This program project brings together a group of investigators and cooperating clinicians who have a major interest in quantifying and developing new procedures and patterns of care to minimize the effects of cancer treatment on the head and neck cancer patients' functional status as soon after treatment as possible. The six projects included in this grant reflect the philosophy that rehabilitation begins with prevention and detection and extends to pretreatment intervention and to the selection of treatment techniques and to the design and evaluation of rehabilitation protocols. Four of the six projects are proposed for 5 years, while 2 are designed to be completed in 4 years. The first project examines the biomechanical effects of head and neck treatment procedures on swallowing function and on the patient's reactions to various bolus types and swallow maneuvers. The second project examines functional effects of radiotherapy plus/minus chemotherapy on speech, voice, and swallow in head and neck cancer patients. The third project assesses the impact of surgical intervention on the speech and swallowing of patients with recurrent or residual disease after primary treatment with radiotherapy plus/minus chemotherapy. The fourth project quantifies the effects of reconstruction on speech and swallowing function in 7 groups of oral cancer patients. This project proposes to continue the work begun in the first 10 years of the current project. The fifth project examines the effects of a specific swallow intervention program on persistent swallowing problems in patients who have been treated for their head and neck cancer more than a year back and are disease free. The sixth project continues our previous development of a Performance Status Scale for head and neck cancer patients by examining functional changes and patient priorities. The long-term objective of this Program Project is to establish and maintain a cooperative interdisciplinary, interinstitutional team of investigators who will continue to develop and implement cancer rehabilitation protocols with carefully quantified outcomes for head and neck cancer.
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