Implementation of a Self-Help Swallowing Exercise Program in Head and Neck Cancer.

The study measured whether centres adopted and delivered Head Matters, not whether patients' swallowing, speech, voice or shoulder problems improved. Implementation was counted if at least one patient received the program, so implemented does not mean routine use for all eligible patients. Professionals reported their own views through a questionnaire. At baseline, 101 started and 74 completed all items; at 1 month, 52 started and 45 completed; at 1 year, 12 were invited and all participated, and only two hospitals reached the 1-year time point. Patient perspectives and patient-reported burden were not included. Non-SLP professionals were analysed as one group because each discipline had few respondents, so differences between physiotherapists, surgeons, oncologists, dietitians and others cannot be separated. The interviews did not include centres that adopted but did not implement, so reasons for failure to deliver may be less detailed. The study was done in the Netherlands in a centralized head and neck cancer network, so transfer to other countries or less coordinated systems may be limited. The coordinator role was important but its time and cost were not quantified.

The authors declared no conflicts of interest. The study was supported by the Maarten van der Weijden Foundation.

Do not read the high adoption and implementation rates as evidence that Head Matters prevents or improves swallowing problems. This study evaluated whether centres and professionals adopted and delivered the program. It did not report patient swallowing outcomes, and professionals noted limited long-term outcome data.