Multidisciplinary Head and Neck Cancer Clinical Pathway Implementation
Presented by Barbara Pisano Messing
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This course seeks to fill a knowledge gap of advanced instruction in head and neck cancer (HNC) management. Speech pathologists with an interest in obtaining advanced-level competencies in head and neck cancer are provided with best practice service delivery models appropriate for the management of HNC patients before, during, and after treatment. Specifically, the course will describe the purpose and implementation of a multidisciplinary head and neck clinical pathway designed to optimize treatment and functional head and neck cancer outcomes. Current national and international models of HNC care delivery designed to manage patients with complex needs are addressed. The course will discuss evidence-based literature to guide speech pathologists in providing exercise protocols and identifying clinician- and patient-related outcome measures at specified time points to promptly identify and address functional deficits in a proactive approach over time.
Meet your instructor
Barbara Pisano Messing
Barbara Pisano Messing is a practicing speech pathologist with 36 years of clinical and administrative experience. Dr. Messing was the administrative-clinical director of the Milton J. Dance, Jr. Head and Neck Center, Head and Neck Surgery, and Johns Hopkins Voice Center at GBMC in Baltimore, Maryland, for 22 years. She is…
Chapters & learning objectives
1. Service Delivery in Head and Neck Cancer
This chapter will discuss head and neck cancer (HNC) multidisciplinary clinical pathway models developed comprehensively with multidisciplinary interventions, providing a road map of care for HNC patients. National and international service delivery guidelines designed to manage HNC patients' complex needs and address functional deficits in a proactive approach over time are discussed.
2. Developing a Multidisciplinary Clinical Pathway in Head and Neck Cancer
HNC management presents with significant challenges because of tumor-related factors, patient-related factors (comorbidities, adherence, location of treatment center), and clinician/provider expertise. This chapter will explore the goal of providing a structured clinical pathway to provide high-quality care using a systematic, multidisciplinary approach to service provision. A patient-centered approach is essential and requires input from key stakeholders, most importantly the patient. A case study will be presented along with an informative interview with an HNC patient and his wife/caregiver describing their experience with the center's multidisciplinary HNC clinical pathway from diagnosis to long-term posttreatment management.
3. Maximizing Functional Outcomes and Minimizing the Effects of Treatment-Related Toxicities
This chapter focuses on the impact of tumor- and treatment-related toxicities impacting the HNC patient’s treatment and survivorship. Treatment-related effects of mucositis, pain, xerostomia, dysgeusia, nausea, fatigue, neuropathy, edema, lymphedema, fibrosis, trismus, and muscle atrophy that impact function, nutrition, and healing are discussed. Evidence-based practice with standardized clinical protocols with validated outcome measures are identified during this chapter. Included in this chapter is an interview with a clinician who is an active member of an HNC multidisciplinary team (MDT) providing HNC care utilizing evidence-based protocols and highlighting the importance of speech pathology interventions before, during, and post treatment.
4. Maximizing Functional Outcomes in Head and Neck Cancer Using a Multidisciplinary Clinical Pathway
This chapter provides important information on the benefit of ongoing monitoring and evaluation during and post treatment using a structured, systematic MDT clinical pathway to maximize patient outcomes. The components of establishing and sustaining an HNC clinical pathway are described, including but not limited to involvement of dedicated staff as key stakeholders with specific roles and responsibilities and the importance of evaluating programmatic resources to ensure sustainability of the clinical pathway. In an interview with an experienced head and neck clinician, perspectives on the practice of providing HNC care using an established best practice MDT clinical pathway are discussed.
