Determining functional outcome criteria in wait list assessment for patients with head and neck cancer

Abstract

The purpose of this study was to contribute to the development of a waiting list prioritization tool, the Jaw Reconstruction Rehabilitation (JRR) tool, for use with head and neck cancer patients who are waiting for oral rehabilitation with osseointegrated implants. The JRR had previously included subjective ratings of speech and swallowing function after reconstructive surgery that were made by a maxillofacial prosthodontist (MFP). However, these ratings were not found to be predictive of patient urgency ratings (based on function and other relevant factors) that were made by the same clinicians. This was of concern given the importance of function to patients. The current study involved the addition of two objective performance-based measures of function: the Modified Barium Swallow Impairment Tool (MBSImp) and the Computerized Assessment of Intelligibility in Dysarthric Speakers (C-AIDS), and two patient-reported measures of function: the M.D. Anderson Dysphagia Inventory (MDADI) and the Speech Handicap Index (SHI). Regression analysis indicated that the JRR tool, even with the addition of the new outcome measures, is only a weak predictor of the statistical variance in patients’ urgency ratings and, thus, should not be used as a prioritization tool. Recommendations for future work on the development of this tool include the addition of inter-rater reliability testing and training clinicians to use the tool.