Multidisciplinary Head and Neck Cancer Clinic and Adherence with Speech Pathology

Objectives: To determine the effect of referral patterns on compliance with speech-language pathology (SLP) treatment of voice and swallowing difficulties in patients with head and neck cancer (HNCA). Study Design: Retrospective cohort study. Methods: Patients with newly diagnosed oropharyngeal HNCA referred for pretreatment SLP evaluation comprised the study population. Compliance was measured by participation in SLP therapy during and after head and neck treatment, as well as by the number of missed and completed visits. Outcomes were compared between patients who were initially evaluated through the multidisciplinary clinic and those evaluated outside of the multidisciplinary clinic format. Results: The final study sample included 118 individuals with oropharyngeal tumors. All patients were treated with primary radiotherapy with or without chemotherapy. Patients evaluated initially through the multidisciplinary clinic had more SLP visits than those who did not participate in the multidisciplinary clinic (mean 1.8 vs. 0.2, P <. 0001). Participation in SLP treatment was significantly greater for patients >= 60 years of age (odds ratio [OR] 2.4, P= .032) and for patients who participated in the multidisciplinary clinic (OR = 19.3, P <. 0001). Tumor stage, sex, race, marital status, and insurance status were not associated with patient compliance. Multivariate analysis revealed that participation in a multidisciplinary clinic was the only significant variable associated with SLP treatment compliance (OR 12.9, P <. 0001), after controlling for all other variables. Conclusions: Patients evaluated in a multidisciplinary clinic are more likely to comply with SLP treatment recommendations.