This project is designed to measure the psychosocial function of 300 treated head and neck cancer patients whose treatment has been completed for at least 12 months, and to test an intervention designed to improve psychosocial function by improving swallowing abilities. Our first hypothesis based on pilot data is that treated head and neck cancer patients continue to suffer significant functional deficits long after treatment has been completed, and that the exact nature of these deficits will vary based on the original tumor site and stage, and nature of treatment (surgery or radiotherapy). Data collected during the first (baseline) year of the project will be used to test this hypothesis and achieve the FIRST OBJECTIVE, i.e., to define deficits in psychosocial function, speech, and swallowing observed 12 months or more post treatment in head and neck cancer patients. A SECOND OBJECTIVE of this project is to define the effects of a specific intervention strategy on patient function. Our second major hypothesis is that swallowing therapy will result in improved speech, swallowing and eating which will lead to the patient's improved socialization and psychosocial function as well as their ability to eat a wider range of foods. Following completion of the baseline data collection, patients exhibiting swallowing disorders will be randomized into one of two groups, an early treatment group and a delayed treatment group. The early treatment group will receive a specific swallowing therapy program once per week for 4 months, consisting of a graded series of exercises including home practice. The delayed treatment group will receive no therapy (control) during this 4-month period. At the end of the 4-month treatment trial, both groups of patients will be retested for psychosocial, speech, and swallowing function. After the retest, the two patient groups will cross over, with the early intervention group serving as the control group for 4 months, and the delayed treatment group receiving the intervention for 4 months. At the end of the second 4-month intervention period, all patients will again be retested for psychosocial, speech, and swallowing function. Finally, one year after completion of intervention for each group, the patients' psychosocial, speech, and swallowing function will be retested for the last time to achieve our THIRD OBJECTIVE, i.e., to determine whether the gains are maintained long term. A FOURTH OBJECTIVE is to define the cost of the intervention proposed and the cost impact of the intervention in terms of reducing the need for expensive prepared feedings, hospitalization for pneumonias which may be depression related or aspiration related and other health care needs. It is our hypothesis that the moneys saved in health care related costs will outweigh the costs of the intervention. A FIFTH and final OBJECTIVE is to determine whether it is possible to predict from baseline measures those patients who will benefit most from the intervention, so that health care dollars for interventions initiated as a result of this project can be invested where they will have greatest impact.
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