Rehabilitation Care Pathway - East Midlands Cancer Network

National Cancer Action Team
Rehabilitation
Care Pathway
Head & Neck

Rehabilitation Care Pathway Head & Neck
Pre Diagnosis
Drop Down Pathways
Anorexia & cachexia
Dysphagia
Fatigue & energy management
PD1 Assessment
a Assess respiratory, functional & mobility status and
treat as necessary
b Ensure optimum and timely access to specialist
assessment & rehabilitation service for all patients.
PD2 Cognitive & Psychological Factors
a Assess & plan anxiety management programme in
order to provide confidence for patient &/ or carers in
management of condition & lifestyle
PD3 Communication
PD4 Information/Support
a Provide information on role & scope of specific AHPs,
referral process & development of therapeutic
relationship
b Advise on AHP clinic availability for patients requiring
rapid access to supportive care
PD5 Nutrition
a Assess nutritional requirements & factors affecting
potential nutritional status
b Provide practical dietary advice
c Influence organisational approach to provision of food
PD6 Referral/Liaison
a Refer to identified AHP for assessment
b Refer using generic AHP/oncology assessment tool
during assessment by medical/nursing/AHP staff doing
the screening
a As specific cancer symptoms emerge, undertake
swallowing & communication assessment
2

Rehabilitation Care Pathway Head & Neck
Diagnosis & Care Planning
Drop Down Pathways
Anorexia & cachexia
Fatigue & energy management
Mobility problems/ loss of function
Dysphagia
D1 Assessment
a Undertake baseline holistic care assessment
considering quality of life, anxiety & depression,
smoking & alcohol use, lifestyle & treat as appropriate
b Integrate with pre-treatment assessment & provide
follow-up clinics
c Support patient consent process
d Ensure understanding of high risk patients & comorbidities
e Assess speech, voice and swallowing
D2 Communication
a Establish case history, current extent of disease &
proposed form of treatment.
b Screen for communication difficulties
c Liaise with previous AHPs, social services, PCT
colleagues & provide AHP differential diagnosis
d Provide pre-treatment AHP clinic
e Assess current communication skills & level of cognitive
functioning
f Ensure onward appropriate referral to colleagues &
other AHPs
g Provide equipment &/ or intervention to support
communication
h Liaise with medical staff on proposed cancer treatment
plan
i surgical voice restoration (SVR) programme – advise
surgeon on appropriate method of rehabilitation of
communication
j Provide prophylactic therapy programme before
treatment starts
k Link with other centres / teams on hand over of care
l Facilitate contact with other patients & make referral
to support groups
m Provide information & ensure patient choice in
decision of treatment (advocate)
D3 Exercise & Physical Well Being
a Optimise physical & respiratory fitness prior to
treatment
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Rehabilitation Care Pathway Head & Neck
D4 Nutrition
a Influence organisational approach to provision of food
b Implement nutritional screening
c
Assess nutritional requirements & status
d Assess factors affecting nutritional intake
e Assess patient’s circumstances & ability to act on
dietetic and SLT advice
f Provide practical dietary advice, including written
information tailored to individual’s needs, prognosis &
circumstances
g Liaise with other health professionals in the oncology
team
h Provide ongoing monitoring & support to patient,
family & carers
i Draw up & review nutritional care plans to achieve
optimal nutritional status
j Where necessary, consider alternative methods of
nutrition support & provide advice & support for
health care professionals, patients & relatives
D5 Referral/Liaison
a Liaise with MDT on treatment planning and
management of primary disease
b Attend AHP led independent or combined clinic/
appointment
Treatment
Drop Down Pathways
Anorexia / Cachexia
Breathlessness
Dysphagia
Fatigue & energy management
Lymphoedema
Mobility problems/ loss of function
Pain
Intervention
T1 Assessment
a Provide ongoing holistic assessment of function,
quality of life, anxiety & depression as appropriate
b Assess respiratory status, functional status & mobility
status
c Assess mobility & provide treatment
d Undertake musculoskeletal assessment
e Carry out interventional assessments
f Undertake joint dietetic & speech and language
therapy assessments
g Undertake assessment & provide rehabilitation for all
patients with emergence of symptoms/ side effects
affecting independent functional status
4

Rehabilitation Care Pathway Head & Neck
h Undertake pre-surgical assessment in clinic as
appropriate
i
j
Undertake instrumental assessments of communication
& / or swallowing
Carry out holistic communication assessment
k Undertake airway assessment
l
Re assess swallow function & instigate dysphagia
therapy (see dysphagia pathway)
T2 Cognitive & Psychological Factors
a Provide techniques to help manage anxiety and mood
b Provide body image management
T3 Communication
a Re assess communication status
b Work with MDT to ascertain the cause of speech,
language, swallowing or voice difficulty
c
Check & analyse medical & surgical notes & decide on
appropriate treatment plan
d Attend theatre & liaise with surgeons on SVR
techniques
e Support, teach & advise relatives of appropriate
communication channels
f
Provide equipment & materials and teach their use to
patients and carers
g Carry out voice, speech & communication therapy
h Carry out videofluoroscopy X-ray if appropriate for
investigation of poor voicing
i
j
Liaise with family
Liaise with local services
k Liaise with MDT
l Instigate the whole programme for surgical voice
restoration (SVR) and prepare for voice prosthesis
fitting including selection of appropriate prosthesis &
preparation of patient
m Fit voice prosthesis & teach patient, family, carers,
nursing staff as appropriate about care & maintenance
n Trouble shoot re voice prosthesis management & liaise
with MDT
o Give patient appropriate oro-motor range of motion &
strengthening exercises in collaboration with the
medical/surgical teams
T4 Exercise & Physical Well Being
a Teach exercises for neck, shoulder, facial,
temperomandibular joint & any other area affected by
plastic reconstruction to ensure reduction in pain,
recovery of movement & improve function
5

Rehabilitation Care Pathway Head & Neck
b Advise on fibrosis pre treatment & treat if appropriate
with soft tissue massage
c
Undertake musculo-skeletal assessment of neck and
TMJ and treat as appropriate
d Assess/ manage range of movement – assess any other
musculoskeletal problems related to any plastic surgery
e Advise on exercise programme in conjunction with SLT
f
Assess & treat facial nerve palsy
g Advise on symptom control
h Advise on support services
T5 Nutrition
a Manage rehabilitation for feeding tube dependent
patients
b Manage nutritional status
c
Start/continue nutritional support (oral/ enteral/
parenteral nutrition)
d Advise on specific diets
e Provide advice on weaning from enteral tube feeding
to oral diet
f
Provide education regarding feed tube management &
the administration of feed
g Coordinate enteral feeding tube discharges & ensure
referral to community services for continued support
h Provide on-going advice on diet, texture modification
& quantity of food based on treatment side effects &
nutritional status
i Start/continue enteral nutritional support &
management for type of feeding tube & on-going
education regarding care
j Liaise with home enteral feeding team for changes to
feeding regime
k Influence organisational approach to provision of food
T6 Referral/Liaison
a Refer to extended members of the team
b Screen for facial problems & refer to other AHPs for
assessment & management
c Contribute to complex discharge planning as part of
MDT
d Ensure dedicated oncology specialist is made available
for all head & neck patients
e Identify complex discharge needs & instigate discharge
planning in liaison with MDT in Assessment Clinic
T7 Respiratory
a Carry out respiratory assessment
b Assist patient to manage respiratory function including
tracheostomy care & weaning
6

Rehabilitation Care Pathway Head & Neck
c Identify patient with or without pre-existing
respiratory disease if patient is to be referred for
surgery
d Commence chest physiotherapy to suit individual
requirements
e Advise on selection, care and use of laryngectomy
tracheostoma valves
f Advise on selection, use & care of laryngectomy stoma
filters/ heat & moisture exchangers
T8 Work, Leisure & Activities of Daily Living
a Advise, assess, treat & support as indicated to maintain
patient’s independence in all activities of daily living
b Advise on compensatory techniques especially
following major head & neck reconstructions
c Assist patient to manage lifestyle & symptoms
d Provide rehabilitation classes to help improve
functional ability
e Respond to variations in functional status
f Maintain awareness of wider issues of cancer prognosis
& the impact of treatment on self image
g Provide ongoing monitoring
Post Treatment
Drop Down Pathways
Anorexia / Cachexia
Dysphagia
Fatigue & energy management
Lymphoedema
Pain
Intervention
PT1 Assessment
a Provide outreach or locality based multi-disciplinary
AHP team for ongoing monitoring & reassessment of
needs in line with changing clinical condition/
functional status at home
b Undertake ongoing respiratory assessment & manage
respiratory problems including tracheostomy care &
weaning
c Undertake mobility assessment & treat if appropriate
d Assess for timely removal & coordination of procedure
for removal of the feeding tube
e Provide ongoing interventional assessment &
therapeutic intervention for swallowing problems &
communication disorders
f Undertake joint dietetic & speech & language therapy
assessments including communication status
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Rehabilitation Care Pathway Head & Neck
PT2 Cognitive & Psychological Factors
a Help provide psychological support on side effects of
treatment & refer as necessary to psychological services
PT3 Communication
a Re-assess status of Surgical Voice Restoration
b Change prosthesis when necessary and troubleshoot
problems
c
Undertake assessment (endoscopy) & treat any
identified vocal cord palsy/ dysfunction
d Ensure out-patient follow up with specialist AHP
e Train & provide support to local services
f
Agree protocol with family
g Carry out assessment at X-ray for voice problems with
laryngectomy patients & advise re appropriateness of
Botox injections
h Refer to self-help group
i Continue oromotor range of motion, articulation &
strengthening exercises to facilitate oral
communication
j Provide & maintain equipment and teach patients &
carers appropriate use
k Refer to other health care professionals for assessment
as necessary
l
Advise MDT on signs of recurrence or complications &
provide appropriate advice & interventions
PT4 Exercise & Physical Well being
a Provide exercises for neck, shoulder, facial,
temperomandibular joint & relevant area of plastic
reconstruction to ensure reduction in pain, return of
movement & to improve function
b Provide advice on scar management & posture
PT5 Information/Support
a Provide SLT led clinic session
PT6 Nutrition
a Continue to monitor nutritional status & manage
symptoms secondary to treatment related symptoms
b Provide rehabilitation for feeding tube dependent
patients
c Provide ongoing nutritional support & symptom
control with weaning from enteral tube feeding to
oral diet
d Monitor ongoing changes to home enteral feeding
needs & communicate with relevant individuals
e Undertake joint dietetic & speech & language therapy
assessments
8

Rehabilitation Care Pathway Head & Neck
PT7 Referral/Liaison
a Attend MDT & contribute to discussions re ongoing
treatment plan
b Ensure AHP representation within the MDT Clinic
(acute or community based)
c
Refer to outpatient physiotherapy with specific
physical problems following treatment
d Screen for facial problems & refer to AHPs for
assessment & management
e AHPs to liaise with keyworker
f
Refer to local support team
g Communicate with relevant professionals involved in
patient care
h Ensure joint working between AHPs & CNS for
intensive rehabilitation & ongoing assessment of
quality of life, anxiety & depression as appropriate
PT8 Work, Leisure & Activities of Daily
Living
a Respond to variations in functional status
b Maintain awareness of wider issues of cancer prognosis
& impact of surgery on self image
c Provide ongoing monitoring & support to maintain
patient’s independence in all activities of daily living
Monitoring & Survivorship
Drop Down Pathways
Anorexia / Cachexia
Dysphagia
Fatigue & energy management
Lymphoedema
Pain
Poor Mobility and loss of function
Intervention
M1 Assessment
a Provide ongoing assessment of quality of life, anxiety
& depression as appropriate
b Undertake interventional assessments
c Undertake joint dietetic & speech & language therapy
assessments
M2 Cognitive and Psychological Factors
a Complete holistic initial assessment including social,
psychological, functional, cognitive & perceptual areas
b Assess & plan anxiety management programme in
order to provide confidence for patient &/ or carers in
management of condition
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Rehabilitation Care Pathway Head & Neck
M3 Communication
a Check for signs of recurrence & deteriorating
symptoms and refer to medical / surgical teams if
concerned
b Liaise with core MDT clinic on regular basis to review
patient progress
c Liaise with work environment re communication needs
and aids
d Select, provide and maintain communication aids
e Liaise to provide financial support as appropriate
f Provide ongoing support to PCT colleagues
g Link with user partnership group
h Undertake re-assessment of needs on a regular basis
i Re-assess status of Surgical Voice Restoration (SVR)
j Change prosthesis when necessary and troubleshoot
problems
k Carry out assessment at X-ray for voice problems with
laryngectomy patients & advise re appropriateness of
Botox injections
l Provide & maintain equipment and teach patients &
carers appropriate use
m Refer to other health care professionals for assessment
as necessary
n Advise MDT on signs of recurrence or complications &
provide appropriate advice & interventions
M4 Information/Support
a Encourage links to support groups
b Manage longer term effects of treatment
M5 Nutrition
a Provide rehabilitation for feeding tube dependent
patients
b Influence organisational approach to provision of food
M6 Referral/ Liaison
a Attend MDT & make recommendations on changing
treatment plan
b Support patients to re-engage in graded social
activities
M7 Work, Leisure & Activities of Daily
Living
a Advise on maintaining role at work or re-engaging in
work place
b Support patients to re-engage in graded social
activities
c Encourage lifestyle modifications
d Assess patients for needs such as psychological support
& other support groups
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Rehabilitation Care Pathway Palliative & EOL
Palliative Care
Drop Down Pathways
Anorexia/cachexia
Breathlessness
Communication
Dysphagia
Fatigue
Lymphoedema
Pain
Mobility & loss of function
Spinal cord compression
Intervention
P1 Assessment
a Carry out comprehensive social assessment
b Undertake functional assessment
c Undertake assessment of cognitive & psychological
ability
d Undertake holistic needs assessment
e Provide ongoing assessment of quality of life, anxiety
& depression, psychological & social needs as
appropriate
f Provide ongoing assessment and feedback to multidisciplinary
team about symptoms such as pain,
breathlessness, fatigue, depression, low mood
g Agree patient centred goals
P2 Cognitive & Psychological Factors
a Assess & assist in management of anxiety & refer on to
appropriate specialist
b Provide anxiety management, relaxation & structured
sleep strategies
c Manage mood through compensatory strategies &
engagement in meaningful occupations
d Retrain and/or educate as necessary in order to help
patient with cognitive & perceptual dysfunction
e Identify psychological needs & provide psychological
support to patients & carers
P3 Communication
a Assess communication skills and capacity to make
informed decisions
b Assess ability to communicate/ convey needs relating to
pain, care, place of death & drawing up will
c Educate patient, carers and healthcare professionals on
optimal communication methods for individual patient
d Implement communication strategies to optimise
communication function
e Trial, prescribe and train in use of communication aids
if required
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Rehabilitation Care Pathway Palliative & EOL
P4 Exercise & Physical Well Being
a Assess current function, mobility, muscle power,
fatigue and general weakness
b Apply restorative or compensatory therapy
interventions where appropriate
c
Advise on pacing, relaxation and controlled exercise
d Provide exercise classes to maintain/improve physical
and psychological functioning and quality of life taking
into account variations in health status
P5 Equipment Provision
a Provide aids/ equipment to support daily living & self
management techniques to optimise management of
activities of daily living
P6 Fatigue
a Assessment and intervention as appropriate with
energy conservation techniques, goal planning, pacing,
diet, exercise and anxiety management
b Ensure treatable causes of fatigue are ruled out by
referral to other disciplines
P7 Information/ Support
a Ensure good communication and coordination
between the various care settings and professions
b Be involved in discussions on preferred priorities and
place of care
c Provide education & support to patient, family & carers
d Provide information prescription & leaflet with links to
charities & support groups
e Enable informed decision making with regards to
treatment & management
f Consider ethical issues & goals of treatment to improve
quality of life
P8 Mobility
a Assess mobility including function, strength, sensation,
joint range, coordination and potential risks (refer to
mobility and loss of function pathway)
b Stabilise/immobilise unstable areas using braces, splints
and positioning
c Help patient to optimise function & assess risk assisting
with activities for the treatment of physical
dysfunction, impaired motor, sensory & self
maintenance skills
d Carry out wheelchair assessment & prescription
including associated pressure relieving cushions
e Assess for specialist & complex seating and/ or
positioning in bed
f Carry out manual handling training & assessment
g Assess the need for and provide hoists at home
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Rehabilitation Care Pathway Palliative & EOL
P9 Nutrition
a Implement nutritional screening at each outpatient
visit/ inpatient admission & refer on to dietitian as
appropriate
b Assess nutritional status & consider nutritional
requirements if appropriate formulating a nutritional
care plan for the patient
c Assess factors affecting nutritional intake & barriers to
optimising nutritional intake & quality of life
d Provide practical nutritional advice including written
information tailored to individuals needs, prognosis &
circumstances
e Consider modified consistency diet for palliative stents
f Implement dietary adaptations to optimise nutrition
related symptom management
g Advise on symptom management, taste changes,
nausea, vomiting, mouth care etc to help improve
quality of life and liaise with palliative/ medical/
nursing team regarding pharmacological management
of symptoms
h Work with family on understanding of & anxiety about
eating & drinking
i Provide dietetic monitoring & follow up including
discharge planning of enterally fed patients where
appropriate
P10 Pain Management
a Identify pain issues and apply non pharmacological
pain management techniques (refer to pain pathway)
P11 Referral/ Liaison
a Refer on to other members of the team if appropriate
b Signpost to other supportive care services as required
dependent on need
c Liaise with multi-disciplinary team and allocate key
worker
d Issues relating to sexual function and expression should
be referred to the most appropriate local specialist
P12 Respiratory
a Maintain optimal respiratory function
b Provide non-pharmacological management of
breathlessness (refer to breathlessness pathway)
P13 Skin Care
a Manage sensory impairment and tissue viability,
lymphoedema and lymphorrhoea as appropriate (refer
to lymphoedema pathway)
13

Rehabilitation Care Pathway Palliative & EOL
P14 Swallowing
a Assess swallow function and monitor regularly for
change
b Manage any dysphagia via compensatory strategies
and/or direct intervention (refer dysphagia pathway)
P15 Work, Leisure & Activities of Daily
Living
a Discuss lifestyle adjustment including roles, loss & self
esteem
b Assess impact illness has on occupational pursuits
c Help patient to manage lifestyle including
investigating meaningful hobbies, leisure, occupational
pursuits and driving
d Undertake environmental and functional assessment
e Assess and support patient to carry out personal care
and domestic activities
f Provide aids/ equipment to support daily living, & self
management techniques to optimise independent
activities of daily living
End of Life
Drop Down Pathways
Anorexia/cachexia
Breathlessness
Communication
Dysphagia
Fatigue
Lymphoedema
Pain
Mobility & loss of function
Spinal cord compression
Intervention
E1 Assessment
a Carry out comprehensive social and functional
assessment
b Assess functional & cognitive ability
c Assess & assist in management of anxiety & refer on to
appropriate specialist
d Undertake holistic needs assessment
14

Rehabilitation Care Pathway Palliative & EOL
E2 Cognitive & Psychological Factors
a Identify psychological needs
b Undertake pre bereavement work with family
c
Apply spiritual care taking multi-disciplinary team
approach
d Provide ongoing psychological support with regards to
adjusting to loss, deteriorating function, grief response
e Assist in management of low moods
f
Apply sleep and relaxation techniques
g Apply restorative or compensatory therapy
interventions
E4 Equipment Provision
a Provide mobility aids for safe moving & handling if
appropriate and manage deteriorating function
E5 Fatigue
a Assessment and intervention as appropriate with
energy conservation techniques, goal planning, pacing,
diet, exercise and anxiety management (refer to
fatigue care pathway)
b Ensure treatable causes of fatigue are ruled out by
referral to other disciplines
E3 Communication
a Assess communication skills and capacity to make
informed decisions
b Assess ability to communicate/ convey needs relating to
pain, care, place of death & drawing up will
c
Educate patient, carers and healthcare professionals on
optimal communication methods for individual patient
d Implement communication strategies to optimise
communication function
e Trial, prescribe and train in use of communication aids
if required
E6 Information/ Support
a Ensure good communication and coordination
between the various care settings and professions
b Provide education & support to carers
c Provide information prescription
d Consider sudden events, scenario planning
e Identify and help to facilitate preferred place of care
(preferred place of dying) where this is home
f Attend case conferences when complex discharge is
apparent
g With the MDT/key worker, identify the dying process
and implement Liverpool Care Pathway ensuring that
unnecessary and invasive treatment is avoided
15

Rehabilitation Care Pathway Palliative & EOL
E7 Mobility
a Carry out risk assessment to optimise comfort (refer to
mobility and loss of function pathway)
b Prevent complications of inactivity
c
Provide seating, position & manual handling advice for
patient & carers
E8 Nutrition
a Influence organisational approach to provision of food
b Assess patients nutritional status, history & recent
history & oral intake
c
Address concerns expressed by patient and their family
regarding food and fluids.
d Implement dietary adaptations to optimise nutrition
related symptom management
e Address feeding & hydration issues with patient, carer
& relatives, MDT in conjunction with palliative care/
medical team
f Advise & encourage on mouth care strategies to
reduce the use of artificial hydration
g Make decisions with multi-disciplinary team around
ethics for feeding & feeding withdrawal
E9 Referral/ Liaison
a Multi-disciplinary team liaison/ referral to other
specialist professions
b Address & support symptom control & quality of life
issues as appropriate on an individual basis in
conjunction with Palliative Care MDT, carers, patients &
relatives
c Ensure appropriate withdrawal of intervention in
liaison with multi-disciplinary team
d Show awareness of advance of symptoms, need for
further palliative/ surgical intervention such as
paracentesis, stenting & debulking & how this further
affects quality of life
E10 Respiratory
a Apply breathing strategies (refer to breathlessness
pathway)
b Carry out respiratory & airway management
16

Rehabilitation Care Pathway Palliative & EOL
E11 Skin Care
a Assess positioning & provide simple
massage/movement/comfort measures
b Identify soft tissue viability & refer on as necessary
c
Assess & manage sensory changes and advise on
suitable clothing
d Manage ascites as appropriate
e Manage lymphorrhoea (refer to lymphoedema
pathway)
E13 Work, Leisure & Activities of Daily
Living
a Undertake environmental and functional assessment
b Manage deteriorating function
c Assess and support patient to carry out personal care
and domestic activities
d Provide aids/ equipment to support daily living, & self
management techniques to optimise independent
activities of daily living
E12 Swallowing
a Assess swallow function and monitor regularly for
change
b Manage any dysphagia via compensatory strategies
and in accordance with patients wishes (refer to
dysphagia pathway)
17

Rehabilitation Care Pathway Head & Neck
Professional intervention matrix
The rehabilitation interventions listed in the care
pathways can either be carried out by a single profession
or could be carried out by a number of professions. There
is the potential for different professions to be involved in
delivering some of the interventions for a number of
reasons.
• Unique skills are required which are within the scope
of a single allied health profession eg videofluoroscopy
is only carried out by Speech and Language Therapists
• The intervention listed may be approached in different
ways. For example P9b (Assess the factors affecting
nutritional intake and barriers to optimising
nutritional intake and quality of life) could involve:
• the Dietitian focusing of nutritional intake and
physiological barriers.
• the Occupational Therapist focusing on cutlery,
seating position and equipment that may help
during feeding and
• the Physiotherapist looking at postural stability and
physical capacity
SALT – Speech and Language Therapists
OT – Occupational Therapy
Other – Other professions including Clinical Nurse
Specialists, Lymphoedema Practitioners
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Rehabilitation Care Pathway Head & Neck
AHP
Intervention Number
Physio PD1 (a/ b)
PD4 (a/ b)
PD6 (a/ b)
D1 (a/ b/ c/
d)
D2 (a)
D3 (a)
D5 (a/ b)
T1 (b/ c/ d/ e/
g/ h,k)
T4 (a/ b/ c/ d
/e/ f/ g/ h)
T6 (a/ b)
T7 (a/ b/ c/ d)
T8 (a/ b/ c/ d/
e/ f/ g)
PT1 (a/ b/ c)
PT4 (a/ b)
PT7 (a/ b/ c/ d/
e/ f/ g/ h)
PT8 (a/ b / c)
M1 (a/ b)
M4 (a/ b)
M6 (a)
M7 (c/ d)
P1 (a/ b/ c/ d/ e/ f/ g)
P2 (a/ e)
P4 (a/ b/ c/ d)
P5 (a)
P6 (a/ b)
P7 (a/ b/ c/ d/ e/ f)
P8 (a/ b/ c/ d/ e/ f/ g)
P10 (a)
P11 (a/ b/ c/ d)
P12 (a/ b)
P13 (a)
P15 (d/ e/ f)
E1 (a/ b/ c/ d)
E2 (a/ b/ c/ d/ e/ f)
E3 (a/ b/ c/ d)
E4 (a)
E5 (a/ b)
E6 (a/ b/ c/ d/ e/ f/ g)
E7 (a/ b)
E9 (a/ b/ c/ d)
E10 (a/ b)
E11 (a/ b)
E13 (b/ d)
OT PD1 (a/ b)
PD2 (a)
PD4 (a/ b)
PD6 (a/ b)
D1 (a/ b/ c/
d)
D5 (a/ b)
T1 (a/ c/ e/ g/
h)
T2 (a/ b)
T5 (a)
T6 (a/ c/ d/ e)
T8 (a/ b/ c/ d/
e/ f/ g)
PT1 (a/ c)
PT2 (a)
PT7 (a/ b/ e/ f/
g)
PT8 (a/ b/ c)
M1 (a/ b)
M2 (a/ b)
M4 (a/ b)
M6 (a)
M7 (a/ b/
c/ d)
P1 (a/ b/ c/ d/ e/ f/ g)
P2 (a/ b/ c/ d/ e)
P3 (a)
P4 (a/ b/ c/ d)
P5 (a)
P6 (a/ b)
P7 (a/ b/ c/ d/ e/ f)
P8 (a/ b/ c/ d/ e/ f/ g)
P9 (a/ b/ c/ h)
P10 (a)
P11 (a/ b/ c/ d)
P12 (b)
P13 (a)
P15 (a/ b/ c/ d/ e/ f)
E1 (a/ b/ c/ d)
E2 (a/ b/ c/ d/ e/ f/ g)
E3 (a/ b/ c/ d/ e)
E4 (a)
E5 (a/ b)
E6 (a/ b/ c/ d/ e/ f/ g)
E7 (a/ b/ c)
E8 (c/ e)
E9 (a/ b/ c/ d)
E11 (a/ b/ c/ d)
E13 (a/ b/ c/ d)
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Rehabilitation Care Pathway Head & Neck
AHP
Intervention Number
Dietetic
PD1 (b)
PD4 (a/ b)
PD5 (a/ b/
c)
PD6 (a/ b)
D1 (a/ b/ c/
d)
D4 (a/ b/ c/
d/ e/ f/ g/
h/ i/ j)
D5 (a/ b)
T1 (e/ f/ h)
T5 (a/ b/ c/ d/
e/ f/ g/ h/ i/ j/
k)
T6 (a/ c/ d)
T8 (a/ b/ c)
PT1 (a/ d/ f)
PT6 (a/ b/ c/ d/
e)
PT7 (a/ b/ e/ f/
g/ h)
PT8 (b)
M1 (a/ b/ c)
M4 (a/ b)
M5 (a/ b)
M6 (a)
P1 (d/ e/ f/ g)
P2 (a/ e)
P5 (a)
P6 (a)
P7 (a/ b/ c/ d/ e/ f)
P9 (a/ b/ c/ d/ e/ f/
g/ h/ i)
P11 (a/ b/ c)
P15 (a/ b/ c)
E1 (b/c)
E2 (a/ b/ c/ d/ e/ f)
E3 (a/b)
E6 (a/ b/ c/ d/ e/ f/ g)
E8 (a/ b/ c/ d/ e/ f/ g)
E9 (a/ b/ c/ d)
E11 (d)
SALT
PD1 (b)
PD3 (a)
PD4 (a/ b)
PD6 (a)
D1 (a,b/ c/
d/ e)
D2 (a/ b/ c/
d/ e/ f/ g/
h/ i/ j/ k/ l/
m)
D4
d,e,g,h,j
D5 (a/ b)
T1 (a, e/ f/ g/
h/ i/ j/ k, l)
T2 a,b
T3 (a/ b/ c/ d/
e/ f/ g/ h/ i/ j/
k/ l/ m/ n/ o)
T4 (e/ f/ g/ h)
T5 a,c,d,e,h
T6 (a/ b/ c/ d/
e)
T7 b,e,f
T8 (a/ e,f,g)
PT1 (a/ b/ d/ e/
f)
PT2 (a)
PT3 (a/ b/ c/ d/
e/ f/ g/ h/ i/ j/ k/
l)
PT4 (a)
PT5 (a)
PT6 (a,b,c/ e)
PT7 (a/ b/ d/ e/
f/ g/ h)
PT8 (a,b,c)
M1 (a/ b/ c)
M2 a
M3 (a/ b/ c/ d/
f/
g,h,i,j,k,l,m,n)
M4 (a/ b)
M5 (a,b)
M6 (a)
M7 (a/ b/ c/ d)
P1 (b/ d/ e/ f/ g)
P2 (a/ e)
P3 (a/ b/ c/ d/ e)
P7 (a/ b/ c/ d/ e/ f)
P9 (a/ c/ g/ h)
P11 (a/ b/ c)
P14 (a/ b)
P15 (a/ b)
E1 (b/ c/ d)
E2 (a/ b/ c/ d/ e/ f/ g)
E3 (a/ b/ c/ d/ e)
E6 (a/ b/ c/ d/ e/ f/ g)
E8 (c/ d/ e/ f/ g)
E9 (a/ b/ c/ d)
E12 (a/ b)
Other
PD1 (b)
PD4 (a/ b)
PD6 (a/ b)
D1 (b/ c/
d)
D5 (a/ b)
T1 (e/ h)
T5 (a/ b)
T7 (a/ c/ e,f)
PT1 (a)
PT7 (a/ b/ e/ f/
g)
PT8 (b)
M1 (b)
M3 (a/ b)
M5 (a)
P1 (d/ e/ f/ g)
P2 (a/ e)
P7 (a/ b/ c/ d/ e/ f)
P8 (h)
P11 (a/ b/ c)
P13 (a)
E1 (a/ b/ c)
E2 (a/ b/ c/ d/ e/ f)
E3 (a/ b/ c/ d)
E6 (a/ b/ c/ d/ e/ f/ g)
E9 (a/ b/ c/ d)
E11 (a/ b/ e)
E13 (b)
20

National Cancer Action Team
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