Background
Head and neck cancer is the seventh most common cancer worldwide with over 930,000 new cases annually. In the UK, there has been an exponential rise in the number of people with oropharyngeal (tonsil or back of the tongue) cancer. This is largely attributed to the human papillomavirus (HPV). Patients are typically younger at diagnosis and fortunately have good survival outcomes. They are often treated using a combination of surgery (either laser or robotic surgery), followed by a course of radiotherapy, which is sometimes combined with chemotherapy. This combination of treatment can be gruelling, leaving people with substantial side effects, including major changes to the ability to eat and drink.
The challenge
Radiotherapy is a highly effective treatment for curing oropharyngeal cancer – but it can result in scarring (or fibrosis) of the swallowing muscles. Fibrosis can progress over time, making it extremely difficult to eat and drink. Speech and language therapists can help, but reversing fibrosis is very challenging. Patients with long-term swallowing problems can experience medical complications such as dehydration, malnutrition and repeated chest infections. Importantly, their quality of life can be affected, reducing people’s social lives, increasing loneliness, anxiety and depression.
Our research
PATHOS is a large, international, randomised control trial, led by Professor Terry Jones (University of Liverpool) and Professor Mererid Evans (Cardiff University). The trial is looking at whether ‘de-intensifying’ or reducing the amount of radiotherapy and chemotherapy treatment can prevent swallowing difficulties while also maintaining the existing excellent survival outcomes.
Swallowing outcome measurement for PATHOS is led by Professor Jo Patterson (University of Liverpool) and Professor Kate Hutcheson (MD Anderson Cancer Centre, Texas). Previously, there were no recommended standards or procedures for swallowing assessment following head and neck cancer treatment. PATHOS has resulted in a harmonised swallowing outcome package, used nationally and internationally. This package has been adopted in other multi-centre trials, laying the foundation for future meta-analysis.
Harnessing the speech and language workforce
Speech and language therapists are involved in research delivery across 32 UK PATHOS centres – a section of the workforce formerly under-utilised for research purposes. We have created an international community of practice, fast-tracking knowledge exchange and addressing implementation to clinical care.
Our research has led to several other related studies, with two speech and language therapists under-taking a PhD at the University of Liverpool to 1) develop valid and reliable clinical swallowing assessments 2) identify predictors of swallowing difficulties after surgery.
Research with impact
Ultimately, PATHOS, if it proves to be a positive trial, will:
- Optimise swallowing function for people with HPV positive oropharyngeal cancer, reducing the burden for patients, their families and healthcare resources.
- Deepen our understanding of swallowing assessment, setting a standard for outcome measurement.
- Provide a research-ready speech and language therapy workforce.