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.