Page 186 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

184
Chapter 7
The model was developed for use with patients receiving primary CRT and all included patients were offered preventive swallowing exercises. Given the specific population for which the model is intended (advanced head and neck cancer patients with CRT, all enrolled in a preventive exercise program), we would not recommend using it for clinical decision making tool with patients receiving other HNC-treatment, unless with utmost caution.
The same data was used to develop as well as evaluate the model. Ideally, future research includes external validation of the models discrimination, calibration and net benefit, in comparable as well as more heterogeneous populations. However, since the currently presented model is the best available evidence and its application is not associated with serious risks, in our view the model can be used in clinical practice prior to external validation to provide the clinician with an estimation of the risk.
The risk on prolonged feeding tube dependency may also be influenced by timing of tube placement and by other factors that are not known prior CRT, such as weight loss and mucositis evolving during treatment. Future research should look into the value of including such factors as predictors in a time-updated risk prediction model, which allows for recalculation of the risk at each moment in time, by incorporating the change in clinical status.
CONCLUSION
The developed risk prediction model can be used to select patients for proactive feeding tube placement during primary CRT for HNC. The nomogram with easily obtainable parameters is a useful tool for clinicians to estimate the risk on prolonged feeding tube dependency to support shared decision making regarding tube placement.