Background:
Excessive oropharyngeal secretions are a frequent side effect from head & neck cancer (HNC) due to dysphagia, odynophagia & malignancy post HNC (Mercadante et al 2015). Treatment related side effects in HNC can negatively impact quality of life (Mason et al 2016). Speech & Language Therapists (SLTs) work closely with the HNC Multidisciplinary team (MDT) to assess & manage dysphagia & oropharyngeal secretions.
Prior to the introduction of this pathway, pharmacological management involved recommending anticholinergic drugs e.g. Hyoscine, to manage oropharyngeal secretions for HNC patients, with little regard for the undesirable risks and consequences. The new pathway now commences with low dosage Glycopyrronium Bromide as a first choice, followed by Atropine sublingual drops and finally Hyoscine.
The aim of this project is to implement a pathway for the pharmacological management of secretions in HNC in SVUH to improve patient care.
Methods:
A pathway for the management of oropharyngeal secretions was developed. In order to establish this into practice, an in-depth review of dosages and contraindications was carried out by Pharmacy in SVUH. The pathway was submitted to Drugs & Therapeutic Committee for review and subsequently implemented into practice.
Results:
This pathway is being implemented for suitable HNC patients in SVUH. Patients are carefully selected as per pathway and the contraindications are carefully considered by the MDT.
Conclusion:
The implementation of a secretion pathway ensures that there is a protocol for pharmacological management of oropharyngeal secretions in patients with HNC. A MDT approach is fundamental in the successful management in HNC (Monreal et al 2022).
Susie Downes 1 , A Joyce 1 , M O'Sullivan 2 , Fergal O’Duffy 3
1 Department of Speech and Language Therapy, St Vincent’s University Hospital, Dublin
2 Department of Pharmacy, St Vincent’s University Hospital, Dublin
3 Department of Otolaryngology & Head& Neck Surgery, St Vincent’s University Hospital, Dublin