Title: Resources for Living (R4L) Pilot: Exploring the Potential of Progressive Cuisine for Quality of Life Improvement for Head and Neck Cancer Survivors
Funder: Department of Health (England)

Abstract: Head and neck treatments, while life saving, may result in reduced ability to swallow (dysphagia) and a reduced quality of life. As the age range of suffers is decreasing and more people will be living longer with dysphagia, there is an increased need to develop support for survivors. However, because the individual experience of dysphagia varies and survivors food preferences are diverse, there has been little research that has addressed how to support survivors, or to address their diminished social experience of food and eating. In pilot work, foods were developed using progressive cuisine including textural modification techniques such as foaming. Techniques and foods were found to be of great value both in making foods easier to swallow, more enjoyable to create, and more palatable and gratifying to eat. Aims and research question This is an ‘internal pilot’ study to scrutinise the potential of progressive cuisine to improve head and neck cancer survivors' eating and relationships with food. The research involves survivors at every stage of the process. The product of the research will be a paper based ‘Resources for Living’(R4L) guide containing recipes, comparative reviews and commentaries by survivors, 'translated' scientific information and psychosocial hints and tips. Through an interative development cycle with input from survivors, researchers and key experts, we will ensure that the R4L is based on robust science and has been expertly verified. Plan of investigation The research programme consists of two interlinked work packages. One is focused on documenting and understanding the qualitative experience of food, generation of new insights using progressive cuisine, and psychosocial input to develop coping strategies. The qualitative component will involve parallel strands of 8 workshops, with 6-8 people per workshop, involving food play and discussion with a chef and the research team, and semi-structured discussion on psychosocial challenges. The workshops will be observed and video recorded and results analysed using qualitative methods. The research team includes survivors who have been purposively recruited as ‘experts’ and who will receive training in data collection and analysis. Workpackage 2 is focused on quantifying how and why certain survivor selected foods are easier to swallow, and documenting variation between survivors. Five expert survivors will participate in instrumental swallow assessments to characterise and quantify swallow physiology, using model foods and textures developed and selected in workshops. Assessments will be conducted in a NHS setting by NHS staff in the presence of a SALT nurse . This will involve the use of videoflouroscopy and dopler ultrasound to establish the relationships between properties of the product, the mouth and throat anatomy and physiology, and ease of swallow. Summary of benefits to survivors and NHS The study will confirm the potential of progressive cuisine to benefit head and neck cancer survivors and other patient groups with swallow and eating challenges. The study will inform a future stepped wedge design RCT grant application in which we formally test the feasibility and acceptability of the R4L guide and its efficacy. The R4L is a package of support which will include recipes, food preparation techniques, advice on health and safety, and psychosocial tips and hints. The exact format will be developed following this research. The development of a R4L package has the potential to significantly extend the cooking and coping skills of survivors and their partners and to expand the range of foods that they can consume (while ensuring food materials are nutritious and safe - i.e. not aspirated into the airway- with minimal pharyngeal residue). We anticipate the main benefit for survivors will be choice about foods that are easier and more gratifying to eat, and improved quality of life.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: CANCER AND NEOPLASMS