Wierzbicka Małgorzata, Kiszka Mariusz, Barnaś Szczepan, Jeziorny Mateusz, Zając Bernard, Dwornikowska-Dąbrowska Mariola, Jędruchniewicz Natalia
Department of Clinical Surgical Sciences, Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland.
Clinical Research Support Centre, 4th Military Clinical Hospital, Wroclaw, Poland.
Otolaryngol Pol. 2025 Mar 14;79(3):1-7. doi: 10.5604/01.3001.0055.0006.
<b>Introduction:</b> The Ready for Safe Cancer Treatment (RESET) tool is a structured, multimodal program designed to optimize hospitalization and enhance the quality of perioperative care for oncological patients. While RESET has been developed as a general framework for surgical oncology, its adaptation to Head and Neck Cancer (HNC) patients remains unexplored despite their unique physiological and psychological needs. HNC patients frequently face severe functional impairments affecting speech, swallowing, and respiration, as well as heightened nutritional deficiencies, sarcopenia, and psychological distress. This study explores the feasibility of tailoring the RESET tool to meet the specialized requirements of HNC patients. <br><br><b>Aim:</b> The aim of this study is to assess the feasibility of adapting the RESET to the specific needs of HNC patients. The research focuses on identifying key areas requiring modification to optimize perioperative care, including prehabilitation, nutritional support, functional rehabilitation, and psychological care. Epidemiological analysis, patient needs assessment, and a review of the core RESET modules will help determine effective strategies for improving treatment quality and recovery outcomes in this patient group. The ultimate goal is to develop a more personalized, evidence-based approach that could be implemented in oncology centers to enhance treatment outcomes for HNC patients. <br><br><b>Methods:</b> RESET is structured into four modules: pre-admission prehabilitation, advanced communication and need assessment upon admission, intra-hospital recovery optimization, and transitional care planning at discharge. This study includes a cross-sectional epidemiological assessment of HNC patient representation at two oncological centers in Poland, an analysis of prehabilitation requirements, a comparative evaluation of core RESET modules, and a gap analysis identifying necessary protocol enhancements. The proposed methodological approach integrates both quantitative and qualitative assessments to ensure a comprehensive evaluation of RESET's adaptation to HNC patients. <br><br><b>Results:</b> Data from 2023-2024 indicate that HNC patients constitute 11-25% of the total oncological population at the studied centers, demonstrating distinct demographic characteristics such as younger age distribution and extended hospitalization periods. Prehabilitation needs analysis underscores the importance of structured nutritional support, targeted muscle preservation strategies, and psychological interventions, including cognitive behavioral therapy. Additionally, core RESET module evaluations highlight the necessity of enhanced post-discharge transitional care, particularly for patients requiring tracheostomy or prolonged enteral nutrition support. The gap analysis identifies critical areas requiring reinforcement, such as comprehensive sarcopenia screening, specialized dysphagia management protocols, and a multidisciplinary approach to psychosocial rehabilitation. <br><br><b>Discussion:</b> HNC patients present unique challenges that demand tailored modifications to the RESET framework. Unlike other oncological cohorts, HNC patients are predisposed to functional impairments, high nutritional deficits, and significant psychosocial burdens. The inclusion of dedicated nutritional strategies, prehabilitation exercises, and psychological support within the RESET protocol may significantly improve treatment outcomes, reduce postoperative complications, and enhance the quality of life. Despite its structured approach, the main limitation of the RESET adaptation for HNC remains the need for dedicated funding and further validation through prospective clinical trials. <br><br><b>Conclusions:</b> Adapting the RESET tool to the needs of HNC patients has the potential to optimize perioperative care, ensuring a more individualized, evidence-based approach. The proposed modifications emphasize enhanced nutritional, physical, and psychological support, aligning RESET with the specific challenges faced by HNC patients. Further research and implementation studies are required to validate the effectiveness of this adapted framework in improving patient outcomes within oncological network hospitals.
引言:“安全癌症治疗准备就绪(RESET)”工具是一个结构化的多模式项目,旨在优化住院流程并提高肿瘤患者围手术期护理质量。虽然RESET已被开发为外科肿瘤学的通用框架,但尽管头颈癌(HNC)患者有独特的生理和心理需求,其对该类患者的适用性仍未得到探索。HNC患者经常面临严重的功能障碍,影响言语、吞咽和呼吸,同时营养缺乏加剧、肌肉减少症和心理困扰也更为突出。本研究探讨了调整RESET工具以满足HNC患者特殊需求的可行性。
目的:本研究的目的是评估调整RESET以满足HNC患者特定需求的可行性。该研究重点在于确定需要修改的关键领域,以优化围手术期护理,包括术前康复、营养支持、功能康复和心理护理。流行病学分析、患者需求评估以及对RESET核心模块的审查将有助于确定改善该患者群体治疗质量和康复结果的有效策略。最终目标是制定一种更个性化、基于证据的方法,可在肿瘤中心实施以提高HNC患者的治疗效果。
方法:RESET分为四个模块:入院前康复、入院时的高级沟通与需求评估、院内恢复优化以及出院时的过渡护理规划。本研究包括对波兰两个肿瘤中心HNC患者代表性的横断面流行病学评估、术前康复需求分析、RESET核心模块的比较评估以及确定必要方案改进的差距分析。所提出的方法学方法整合了定量和定性评估,以确保对RESET适应HNC患者的情况进行全面评估。
结果:2023 - 2024年的数据表明,HNC患者占研究中心肿瘤患者总数的11% - 25%,显示出不同的人口统计学特征,如年龄分布更年轻和住院时间延长。术前康复需求分析强调了结构化营养支持、针对性肌肉保留策略以及心理干预(包括认知行为疗法)的重要性。此外,RESET核心模块评估突出了加强出院后过渡护理的必要性,特别是对于需要气管切开术或长期肠内营养支持的患者。差距分析确定了需要加强的关键领域,如全面的肌肉减少症筛查、专门的吞咽困难管理方案以及心理社会康复的多学科方法。
讨论:HNC患者面临独特的挑战,需要对RESET框架进行针对性修改。与其他肿瘤患者群体不同,HNC患者易出现功能障碍、高营养缺乏和重大心理社会负担。在RESET方案中纳入专门的营养策略、术前康复锻炼和心理支持可能会显著改善治疗效果、减少术后并发症并提高生活质量。尽管采用了结构化方法,但RESET适应HNC的主要局限性仍然是需要专项资金以及通过前瞻性临床试验进行进一步验证。
结论:使RESET工具适应HNC患者的需求有可能优化围手术期护理,确保采用更个性化、基于证据的方法。所提出的修改强调加强营养、身体和心理支持,使RESET与HNC患者面临的特定挑战相匹配。需要进一步的研究和实施研究来验证这种调整后的框架在肿瘤网络医院改善患者结局方面的有效性。