Observations of eating and drinking in head

1
Observations of eating and drinking in head
neck cancer patients

• Jo Patterson Tim Rapley
• RCSLT Conference 2009

2
Dysphagia in Head Neck Cancer

• HNC dysphagia literature based on
• Quantitative methods
• Instrumental assessments
• Biomechanical findings
• Interventions involving postures, manoeuvres,
  exercises, diet modification

3
Patients experience

• Pre-treatment (Scott 2006, Roing 2007)
• variation in symptoms, minor to major changes
• Lack of knowledge
• During treatment (Rose 2002, Larsson 2003)
• Physical symptoms, anxiety, lifestyle changes
• Early post treatment (Semple 2007, Richardson
  2002)
• Abandonment, loss of confidence
• Long-term (Roing 2008, Bjorklund 2008)
• Transformation, goal setting, adaptation

4
Methods

• 9/12 patients participated
• All reported swallowing problems
• Minimal instructions given to patient
• Patient /- partner observed at home
• Food preparation, routines, experiences
• Field notes / photographs / diagrams

5
Method
Observation
Write up
Analysis
6
Analysis
Read field notes
Discussion
Coding
7
Results

• Body changes
• Behaviour
• Oral changes

8
Body getting food down
9
Body mouth

• Taste
• Im getting a little bit of taste, I think
  having it hot helps, kinda reminds me that Im
  eating
• Sensitivity
• Dryness
• the more things I can swallow the better. Some
  days I can eat a banana some days I cant,
  depends on how slavary my mouth is, some days its
  like crying a river other days like sandpaper
• Dentures / teeth

10
Behaviour eating routines

• Meal timings
• I have to eat what I can and when I can
• Snacking

11
Behaviour variety

• Repetition
• Ive already had a couple of
• bowls of cornflakes today,I get
• sick of everything
• Boredom
• Food desire
• Shopping

12
Behaviour others

• Pleasure watching others
• Guilt
• she (wife) just picks, whereas before we
  wouldve sat down to a meal, she now has a couple
  of slices of toast
• Encouragement support
• she (wife) gets on at him, telling him to keep
  chewing and telling him to say to himself, Ill
  have just one more mouthful

13
Oral timing

• Pacing
• Time to completion
• Talking and eating
• normally Id have the porridge in a lot less
  time its just that Im talking today
• Amount

14
Oral eating manners

• Spitting
• Noises
• I dont like eating in front of people all
  the noises and slurps and I can never tell
  whether its going to go down the right way
• Mess
• Choking
• Embarrassment repair

15
Conclusions

• Eating drinking multi-dimensional, highly
  individual
• Limitations of quantitative and qualitative
  designs
• Medical and social interventions
• Patient and family
• Future research interviews