title: Multidisciplinary head and neck cancer clinic and adherence with speech pathology.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, # Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. hstarme1@jhmi.edu
authors.forename: Heather
authors.initials: H
authors.lastname: Starmer
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sanguineti
authors.forename: Shanthi
authors.initials: S
authors.lastname: Marur
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D002173:Cancer Care Facilities; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000628:therapy*; D010348:Patient Care Team; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000379:methods; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013066:Speech-Language Pathology; D016896:Treatment Outcome