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Development of an ICF-based Clinical Practice Guideline for the Assessment of Function in Head and Neck Cancer


Functional outcome following head and neck cancer (HNC) is not regularly assessed in a standardized way in clinical practice. Clinical trials assessing functional outcome apply many different instruments. Therefore, research results are not always comparable and have limited clinical implications. Aim of this study was the identification, interdisciplinary evaluation, and recommendation of functional outcome instruments for use in clinical practice and clinical trials in patients with HNC. All work was based on the functional aspects defined in the International Classification of Functioning, Disability and Health Core Set for Head and Neck Cancer (ICF-HNC), which covers the typical spectrum of problems in functioning experienced by patients with HNC.

The project was divided into three parts:

Preparatory studies

  1. (a) systematic literature review (MEDLINE) to identify instruments which are used in clinical trials for the measurement of functional outcome in head and neck cancer,
    (b) Delphi surveys in different health professional groups (professional groups involved: physicians, psychologists, speech and language therapists, physiotherapists, and social workers) to investigate which aspects of functioning and disability in patients with HNC are treated by experienced clinicians and which measurement methods are thereby applied in clinical practice
    (c) survey on patients’ priorities
  2. Consensus Conference: interdisciplinary, formal decision-making and consensus process based on the results of the preparatory studies
  3. Implementation of the recommended screening instruments in clinical practice (three participating hospitals): systematic and standardized assessment of functional problems over 2 years within the cancer follow-up using a web-based data collection system

Recommendations of the interdisciplinary expert committee (as of October 2011)

A national interdisciplinary panel of experts met in Munich in October 2011. Decision making health professionals included physicians (medical sub-specialities: otorhinolaryngology, oral-maxillofacial-surgery, radiation oncology, internal oncology, phoniatrics, rehabilitation medicine), psychologists, speech and language therapists, physiotherapists, and social workers. Recommendations which came out of the Conference included in particular:

1. Recommendation: Screening
This applies to all patients who are examined in the context of cancer follow-up. These recommendations have been implemented in three study centres.

2. Recommendation: Detailed evaluation of the problem and treatment planning
This affects patients in whom a corresponding problem was identified in the screening.

3. Recommendation: Clinical trials related to functional outcomes in head and neck cancer

Clinical Practice Guideline for the assessment of function in patients with head and neck cancer

Manual to develop a ICF-based guideline for measuring of functioning

Cooperation partners

Department of Otorhinolaryngology, Ludwig-Maximilians-University, Munich, GermanyClinics involved in the implementation of the screening recommendations:

Department of Otorhinolaryngology Head and Neck Surgery, University of Leipzig (Responsible for the study: Prof. Dr. med. Andreas Dietz, Director of the Clinic)Department of Otorhinolaryngology Head and Neck Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main (Responsible for the study: PD Dr. med. Sebastian S (pdf, 3151 KB)trieth, Managing Senior Physician)


06/2010 - 06/2013


Funded by Deutsche Krebshilfe e.V.


Prof. Ulrich Harréus
Department of Otorhinolaryngology, Ludwig-Maximilians-University, Munich

Prof. Dr. Alarcos Cieza, MPH


Prof. Ulrich Harréus

Dr. Marita Stier-Jarmer, MA, MPH