American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

Scottish Intercollegiate Guidelines Network
Diagnosis and Management of Head and Neck Cancer: A National Clinical Guideline

Scottish Intercollegiate Guidelines Network. (2006).
Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN), SIGN Publication No. 90, 96 pages.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations for the diagnosis and management of head and neck cancer. The guideline is intended for all healthcare professionals working with patients with head and neck cancers. Recommendations of specific application to the field of speech-language pathology are included regarding swallowing and communication. Levels of evidence are provided and defined as follows: Recommendations are graded A, B, C, D, or "Good Practice Point" based on the strength of supporting evidence. Grade A recommendations are based on evidence from systematic reviews and meta-analyses of randomized controlled trials that are directly relevant to the population. Grade B recommendations include high quality case control or cohort studies or high quality systematic reviews of those studies that are directly applicable to the population, or recommendations extrapolated from Grade A evidence. Grade C recommendations include well conducted case control or cohort studies or recommendations extrapolated from Grade B evidence. Grade D recommendations are based on evidence from non-analytic studies or expert opinion or recommendations extrapolated from Grade C evidence. Good Practice Points are recommendations based on the clinical experience of the guideline development group. 

Recommendations:

  • Assessment/Diagnosis
    • Assessment Instruments
      • Swallowing
        • FEES/Videofluoroscopy - "All patients with oral, oropharyngeal, hypopharyngeal and laryngeal cancer should have access to instrumental investigation for dysphagia. [Modified barium swallow] MBS and [Fiberoptic endoscopic evaluation of swallowing] FEES are both valid methods for assessing dysphagia. The [speech and language therapist] SLT should consider which is the most appropriate for different patients in different settings” (Grade C Evidence) (p. 49).
  • Treatment
    • Speech/Voice
      • General Findings
        • “All patients undergoing chemoradiation should have access to a specialist speech and language therapist before, during and after treatment” (Grade C Evidence) (p. 49).
        • “Where communication problems are likely to occur, patients should be seen by a specialist head and neck speech and language therapist soon after diagnosis and before treatment commences” (Grade C Evidence) (p. 50).
      • Electrolarynx - “Electrolarynx should be offered where appropriate” (Good Practice Point) (p. 50).
      • Esophageal Speech - “Patients undergoing laryngectomy should have specialist speech and language therapy to restore voice either by a tracheosophageal voice prosthesis and/or oesophageal speech” (Grade C Evidence) (p. 50).
      • Tracheoesophageal Prothesis - “Patients undergoing laryngectomy should have specialist speech and language therapy to restore voice either by a tracheosophageal voice prosthesis and/or oesophageal speech” (Grade C Evidence) (p. 50).
    • Swallowing
      • General Findings - “All patients undergoing chemoradiation should have access to a specialist speech and language therapist before, during and after treatment” (Grade C Evidence) (p. 49). 

Keywords: Head and Neck Cancer

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Added to Compendium: November 2011

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