Patient Oriented Research in Communication and Swallowing Disorders

PROJECT SUMMARY Patients with head and neck cancer (HNC) are susceptible to a dramatic decline in their ability to communicate as a result of cancer treatment. HNC survivors may develop debilitating hearing loss as a result of treatment with cisplatin chemotherapy and radiation. Ototoxicity monitoring leads to early detection of hearing loss, but barriers to compliance with monitoring programs represent a missed opportunity for rehabilitation. HNC patients may also become unable to speak or swallow as a result of surgery or radiation to the larynx or pharynx. Older patients may be particularly vulnerable to speech and swallowing declines after cancer treatment, but chronologic age is a poor predictor of functional outcomes. Clinical predictors of poor swallowing and speech function are needed to inform patient counseling and shared decision making in older patients. Aim 1 of this proposal is a randomized, controlled trial comparing standard scheduling of ototoxicity monitoring visits for HNC patients versus an intervention aimed at increasing participation by scheduling remote audiograms. Patients living at considerable distance from our center or those with advanced disease will be targeted for randomization. In Aim 2, we will assess whether frailty screening tools and/or sarcopenia can be used to predict severe speech and swallowing decline in older adults treated for HNC. This K24 will also allow me to improve and expand mentoring of trainees and junior faculty in patient-oriented, NIDCD-relevant research, with a focus on mentoring of medical students interested in otolaryngology. Additional training opportunities will also allow me to expand my own patient-oriented research and mentoring skillsets, including qualitative research, health disparities, medical ethics, database analysis and advanced biostatistical analyses.