Meten is weten: het belang van inventarisatie van functionele outcome na behandeling H&H oncologie

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Melissa Devos
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1 Meten is weten: het belang van inventarisatie van functionele outcome na behandeling H&H oncologie Ann Goeleven Dienst NKO ziekten, Gelaats en Halschirurgie, UZ Leuven Logopedische en Audiologische Wetenschappen, KU Leuven

2 Wat weten we? belangrijke medische evoluties acceptabele locoregionale tumorcontrole toegenomen focus op orgaanpreservatie orgaansparend functiesparend toegenomen aandacht voor functionele parameters in aanpassing van medische behandeling

3 Wat weten we? spraakverstaanbaarheid na chirurgie en RT/RCT aanvaardbaar (92-98 % SVH) maar grote variatie afhankelijk van uitgebreidheid chirurgie

4 Wat weten we? dysfagie belangrijke functionele parameter na H&H chirurgie orale resecties % aspiratie partiële laryngectomie en orofaryngectomie 8-54% aspiratie

5 Wat weten we? na radiotherapie radiochemotherapie 6-31 % aspiratie (>1 jaar post) tot 43 % ernstige dysfagie 4-8 % permante PEG dysfagie = meest kritische complicatie en dosis beperkende factor? acute maar vooral late toxiciteit na RCT Dirix e.a 2008, Eisbruch e.a 2011, Caudell e.a 2009, Olsen e.a

6 Wat weten we? slikproblemen reeds vaak aanwezig VOOR behandeling lijken de ernst en prognose van dysfagie na behandeling te bepalen Hutcheson e.a 2008, Dirix e.a 2008

7 Wat weten we? slikproblemen lijken invloed te hebben op oncologische outcome gewichtsverlies compliance met behandeling afname QOL toegenomen risico op depressie Wilson e.a, 2011, Hunter e.a 2012

8 Wat weten we? studies naar functionele outcome to date: beperkte aantallen grote diversiteit in patiëntenpopulatie aard medische behandeling aard/intensiteit van behandeling leeftijd roken/drinken psycho-sociale factoren

9 Wat weten we? maar vooral zeer zelden worden oncologische outcome en functionele outcome in eenzelfde studie geëvalueerd grote diversiteit in meettechnieken en instrumenten om functionele outcome in kaart te brengen! Hutcheson e.a 2015, Kraaijenga e.a 2014, Khan e.a 2015 ).

10 Wat meten we? satisfactory voice oral feeding was possible good swallowing invalidating swallowing problems

11 Wat meten we? overleving oncologische outcome - herval nood aan laryngectomie QOL ( functional outcome!) EORTC H&N xerostomie (XQ) stem VHI Akoestische/aerodynamische metingen spraakverstaanbaarheid SHI

12 Wat meten we? slik PEG plaatsing permanente PEG permanente tracheakanule herstart orale intake incidentie pneumonie consistentie-beperkingen BMI, gewichtsveranderingen klinische slikevaluatie studiespecifieke vragenlijsten

13 Wat meten we? Zelfrapportering MDADI MD Anderson Dysphagia Inventory (Chen e.a, 2001) (Speyer e.a, 2011) SWAL QOL (Mc Horney e.a, 2000) (Vanderwegen e.a, 2012) DHI Dysphagia Handicap Index (Silbergleit e.a, 2012) (Speyer e.a, 2011)

14 Wat meten we? Subjectieve analyse FOIS Functional Oral Intake Scale (0-7 scale) (Crary e.a, 2005) PSS Performance Status Scale (List e.a, 1990) Sydney Swallow Questionnaire (SQQ) (Dwivedi et al.,2010)

15 Wat meten we? Subjectieve analyse FOIS Functional Oral Intake Scale (0-7 scale) (Crary e.a, 2005) PSS Performance Status Scale (List e.a, 1990) 1. nothing by mouth (NPO) 2. tube dependent with minimal attempts of food or liquid 3. tube dependent with consistent intake of liquid or food 4. total oral diet of a single consistency 5. total oral diet with multiple consistencies but requiring special preparation or compensations. 6. total oral diet with multiple consistencies without special preparation, but with specific food limitations. 7. total oral diet with no restriction Sydney Swallow Questionnaire (SQQ) (Dwivedi et al.,2010)

16 Wat meten we? Subjectieve analyse FOIS Functional Oral Intake Scale (0-7 scale) (Crary e.a, 2005) PSS Performance Status Scale (List e.a, 1990) Sydney Swallow Questionnaire (SQQ) (Dwivedi et al.,2010) NORMALCY OF DIET 100 Full diet (no restrictions) 90 Full diet (liquid assist) 80 All meat 70 Raw carrots, celery but may limit intake to less "messy foods (e.g., liquids) 60 Dry bread and crackers 50 Soft chewable foods (e.g., macaroni, canned/soft fruits, cooked vegetables, 40 Soft foods requiring no chewing (e.g., mashed potatoes, apple sauce, pudding) 30 Pureed foods (in blender) 20 Warm liquids 0 Non oral feeding (tube fed) PUBLIC EATING 100 No restriction of place, food or companion 75 No restriction of place, but restricts diet when in public (eats anywhere, but may limit intake to less "messy foods (e.g., liquids) 50 Eats only in presence of selected persons in selected places 25 Eats only at home in presence of selected persons 0 Always eats alone UNDERSTANDABILITY OF SPEECH 100 Always understandable 75 Understandable most of the time; occasional repetition necessary 50 Usually understandable; face-to-face contact necessary 25 Difficult to understand 0 Never understandable; may use written communication

17 Wat meten we? Subjectieve analyse FOIS Functional Oral Intake Scale (0-7 scale) (Crary e.a, 2005) PSS Performance Status Scale (List e.a, 1990) Sydney Swallow Questionnaire (SQQ) (Dwivedi et al.,2010) Questions VAS Q1 How much difficulty do you have swallowing at present? Q 2 How much difficulty do you have swallowing THIN liquids? (e.g., tea, soft drink, beer, coffee) Q3 How much difficulty do you have swallowing THICK liquids? (e.g., milkshakes, soups, custard) Q 4 How much difficulty do you have swallowing SOFT foods? (e.g., mornays, scrambled egg, mashed potato) Q5 How much difficulty do you have swallowing HARD foods? (e.g., steak, raw fruit, raw vegetables) Q 6 How much difficulty do you have swallowing DRY foods? (e.g., bread, biscuits, nuts Q7 Do you have any difficulty swallowing your saliva? Q 8 Do you ever have difficulty starting a swallow? Q 9 Do you ever have a feeling of food getting stuck in the throat when you swallow? Q 10 Do you ever cough or choke when swallowing solid foods? (e.g., bread, meat, or fruit) Q 11 Do you ever cough or choke when swallowing liquids? (e.g., coffee, tea, beer) Q 12* How long does it take you to eat an average meal?* Q 13 When you swallow does food or liquid ever go up behind your nose or come out of your nose? Q14 Do you ever need to swallow more than once for food to go down? Q15 Do you ever cough up or spit out food or liquids DURING a meal? Q16 How do you rate the severity of your swallowing problem today? Q17 How much does your swallowing problem interfere with your enjoyment or quality of life?

18 Wat meten we? Objectieve analyse ROM / tongue- mouth opening Range of Motion IOPI SVF FEES

19 Wat w(m)eten we niet? effect pre-morbide status op dysfagie effect therapie, aard, frekwentie, duur, kwaliteit effect therapie compliance third party effect effect psycho-sociale factoren/context op functional outcome

20 Wat moeten we meten? pretreatment functional baseline posttreatment korte termijn én lange termijn multifactoriële meting van: spraakverstaanbaarheid stem slik! in combinatie met oncologische outcome! binnen ICF kader

21 Wat moeten we meten? gestandaardiseerde metingen van functional outcome bepalen in belangrijke mate mee de optimalisatie van medische/paramedische begeleiding van deze patienten standaard ingebed in begeleiding ifv vergelijkend onderzoek opstellen van best clinical practice guidelines (preventie, behandeling, begeleiding,..)

22 If it is found that the oncologic outcomes are equivalent.. then the most important factor for triaging patients to TORS or chemoradiation will be swallowing outcomes Weinstein e.a 2009

23 Is meten weten? weten stimuleert verbeteren

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