Trismus Management After Radiation Therapy In Head And Neck Cancer: A French National Survey Of Practice

The prevalence of trismus (T) after radiation therapy in head and neck cancer (HNC) ranges from 5% to 38%. There is no standardized T management for head and neck cancer patients and evidence to support any particular protocol. To gain an understanding of current usual practices, a national internet-based survey was developed and sent to all therapists treating HNC patients, as speech therapists (SLPs), physiotherapist (Pi), dentist, and osteopath (Os). Questions were generated after discussion and the agreement of all members of a HN multidisciplinary team and were hosted on a website. Therapists were contacted with an e-mail invitation containing a link to the hosting website. The internet-based questionnaire of 66 questions was administered from May 22 to December 9 2014. A total of 370 participants responded to the internet based survey, the distributions of professions of the responders were as follow: SLPs 284, Pi 50, dentist 1, and Os 35. During their initial training 12% of the interviewed therapists had education on T, 88.37% of them judged the teaching incomplete or insufficient. For 100% of Pi and Os, and 85% of SLPs considered T as part of their domain of skills. Pi considered themselves as highly qualified in 36.39% of case, Os 33.42%, SLP 32.08%. Among the professionals that support specific HN pathologies 17% Os, 32% SLPs, 26% Pi have already treated T, while 21% of Pi, 29% of SLP and 25% of Os have never treated T. For 82% of this population lack of training is the major reason. Among the professionals who do not treat specific HN pathologies the major reasons cited are “never faced this type of pathology” (79%), “not trained” (27%), “not interested” (13%). For therapists 61% of the patients had difficulty to find a professional able to treat them. Usual practices were analyzed, the results suggested that therapists intervened reactively (75%) rather than proactively (25%). However therapists are more likely to intervene with patients proactively (63%) than curatively (37%). Therapists believe in 96% of case that the exercises should be performed every day. The intensity proposed is: less than 5 min 44%, between 6 and 10 min 32%, 15 min 14%, more than 20 min 10%. For 61% of patient the therapists judged the compliance satisfactory. All the categories of therapists proposed thermotherapy (25.5%), relaxation (65%), massage (92%), passive motion exercises (82%), active motion exercises (94%), manual stretching (80%), breathing (76%), technical compensatory (82%), and use of a jaw rehabilitation device (33%). Responses from 370 therapists revealed that there is a lack of consensus regarding timing, intensity, and type of T therapy. This is undoubtedly due the lake of training, to a paucity of research addressing the efficacy of T treatments in the HNC population.