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 8 projects included in this grant reflect the philosophy that rehabilitation begins prior to treatment and that the selection of treatment techniques can be the most significant rehabilitation procedure. Project 1, a three year study, examines the impact of a two week pre-operative program of nutritional intervention on post-operative surgical morbidity and other select measures. Project 2, a five year study, compares two treatment procedures for T1 glottic carcinoina (radiation therapy and laser excision) according to their effects on voice and swallowing function as well as disease cure. Project 3, a five year study, assesses the effects of surgical closure after oral and oropharyngeal resection on select measures of speedh and swallowing. Project 4, a four year study, proposes to design and evaluate a specific combined prosthetic and speech intervention according to its effect on both speech and swallowing. Project 5 a four year study, examines the effectiveness of a new program of swallowing intervention for dysphagic partial laryngectomees and surgically treated brain tumor patients, as compared to the standard intervention. Project 6, a three year study, compares voice and swallowing functions of two groups of toal laryngectomized patients with tracheo esophageal puncture voice restoration and management of esophageal spasm. The spasm is treated with a myotomy in one group and a neurectomy in the other. Project 7, a three year study, examines the effect of a physical therapy intervention program on select measures of shoulder function in patients with radical neck dissections and modified neck dissection. Project 8, a four year study, involves development and evaluation of a new """"""""karnofsky type"""""""" scale to evaluate the functional status of head and neck cancer patients in future clinical trials and other research activities requiring a quick assessment of function of head and neck cancer patients. The specific goals of all of the proposed projects are to identify those treatment and/or rehabilitation interventions which result in best patient functioning in the short and long term. The long term objective of this Program Project is to develop a cooperative interdisciplinary, inter institutional team of investigators who will continue to develop and implement cancer rehabilitation protocols with carefully quantified outcomes, at least some of which may later be attached to treatment trials.
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