Radiation Oncology (Speech Pathology)
Adult

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Useful Management Information

This service manages patients who have had radiation to the head and neck region.
Patients can be referred to this service for the management of swallowing and communication at any time following radiation (nil limitation on years post-XRT).

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Suspected or confirmed oropharyngeal dysphagia in radiation oncology population with radiation toxicities and has the potential to require more complex, or emergent care if assessment is delayed or is preventing eating and drinking. Indicators for this category: History of recurrent chest infections Co-occurring dysphonia or dysarthria Gagging, choking, and/or coughing when swallowing food/fluids Food or liquids coming back up to throat, mouth, and/or nose after swallowing Patient feels like foods or liquids have been getting stuck in their throat AND are very concerned/anxious about swallowing problem Weight loss/loss of appetite/food avoidance Co-occurring chronic respiratory or neurological condition/s
Category 2 (appointment within 90 calendar days)	Suspected or confirmed oropharyngeal dysphagia in radiation oncology population/s and condition is likely to require more complex care if assessment is delayed beyond 90 days. Indicators for this category: Patient feels like foods or liquids have been getting stuck in their throat AND are not concerned. Stable oropharyngeal dysphagia and/or to review progress/management plan. Radiation oncology patients with communication disorders (including dysarthria and dysphonia) that are likely to require more complex care if assessment is delayed beyond 90 days: Impact on functional communication and ability to participate in life roles resulting in potential impact on quality of life. and Potential risk of depression and/or anxiety, and/or carer burden as a result of communication impairment which may require more complex care. Radiation oncology patients with trismus that is painful, impacting oral intake, oral care and/or communication.
Category 3 (appointment within 365 calendar days)	Post radiation oncology with trismus that is non-symptomatic and stable.
If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service.

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Head and neck surgical and radiation history including type and staging of cancer, surgery, date of surgery, and treating surgeon or radiation/medical oncologist
Reason for referral – please provide information regarding the nature of swallowing or communication impairment
Medical and social history
Relevant medical imaging and reports
Next of Kin

If a specific test result cannot be obtained due to access, financial, religious, cultural or consent reasons a clinical override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

Patient awareness of referral
Any other health care professionals currently involved (e.g. other Allied Health Professionals, Health Clinicians)
Previous speech pathology or specialist assessment reports

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Not Available

Internal Referrals

(E-Blueslips)

Fax

(07) 5687 4497

Post

Allied Health Outpatients
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

(07) 5687 3027

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Facilities

Gold Coast University Hospital

Robina Hospital

Tugun Satellite Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Radiation Oncology (Speech Pathology)Adult