving dysphagia intervention trended toward a higher rate of peg removal at 3 months after ccrt [61% (32%–78%) vs. 53% (23%–71%), p = 0.23]. During ccrt, monthly pharmaceutical costs ranged between $239 and $348, with work loss in the range of 18–30 days for patients and 8–12 days for caregivers.

Conclusions

We demonstrated the feasibility of comparing health and economic outcomes in patients receiving and not receiving early slp dysphagia intervention. These preliminary findings suggest that early slp dysphagia intervention for hnc patients might reduce peg dependency despite worsening health. Findings also highlight effects on financial security for these patients and their caregivers.

Author Biographies

R. Martino, University of Toronto
Department of Speech–Language Pathology; Rehabilitation Sciences Institute; Department of Otolaryngology–Head and Neck Surgery;
J. Ringash, Princess Margaret Cancer Centre, University Health Network; University of Toronto
Department of Radiation Medicine;  Department of Radiation Oncology
L. Durkin, University of Toronto; University Health Network
Department of Speech–Language Pathology
E. Greco, University of Toronto
Rehabilitation Sciences Institute
S. Hui Huang, University Health Network
Department of Radiation Medicine, Princess Margaret Cancer Centre
W. Xu, Princess Margaret Cancer Centre, University Health Network
Department of Radiation Medicine
C.J. Longo, McMaster University
DeGroote School of Business
Published
2017-12-20
How to Cite
Martino, R., Ringash, J., Durkin, L., Greco, E., Hui Huang, S., Xu, W., & Longo, C. (2017). Feasibility of assessing patient health benefits and incurred costs resulting from early dysphagia intervention during and immediately after chemoradiotherapy for head-and-neck cancer. Current Oncology, 24(6), e466-e476. https://doi.org/10.3747/co.24.3543
Section
Cancer Rehabilitation and Survivorship