Summary of the Clinical Practice Guideline

Article Citation

Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

Forastiere, A. A., Ismaila, N., et al. (2018).
Journal of Clinical Oncology, 36(11), 1143-1169.
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American Society of Clinical Oncology

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Article Details

Description

This is an update of a 2006 guideline providing recommendations for larynx-preservation strategies for individuals with laryngeal cancer. Intended audiences include oncologists, surgeons, nurses, oncology pharmacists, and speech-language pathologists.

Evidence Ratings for This Document

Recommendations were classified according to their type and strength. Type of Recommendation is based on how each recommendation was developed, with types defined below:

  • Evidence-based: Sufficient evidence was available to formulate a clinical practice recommendation
  • Formal Consensus: Due to insufficient available evidence, recommendation was based on a formal consensus process within the Expert Panel
  • Informal Consensus: Due to insufficient available evidence, and agreement of the Expert Panel that formal consensus was unnecessary, recommendation was based on what is considered by the Expert Panel to be best current clinical practice guidance
  • No Recommendation: Due to insufficient available evidence, agreement, or confidence, no clinical practice guidance is provided

Strength of Recommendation is based on the development group's confidence that each recommendation reflects best practice, and the extent of the Expert Panel's agreement. Ratings defined below:

  • Strong: High confidence; recommendation based on strong evidence of true net effect (e.g., benefits exceed harms), consistent results, and no or minor concerns about study quality
  • Moderate: Moderate confidence; recommendation based on good evidence of true net effect (e.g., benefits exceed harms), consistent results, and few or minor concerns about study quality
  • Weak: Some confidence; recommendation based on limited evidence of true net effect (e.g., benefits exceed harms), consistent results with important exceptions, and study quality concerns

Quality of Evidence to support the recommendation is evaluated according to the confidence that available evidence reflects the true direction and magnitude of the net effect (i.e., balance of benefits and harms), and likelihood of further research to change the direction and/or magnitude of the net effect. Ratings are defined as follows:

  • High: High confidence; further research very unlikely to change magnitude/direction of net effect
  • Intermediate: Moderate confidence; further research unlikely to change direction of net effect, but may change magnitude
  • Low: Low confidence; further research may change magnitude/direction of net effect
  • Insufficient: Insufficient evidence to determine true magnitude/direction of net effect; expert opinion/consensus is reasonable to inform this topic's related outcomes

Recommendations from This Guideline

What are Recommendations?

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Assessment

Pre- and post-treatment function should be evaluated with "instrumental, performance status, and quality-of-life measures of voice and swallowing" (p. 1147). Examples of routine assessment methods include:

  • "self-recorded and/or expert-rated voice-quality measures; 
  • voice-related quality-of-life tools; 
  • videostroboscopy; 
  • radiographic (videofluoroscopic) or fiber-optic laryngoscopic evaluation of swallowing; and
  • dietary assessment (Type [of recommendation]: evidence-based, benefits outweigh harms; Quality of evidence: intermediate; Strength of recommendation: moderate"; p. 1147). 

Keywords: Quality of Life, Cancer Type/Location, Laryngeal, Speech/Voice, Swallowing

Patients should receive baseline voice and swallowing assessment as part of comprehensive pre-treatment evaluation. Assessment should include "voice (use and requirements), and counseling with regard to the potential effect of treatment options on voice, swallowing, and quality of life" (p. 1147), as well as establishing "the functional impact of tumor volume and extent and stage of disease on voice and swallowing outcomes (Type [of Recommendation]: evidence-based, benefits outweigh harms; Quality of evidence: intermediate; Strength of recommendation: moderate"; p. 1147).

Keywords: Counseling and Education, Timing (e.g. Pre-/Post-Cancer Treatment), Pre-Cancer Treatment, Cancer Type/Location, Laryngeal, Speech/Voice, Swallowing

"Selection of therapy for an individual patient requires assessment by the multidisciplinary team as well as consideration of voice and swallowing function; patient comorbidity, psychosocial situation, and preferences; and local therapeutic expertise. The multidisciplinary team should include surgical oncology, medical oncology, radiation oncology, speech pathology, radiology, pathology, nursing, dietetics, psychology, and a variety of rehabilitative services, including dental/prosthodontics, smoking cessation, and other ancillary services as required for such things as pain management and psychosocial support (Type [of Recommendation]: evidence-based, benefits outweigh harms; Quality of evidence: intermediate; Strength of recommendation: moderate"; p. 1147)

Keywords: Provider (e.g. SLP/Audiologist/Caregiver), Head and Neck Cancer, Adults, Cancer Type/Location, Laryngeal

Treatment

Patients should receive baseline voice and swallowing assessment as part of comprehensive pre-treatment evaluation. Assessment should include "voice (use and requirements), and counseling with regard to the potential effect of treatment options on voice, swallowing, and quality of life" (p. 1147), as well as establishing "the functional impact of tumor volume and extent and stage of disease on voice and swallowing outcomes (Type [of Recommendation]: evidence-based, benefits outweigh harms; Quality of evidence: intermediate; Strength of recommendation: moderate"; p. 1147).

Keywords: Counseling and Education, Timing (e.g. Pre-/Post-Cancer Treatment), Pre-Cancer Treatment, Cancer Type/Location, Laryngeal, Speech/Voice, Swallowing

Service Delivery

"Selection of therapy for an individual patient requires assessment by the multidisciplinary team as well as consideration of voice and swallowing function; patient comorbidity, psychosocial situation, and preferences; and local therapeutic expertise. The multidisciplinary team should include surgical oncology, medical oncology, radiation oncology, speech pathology, radiology, pathology, nursing, dietetics, psychology, and a variety of rehabilitative services, including dental/prosthodontics, smoking cessation, and other ancillary services as required for such things as pain management and psychosocial support (Type [of Recommendation]: evidence-based, benefits outweigh harms; Quality of evidence: intermediate; Strength of recommendation: moderate"; p. 1147)

Keywords: Provider (e.g. SLP/Audiologist/Caregiver), Head and Neck Cancer, Adults, Cancer Type/Location, Laryngeal

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