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Article ; Online: Internal oedema and dysphagia characteristics in patients with head and neck cancer.

Starmer, Heather M / Hutcheson, Katherine / Patterson, Joanne

Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery

2023 Volume 48, Issue 4, Page(s) 700–704

MeSH term(s)	Humans ; Deglutition Disorders ; Edema ; Head and Neck Neoplasms
Language	English
Publishing date	2023-03-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2205891-6
ISSN	1749-4486 ; 1749-4478 ; 0307-7772 ; 1365-2273
ISSN (online)	1749-4486
ISSN	1749-4478 ; 0307-7772 ; 1365-2273
DOI	10.1111/coa.14046
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Zs.A 1309: Show issues

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Article ; Online: Development of a head and neck lymphoedema specific quality of life tool: The Comprehensive Assessment of Lymphoedema Impact in the Head and Neck.

Starmer, Heather M / Patterson, Joanne / Young, Bridget / Fleming, Jason / Cherry, Mary Gemma

Head & neck

2024 Volume 46, Issue 5, Page(s) 1103–1111

Abstract: Purpose: To develop a head and neck lymphoedema (HNL) specific quality of life (QoL) instrument to assess physical, functional, and social/emotional impacts of HNL.: Methods: Instrument candidate items were reviewed by patients with HNL and ... ...

Abstract	Purpose: To develop a head and neck lymphoedema (HNL) specific quality of life (QoL) instrument to assess physical, functional, and social/emotional impacts of HNL. Methods: Instrument candidate items were reviewed by patients with HNL and clinicians and rated for importance, clarity, and invasiveness. The Content Validity Ratio was applied for item reduction. Three-step cognitive interviews were conducted with HNL patients to validate the items, survey format, and instructions. Results: Initially, 130 candidate questions were developed. Following item reduction, 52 items progressed to three-step cognitive interviews. Following cognitive interviews, the Comprehensive Assessment of Lymphoedema Impact in Head and Neck (CALI-HaN) included 33 items; 1 global, 10 physical, 7 functional, and 15 emotional. Conclusions: Physical, functional, and socioemotional effects need to be considered when measuring QoL in patients with HNL. This study describes initial development of the CALI-HaN, an instrument that shows promise for clinical and research applications following future validation.
MeSH term(s)	Humans ; Quality of Life/psychology ; Head and Neck Neoplasms/complications ; Lymphedema/diagnosis ; Lymphedema/etiology ; Surveys and Questionnaires
Language	English
Publishing date	2024-02-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	645165-2
ISSN	1097-0347 ; 0148-6403 ; 1043-3074
ISSN (online)	1097-0347
ISSN	0148-6403 ; 1043-3074
DOI	10.1002/hed.27704
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Zs.A 1493: Show issues

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Article ; Online: Head and neck lymphedema and quality of life: the patient perspective.

Starmer, Heather M / Cherry, Mary Gemma / Patterson, Joanne / Fleming, Jason / Young, Bridget

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

2023 Volume 31, Issue 12, Page(s) 696

Abstract: Purpose: Head and neck lymphedema (HNL) is common after head and neck cancer (HNC). This study aimed to explore quality of life (QoL) in patients with HNL to guide the development of a patient-reported QoL measure.: Methods: We conducted semi- ... ...

Abstract	Purpose: Head and neck lymphedema (HNL) is common after head and neck cancer (HNC). This study aimed to explore quality of life (QoL) in patients with HNL to guide the development of a patient-reported QoL measure. Methods: We conducted semi-structured interviews with 22 HNC survivors with HNL. Interviews explored participants' experiences of living with HNL. Analysis of interview transcripts drew on qualitative content analysis to ensure themes were grounded in patient experience. Results: Two main themes were established: "I want to live my life" and "It was like things were short-circuited." These themes encompassed the substantial disruption patients attributed to the HNL and their desire to normalize life. Conclusions: Understanding the impact of HNL on individual patients may be critical to optimizing treatment strategies to improve the physical burden of HNL and QoL. This study provides the framework for developing a patient-reported HNL QoL measure. Implications for cancer survivors: The development of an HNL-specific QoL measure, grounded in the patient perspective, may provide cancer care teams with a tool to better understand HNL's impact on each patient to tailor patient-centered care and optimize QoL outcomes.
MeSH term(s)	Humans ; Quality of Life ; Neck ; Lymphedema/etiology ; Lymphedema/therapy ; Patient-Centered Care ; Patients
Language	English
Publishing date	2023-11-14
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1134446-5
ISSN	1433-7339 ; 0941-4355
ISSN (online)	1433-7339
ISSN	0941-4355
DOI	10.1007/s00520-023-08150-2
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Zs.A 3697: Show issues

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Article ; Online: Dysphagia in head and neck cancer: prevention and treatment.

Starmer, Heather M

Current opinion in otolaryngology & head and neck surgery

2014 Volume 22, Issue 3, Page(s) 195–200

Abstract: Purpose of review: Swallowing difficulties are among the most problematic outcomes associated with head and neck cancer (HNCA) and the strategies employed to treat it. With a rising incidence of human papilloma virus-associated HNCA, a larger number of ... ...

Abstract	Purpose of review: Swallowing difficulties are among the most problematic outcomes associated with head and neck cancer (HNCA) and the strategies employed to treat it. With a rising incidence of human papilloma virus-associated HNCA, a larger number of patients are expected to survive their cancer, and therefore will be more susceptible to long-term treatment toxicities. Optimization of long-term swallowing outcomes is an important objective for those working with patients with HNCA. Recent findings: The role of the swallowing therapist in the management of patients with HNCA cannot be overstated. This begins with pretreatment evaluation of swallowing. At the time of initial assessment, education should be provided regarding treatment toxicities and the importance of prophylactic swallowing exercises and oral intake. Recent evidence suggests that maintaining an oral diet and engaging in swallowing exercise during radiation have a positive impact on diet level, swallowing physiology, patient-perceived swallowing-related quality of life, and reduced feeding tube use. Although treatment strategies such as radiation de-intensification and transoral surgical treatments show promise for reducing toxicities, evidence regarding their impact is still being amassed. Summary: Maintaining an oral diet and performing prophylactic swallowing exercises are currently the most evidence-based strategies for dysphagia prevention in HNCA.
MeSH term(s)	Deglutition Disorders/diagnosis ; Deglutition Disorders/etiology ; Deglutition Disorders/prevention & control ; Diet ; Exercise Therapy ; Head and Neck Neoplasms/complications ; Head and Neck Neoplasms/pathology ; Head and Neck Neoplasms/therapy ; Humans
Language	English
Publishing date	2014-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1232518-1
ISSN	1531-6998 ; 1068-9508
ISSN (online)	1531-6998
ISSN	1068-9508
DOI	10.1097/MOO.0000000000000044
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Zs.A 4814: Show issues

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Article ; Online: Implementation of a targeted HPV educational program in a population with HIV.

Ayoub, Noel / Sunwoo, John B / Starmer, Heather M

World journal of otorhinolaryngology - head and neck surgery

2019 Volume 5, Issue 2, Page(s) 105–111

Abstract: Patients living with human immunodeficiency virus (PLWH) are at higher risk of developing human papillomavirus (HPV)-associated malignancies. This prospective, longitudinal study evaluated the baseline knowledge of PLWH regarding HPV infection and its ... ...

Abstract	Patients living with human immunodeficiency virus (PLWH) are at higher risk of developing human papillomavirus (HPV)-associated malignancies. This prospective, longitudinal study evaluated the baseline knowledge of PLWH regarding HPV infection and its association with head neck cancer, and it aimed to determine whether a focused educational session could promote both short- and long-term knowledge acquisition in this population. Twenty-seven subjects participated in an interactive educational session and completed pre-test and immediate and delayed (4-month) post-test questionnaires. When compared to their pre-test answers, subjects demonstrated significant improvements in all 28 questions immediately following education. Knowledge preservation was demonstrated 4 months after initial evaluation, with subjects performing significantly better than their pre-test scores in 24 of the original 28 questions. These results suggest that short, focused, educational programs for PLWH may promote a better understanding of HPV's association with human immunodeficiency virus (HIV) and HPV risk factors, methods of transmission, and prevention.
Language	English
Publishing date	2019-02-23
Publishing country	China
Document type	Journal Article
ISSN	2589-1081
ISSN (online)	2589-1081
DOI	10.1016/j.wjorl.2018.09.006
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Article ; Online: Effectiveness of a Home-based Head and Neck Lymphedema Management Program: A Pilot Study.

Yao, Theresa / Beadle, Beth / Holsinger, C Floyd / Starmer, Heather M

The Laryngoscope

2020 Volume 130, Issue 12, Page(s) E858–E862

Abstract: Objective: This study aimed to compare outcomes in patients with head and neck lymphedema receiving either a home-based lymphedema treatment program or a hybrid approach including both home-based treatment and regular clinical visits.: Methods: ... ...

Abstract	Objective: This study aimed to compare outcomes in patients with head and neck lymphedema receiving either a home-based lymphedema treatment program or a hybrid approach including both home-based treatment and regular clinical visits. Methods: Outcomes were assessed in patients receiving head and neck lymphedema rehabilitation. Baseline measures of neck, submental, and facial edema were obtained and repeated following treatment. A home program was recommended for all patients, and those receiving hybrid care received the same recommendations as well as a visit with the lymphedema therapist for additional treatment. Their outcomes were compared using standard statistical analysis. Results: Fifty consecutive individuals were included, 25 in each group. Adherence to at least 50% of recommended treatment was reported in 68% of those receiving home-based treatment and 84% of those receiving hybrid care. Significant improvement was demonstrated for 66% of patients. There was no statistically significant difference between treatment groups with regard to clinically significant improvement (P = .15). Patients receiving hybrid therapy demonstrated treatment advantages regarding facial edema (P = .037). Adherence to treatment was associated with clinical improvement (P = .047). Conclusions: Comparable benefits were observed regardless of whether patients had a home-based or hybrid lymphedema treatment approach. These data suggest a home-based treatment approach may be appropriate for patients unable to participate in clinical sessions. However, for patients with significant facial edema, a hybrid approach may be preferable. Adherence was associated with better outcomes. Given these findings, future investigations should consider strategies to improve adherence to optimize the outcomes lymphedema treatment. Level of evidence: 3b Laryngoscope, 2020.
MeSH term(s)	Adult ; Aged ; Female ; Head ; Home Care Services ; Humans ; Lymphedema/therapy ; Male ; Middle Aged ; Neck ; Pilot Projects ; Program Evaluation ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2020-02-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.28549
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Article ; Online: Development and reliability of the revised Patterson Edema Scale.

Starmer, Heather M / Drinnan, Michael / Bhabra, Mandeep / Watson, Laura-Jayne / Patterson, Joanne

Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery

2021 Volume 46, Issue 4, Page(s) 752–757

Abstract: Objective: The Patterson Edema scale was developed in 2007 to address the lack of a reliable, sensitive scale to measure laryngeal and pharyngeal oedema in patients with head and neck cancer. The objective of this study was to revise the existing ... ...

Abstract	Objective: The Patterson Edema scale was developed in 2007 to address the lack of a reliable, sensitive scale to measure laryngeal and pharyngeal oedema in patients with head and neck cancer. The objective of this study was to revise the existing Patterson scale to improve its reliability and utility. Design: Prospective investigation. Setting: Academic medical center. Participants: Speech-Language Pathologists, Otolaryngologists, and Radiation Oncologists. Main outcome measures: Ratings using the Revised Patterson Edema Scale. Methods: A consensus group reviewed existing literature regarding the performance of the original Patterson scale and revised the existing scale in regard to items to be included and descriptors for each severity level. The scale was then utilised by 18 speech language pathologists from the US and UK with >2 years-experience working with dysphagia and dysphonia with endoscopy. Each SLP rated a total of eight parameters (epiglottis, vallecula, pharyngoepiglottic folds, aryepiglottic folds, arytenoids, false vocal folds, true vocal folds and pyriform sinuses) using the Revised Patterson Edema Scale. Feedback was solicited from raters regarding areas where clarity was lacking for further scale revision. Scale revisions were completed and additional ratings were completed by otolaryngologists, radiation oncologists and less experienced SLP providers to establish reliability across disciplines. Quadratic weighted Kappa values were obtained to establish interrater reliability. Results: Feedback received from raters included suggestions for clarification of how to rate unilateral oedema, use of a standard task battery to visualise and rate structures consistently, and clarification of true vocal fold oedema rating parameters. Overall interrater reliability was established using quadratic weighted Kappa with good agreement noted for the epiglottis, vallecula, arytenoids and false vocal folds; moderate agreement noted for aryepiglottic folds, pharyngoepiglottic folds and pyriform sinuses; and fair agreement noted for true vocal folds. Conclusions: The Revised Patterson Edema Scale demonstrates moderate-substantial interrater reliability for most parameters across multiple disciplines and experience levels, with the exception of the true vocal folds where agreement was fair. We believe the Revised Patterson Oedema Scale provides a reliable tool for clinicians and researchers to rate oedema in the supraglottic larynx and pharynx following treatment for head and neck cancer.
MeSH term(s)	Consensus ; Edema/classification ; Edema/etiology ; Head and Neck Neoplasms/complications ; Humans ; Larynx ; Pharynx ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Severity of Illness Index
Language	English
Publishing date	2021-02-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2205891-6
ISSN	1749-4486 ; 1749-4478 ; 0307-7772 ; 1365-2273
ISSN (online)	1749-4486
ISSN	1749-4478 ; 0307-7772 ; 1365-2273
DOI	10.1111/coa.13727
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Article ; Online: Patient Reported Outcomes and Objective Swallowing Assessments in a Multidisciplinary Dysphagia Clinic.

Dewan, Karuna / Clarke, John O / Kamal, Afrin N / Nandwani, Monica / Starmer, Heather M

The Laryngoscope

2020 Volume 131, Issue 5, Page(s) 1088–1094

Abstract: Objectives/hypothesis: Dysphagia encompasses a complex compilation of symptoms which often differ from findings of objective swallowing evaluations. The purpose of this investigation was to compare the results of subjective dysphagia measures to ... ...

Abstract	Objectives/hypothesis: Dysphagia encompasses a complex compilation of symptoms which often differ from findings of objective swallowing evaluations. The purpose of this investigation was to compare the results of subjective dysphagia measures to objective measures of swallowing in patients evaluated in a multidisciplinary dysphagia clinic. Study design: Prospective cohort study. Methods: The study cohort included all patients evaluated in the multidisciplinary dysphagia clinic over 24 months. Participants were evaluated by a multidisciplinary team including a laryngologist, gastroenterologist, and speech-language pathologist. Evaluation included a videofluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), and transnasal esophagoscopy (TNE). Data collected included diet (FOIS), Eating Assessment Tool (EAT-10) score, Reflux symptom index (RSI) score, and the findings of the VFSS exam. Results: A total of 75 patients were included in the analysis. The average EAT-10 score was 16.3 ± 2.1, RSI was 21.4 ± 0.6, and FOIS score was 6.0 ± 1.33. VFSS revealed impairments in the oral phase in 40% of the cohort, pharyngeal in 59%, and esophageal in 49%. Abnormalities were noted in one phase for 32%, in 2 phases in 32%, and three phases in 18%. Patients with abnormal pharyngeal findings on VFSS had significantly higher EAT-10 scores (P = .04). Patients with abnormal oral findings on VFSS were noted to have significantly lower FOIS scores (P = .03). Conclusions: Data presented here demonstrate a relationship between patient reported symptoms and objective VFSS findings in a cohort of patients referred for multidisciplinary swallowing assessment suggesting such surveys are helpful screening tools but inadequate to fully characterize swallowing impairment. Level of evidence: 3 Laryngoscope, 131:1088-1094, 2021.
MeSH term(s)	Aged ; Deglutition/physiology ; Deglutition Disorders/diagnosis ; Deglutition Disorders/physiopathology ; Deglutition Disorders/therapy ; Esophagoscopy/methods ; Female ; Fluoroscopy/methods ; Humans ; Male ; Middle Aged ; Patient Care Team ; Patient Reported Outcome Measures ; Prospective Studies
Language	English
Publishing date	2020-10-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.29194
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Article ; Online: Building an integrated multidisciplinary swallowing disorder clinic: considerations, challenges, and opportunities.

Starmer, Heather M / Dewan, Karuna / Kamal, Afrin / Khan, Abraham / Maclean, Julia / Randall, Derrick R

Annals of the New York Academy of Sciences

2020 Volume 1481, Issue 1, Page(s) 11–19

Abstract: Dysphagia is a complex condition with numerous causes, symptoms, and treatments. As such, patients with dysphagia commonly require a multidisciplinary approach to their evaluation and treatment. Integrated multidisciplinary clinics provide an optimal ... ...

Abstract	Dysphagia is a complex condition with numerous causes, symptoms, and treatments. As such, patients with dysphagia commonly require a multidisciplinary approach to their evaluation and treatment. Integrated multidisciplinary clinics provide an optimal format for a collaborative approach to patient care. In this manuscript, we will discuss considerations for teams looking to build a multidisciplinary dysphagia clinic, including what professionals are typically involved, what patients benefit most from this approach, what tests are most appropriate for which symptoms, financial issues, and traversing interpersonal challenges.
MeSH term(s)	Deglutition Disorders/economics ; Deglutition Disorders/therapy ; Humans ; Interdisciplinary Studies ; Patient Care Team/economics
Language	English
Publishing date	2020-07-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	211003-9
ISSN	1749-6632 ; 0077-8923
ISSN (online)	1749-6632
ISSN	0077-8923
DOI	10.1111/nyas.14435
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Article: Timing of postoperative oral feeding after head and neck mucosal free flap reconstruction.

Stramiello, Joshua / Nuyen, Brian / Saraswathula, Anirudh / Blumenfeld, Liza / Divi, Vasu / Rosenthal, Eben / Orosco, Ryan / Starmer, Heather M

Laryngoscope investigative otolaryngology

2021 Volume 6, Issue 5, Page(s) 1031–1036

Abstract: Objective: Fistula remains a common complication of upper aerodigestive tract reconstruction. Optimal timing of oral feeding is unknown and the impact of early feeding on swallow function and fistula rates remains controversial. The purpose of this ... ...

Abstract	Objective: Fistula remains a common complication of upper aerodigestive tract reconstruction. Optimal timing of oral feeding is unknown and the impact of early feeding on swallow function and fistula rates remains controversial. The purpose of this study is to better understand the effects of "early feeding" on fistula rate and swallow in patients with free flap reconstruction of upper aerodigestive tract defects. Methods: Retrospective cohort study. One hundred and four patients undergoing free flap reconstruction of mucosalized head and neck defects. Two groups, early feeding (oral intake on or before postoperative day 5) and late-feeding (oral intake after postoperative day 5). Primary outcome was incidence of salivary fistula. Secondary outcomes included Functional Oral Intake Scale scores. Results: Fistula rate was 16.5% in late-feeding group and 0% in early-feeding group ( Discussion: This cohort analysis suggests that in properly selected patients with free flap reconstruction for mucosal defects, early feeding may not increase risk of salivary fistula and may improve swallow functional outcomes earlier.
Language	English
Publishing date	2021-09-09
Publishing country	United States
Document type	Journal Article
ISSN	2378-8038
ISSN	2378-8038
DOI	10.1002/lio2.655
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