Wall Laurelie R, Ward Elizabeth C, Cartmill Bena, Hill Anne J, Porceddu Sandro V
Centre for Functioning and Health Research, Queensland Health, Level 3, Centro Buranda, Ipswich Rd, Buranda, QLD, 4102, Australia.
Division of Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.
Dysphagia. 2017 Apr;32(2):279-292. doi: 10.1007/s00455-016-9757-z. Epub 2016 Nov 14.
Intensive, prophylactic swallowing therapy programs have been developed to improve dysphagia outcomes for patients with head/neck cancer (HNC) receiving (chemo)radiotherapy ([C]RT). Across studies, variable therapy adherence rates have been reported. Preliminary research suggests that service-delivery mode and demographic factors may influence adherence. This study examined patient adherence to a prophylactic swallowing therapy protocol across three service-delivery models: (1) clinician-directed face-to-face therapy, (2) technology-assisted therapy using the telepractice application, SwallowIT and (3) independent patient-directed therapy. The secondary aim explored the impact of patient factors on adherence. Patients with oropharyngeal HNC receiving definitive (C)RT were randomised to receive the Pharyngocise exercise protocol via clinician-directed (n = 26), patient-directed (n = 27) or SwallowIT-assisted (n = 26) models. Adherence was calculated as the percentage of prescribed exercise completed. Multiple patient factors were recorded at baseline. Adherence across the 6 weeks in all groups was low (27%), and declined from week 4 of (C)RT. The clinician-directed model yielded significantly (p = 0.014) better adherence than patient-directed therapy in weeks 1-3. There was also a trend for higher adherence in the SwallowIT group compared to patient-directed in weeks 1-3 (p = 0.064). Multivariable linear modelling identified active smoking at baseline (p < 0.001) and concomitant chemotherapy (p = 0.040) as significant negative predictors of adherence, with baseline reduced motivation trending towards significance. Although (C)RT-related toxicities will impact adherence, adopting service-delivery models with greater structure/support and providing extra assistance to patients with known risk factors may help optimise therapy adherence to prophylactic therapy programs. Telepractice may provide an alternate model to support adherence where service constraints limit intensive clinician-directed therapy.
为改善头颈部癌症（HNC）患者在接受（化疗）放疗（[C]RT）时的吞咽困难结局，已制定了强化预防性吞咽治疗方案。在各项研究中，所报告的治疗依从率各不相同。初步研究表明，服务提供模式和人口统计学因素可能会影响依从性。本研究考察了患者在三种服务提供模式下对预防性吞咽治疗方案的依从性：（1）临床医生指导的面对面治疗；（2）使用远程医疗应用程序SwallowIT的技术辅助治疗；（3）患者自主指导的治疗。次要目的是探讨患者因素对依从性的影响。接受根治性（C）RT的口咽HNC患者被随机分配，通过临床医生指导（n = 26）、患者自主指导（n = 27）或SwallowIT辅助（n = 26）模式接受咽肌锻炼方案。依从性以完成规定锻炼的百分比来计算。在基线时记录了多个患者因素。所有组在6周内的依从性都很低（27%），并且从（C）RT的第4周开始下降。在第1 - 3周，临床医生指导的模式产生的依从性显著（p = 0.014）优于患者自主指导的治疗。在第1 - 3周，与患者自主指导相比，SwallowIT组的依从性也有更高的趋势（p = 0.064）。多变量线性建模确定基线时主动吸烟（p < 0.001）和同步化疗（p = 0.040）是依从性的显著负预测因素，基线时动力降低有显著趋势。虽然（C）RT相关毒性会影响依从性，但采用结构/支持性更强的服务提供模式，并为具有已知风险因素的患者提供额外帮助，可能有助于优化对预防性治疗方案的治疗依从性。在服务限制强化临床医生指导治疗的情况下，远程医疗可能提供一种支持依从性的替代模式。
