Top

Published in:

Open Access 01-08-2017 | Original Article

Prophylactic Swallow Therapy for Patients with Head and Neck Cancer Undergoing Chemoradiotherapy: A Randomized Trial

Authors: Barbara Pisano Messing, Elizabeth C. Ward, Cathy L. Lazarus, Melissa Kim, Xian Zhou, Jessica Silinonte, Dorothy Gold, Karen Harrer, Karen Ulmer, Samantha Merritt, Geoffrey Neuner, Marshall Levine, Ray Blanco, John Saunders, Joseph Califano

Published in: Dysphagia | Issue 4/2017

Abstract

Evidence supporting prophylactic swallow exercises for patients with head and neck cancer (HNC) has not been universally demonstrated. This RCT examined diet level, feeding tube use, swallow function, and quality of life (QOL) of patients undergoing chemoradiotherapy who performed prophylactic swallowing exercises. Sixty HNC patients were randomized into exercise versus control groups. Swallowing, oromotor, toxicity, and QOL data were recorded (baseline, 3, 6, 12, 24 months). Physiological swallow function was examined at baseline and 3 months. Swallow exercises were completed twice daily. Oral intake at 3 months was 10% better in the exercise group, which was not statistically significant (p = 0.49). Significant (p < 0.05) differences in secondary outcomes including oromotor function, pharyngeal impairment, oral pharyngeal swallow efficiency, and incisal opening were noted at early time points (3–6 months) in the exercise group. Possible positive early improvements in swallow function are associated with swallowing exercises, although these improvements are not significant longer term.

National Institute of Dental and Craniofacial Research Website. http://www.nidcr.nih.gov/oralhealth/Topics/CancerTreatment/OralComplicationsCancerOral.htm. Updated July 14, 2015. Accessed 31 Jan 2016.

Colangelo LA, Logemann JA, Pauloski BR, Pelzer HJ, Rademaker AW. T stage and functional outcome in oral and oropharyngeal cancer patients. Head Neck. 1996;18(3):259–68. doi:10.1002/(SICI)1097-0347(199605/06)18:3<259:AID-HED8>3.0.CO;2-Z.CrossRefPubMed

Chasen MR, Bhargava R. A descriptive review of the factors contributing to nutritional compromise in patients with head and neck cancer. Support Care Cancer. 2009;17(11):1345–51. doi:10.1007/s00520-009-0684-5.CrossRefPubMed

Kulbersh BD, Rosenthal EL, McGrew BM, Duncan RD, McColloch NL, Carroll WR, Magnuson JS. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. The Laryngoscope. 2006;116:883–6. doi:10.1097/01.mlg.0000217278.96901.fc.CrossRefPubMed

Newman L, Vieira F, Schwiezer V, et al. Eating and weight changes following chemoradiation therapy for advanced head and neck cancer. Arch Otolaryngol Head Neck Surg. 1998;124:589–92. doi:10.1001/archotol.124.5.589.CrossRefPubMed

Murry T, Madasu R, Martin A, Robbins KT. Acute and chronic changes in swallowing and quality of life following intraarterial chemoradiation for organ preservation in patients with advanced head and neck cancer. Head Neck. 1998;20:31–7. doi:10.1002/(SICI)1097-0347(199801)20:1<31:AID-HED6>3.0.CO;2-4.CrossRefPubMed

Eisbruch A, Schwartz M, Rasch C, et al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phy. 2004;60(5):1425–39. doi:10.1016/j.ijrobp.2004.05.050.CrossRef

Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, Dutta S, Midyett FA, Barloon J, Sallah S. Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol. 2004;15:383–8. doi:10.1093/annonc/mdh101.CrossRefPubMed

Pillai R, Balaram P, Reddiar KS. Pathogenesis of oral submucous fibrosis. Relationship to risk factors associated with oral cancer. Cancer. 1992;69:2011–20. doi:10.1002/1097-0142(19920415)69:8<2011:AID-CNCR2820690802>3.0.CO;2-B.CrossRefPubMed

10.

Hutcheson KA, Lewin JS, Barringer DA, Lisec A, Gunn GB, Moore MWS, Holsinger FC. Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer. 2012;118:5793–9. doi:10.1002/cncr.27631.CrossRefPubMedPubMedCentral

11.

Awan MJ, Mohamed ASR, Lewin JS, et al. Late radiation-associated dysphagia (late-rad) with lower cranial neuropathy after oropharyngeal radiotherapy: a preliminary dosimetric comparison. Oral Oncol. 2014;50(8):746–52. doi:10.1016/j.oraloncology.2014.05.003.CrossRefPubMedPubMedCentral

12.

Eisbruch A, Lyden T, Bradford CR, Dawson LA, Haxer MJ, Miller AE, Wolf GT. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiation Oncol* Biology* Physics. 2002;53(1):23–8. doi:10.1016/S0360-3016(02)02712-8.CrossRef

13.

Adelstein DJ, Lavertu P, Saxton JP, Secic M, Wood BG, Wanamaker JR, Eliachar I, Strome M, Larto MA. Mature results of a Phase III randomized trial comparing concurrent chemoradiotherapy with radiation therapy alone in patients with Stage III and IV squamous cell carcinoma of the head and neck. Cancer. 2000;88:876–83. doi:10.1002/(SICI)1097-0142(20000215)88:4<876:AID-CNCR19>3.0.CO;2-Y.CrossRefPubMed

14.

Al-Sarraf M, LeBlanc M, Giri PG, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998;16(4):1310–7. doi:10.1016/S1278-3218(98)80364-8.CrossRefPubMed

15.

Brizel DM, Albers ME, Fisher SR, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med. 1998;338(25):1798–804. doi:10.1056/NEJM199806183382503.CrossRefPubMed

16.

Kraaijenga SAC, Oskam IM, van der Molen L, Hamming-Vrieze O, Hilgers FJM, van den Brekel MWM. Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer. Oral Oncol. 2015;51(8):787–94. doi:10.1016/j.oraloncology.2015.05.003.CrossRefPubMed

17.

Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA. Speech and swallowing rehabilitation for head and neck cancer patients. Oncology. 1997;11(5):651–6 PMID: 9159792.PubMed

18.

Krisciunas GP, Sokoloff W, Stepas K, Langmore SE. Survey of usual practice: dysphagia therapy in head and neck cancer patients. Dysphagia. 2012;27(4):538–49. doi:10.1007/s00455-012-9404-2.CrossRefPubMedPubMedCentral

19.

Roe JW, Ashforth KM. Prophylactic swallowing exercises for patients receiving radiotherapy for head and neck cancer. Curr Opin Otolaryngol Head Neck Surg. 2011;19(3):144–9. doi:10.1097/MOO.0b013e3283457616.CrossRefPubMed

20.

Wall LR, Ward EC, Cartmill B, Hill AJ. Physiological changes to the swallowing mechanism following (chemo) radiotherapy for head and neck cancer: a systematic review. Dysphagia. 2013;28(4):481–93. doi:10.1007/s00455-013-9491-8.CrossRefPubMed

21.

Schindler A, Denaro N, Russi EG. Dysphagia in head and neck cancer patients treated with radiotherapy and systemic therapies: literature review and consensus. Crit Rev Oncol/Hematol. 2015;96(2):372–84. doi:10.1016/j.critrevonc.2015.06.005.CrossRef

22.

Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R. “Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(1):210–9. doi:10.1016/j.ijrobp.2011.06.1954.CrossRefPubMed

23.

Carroll WR, Locher JL, Canon CL, Bohannon IA, McColloch NL, Magnuson JS. Pretreatment swallowing exercises improve swallow function after chemoradiation. The Laryngoscope. 2008;118(1):39–43. doi:10.1097/MLG.0b013e31815659b0.CrossRefPubMed

24.

Duarte VM, Chhetri DK, Liu YF, Erman AA, Wang MB. Swallow preservation exercises during chemoradiation therapy maintains swallow function. Otolaryngol Head Neck Surg. 2013;149(6):878–84. doi:10.1177/0194599813502310.CrossRefPubMedPubMedCentral

25.

Hutcheson KA, Bhayani MK, Beadle BM, et al. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol-Head Neck Surg. 2013;139(11):1127–34. doi:10.1001/jamaoto.2013.4715.CrossRefPubMedPubMedCentral

26.

Kotz T, Federman AD, Kao J, Milman L, et al. Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial. Archiv Otolaryngol-Head Neck Surg. 2012;138(4):376–82. doi:10.1001/archoto.2012.187.CrossRef

27.

Kraaijenga SAC, van der Molen L, van den Brekel MWM, Hilgers FJM. Current assessment and treatment strategies of dysphagia in head and neck cancer patients: a systematic review of the 2012/13 literature. Curr Opin Support Palliat Care. 2014;8(2):152–63. doi:10.1097/SPC.0000000000000050.CrossRefPubMed

28.

van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Rasch CR, Hilgers FJ. A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia. 2011;26(2):155–70. doi:10.1007/s00455-010-9288-y.CrossRefPubMed

29.

van der Molen L, van Rossum MA, Rasch CR, Smeele LE, Hilgers FJ. Two-year results of a prospective preventive swallowing rehabilitation trial in patients treated with chemoradiation for advanced head and neck cancer. Eur Arch Otorhinolaryngol. 2014;271(5):1257–70. doi:10.1007/s00405-013-2640-8.CrossRefPubMed

30.

Virani A, Kunduk M, Fink DS, McWhorter AJ. Effects of 2 different swallowing exercise regimens during organ-preservation therapies for head and neck cancers on swallowing function. Head Neck. 2015;37(2):162–70. doi:10.1002/hed.23570.CrossRefPubMed

31.

Mortensen HR, Jensen K, Aksglæde K, Lambertsen K, Eriksen E, Grau C. Prophylactic swallowing exercises in head and neck cancer radiotherapy. Dysphagia. 2015;. doi:10.1007/s00455-015-9600-y.PubMed

32.

Vincent M. The Karnofsky performance status scale. Cancer. 1984;53:2002–7. doi:10.1002/1097-0142(19840501)53:9<2002:AID-CNCR2820530933>3.0.CO;2-W.CrossRef

34.

Crary MA, Mann GDC, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Archiv Phys Med Rehabil. 2005;86(8):1516–20. doi:10.1016/j.apmr.2004.11.049 ISSN 0003-9993.CrossRef

34.

ATOS Medical Website. www.atosmedical.com Accessed 4 Dec 2015.

35.

Eilers J, Berger AM, Petersen MC. Development, testing, and application of the oral assessment guide. Oncol Nurs Forum. 1987;15(3):325–30 PMID:3287344.

36.

Trotti A, Colevas AD, Setser A, Rusch V, Jaques D, Budach V, Rubin P. CTCAE v3. 0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 2003;13(3):176–81.CrossRefPubMed

37.

O’Neil KH, Purdy M, Falk J, Gallo L. The dysphagia outcome and severity scale. Dysphagia. 1999;14(3):139–45. doi:10.1007/PL00009595.CrossRefPubMed

38.

Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8. doi:10.1007/BF00417897.CrossRefPubMed

39.

Rademaker AW, Pauloski BR, Logemann JA, Shanahan TK. Oropharyngeal swallow efficiency as a representative measure of swallowing function. J Speech Hearing. 1994;37:314–25. doi:10.1044/jshr.3702.314.CrossRef

40.

van den Berg MGA, Kalf JG, Hendriks JCM, Takes RP, van Herpen CML, Wanten GJA, Drenth JPH, Kaanders JHAM, Merkx MAW. Normalcy of food intake in patients with head and neck cancer supported by combined dietary counseling and swallowing therapy: a randomized clinical trial. Head Neck. 2016;38:E198–206. doi:10.1002/hed.23970.CrossRefPubMed

41.

Shinn EH, Basen-Engquist K, Baum G, Steen S, Bauman RF, Morrison W, Garden AS, Sheil C, Kilgore K, Hutcheson KA, Barringer D, Yuan Y, Lewin JS. Adherence to preventive exercises and self-reported swallowing outcomes in post-radiation head and neck cancer patients. Head Neck. 2013;35:1707–12. doi:10.1002/hed.23255.CrossRefPubMedPubMedCentral

42.

Zhen Y, Wang JG, Tao D, Wang HJ, Chen WL. Efficacy survey of swallowing function and quality of life in response to therapeutic intervention following rehabilitation treatment in dysphagic tongue cancer patients. Eur J Oncol Nurs. 2012;16(1):54–8. doi:10.1016/j.ejon.2011.03.002.CrossRefPubMed

43.

Schatz K, Langmore SE, Olson N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Annals Otol Rhinol Laryngol. 1991;100(8):678–81. doi:10.1177/000348949110000815.CrossRef

44.

Leder SB, Sasaki CT, Burrell MI. Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration. Dysphagia. 1998;13(1):19–21. doi:10.1007/PL00009544.CrossRefPubMed

45.

Steven BL, Joseph TM. Fiberoptic Endoscopic Evaluation of Swallowing. Phys Med Rehabil Clin North Am. 2008;19(4):787–801. doi:10.1016/j.pmr.2008.05.003 ISSN 1047-9651.CrossRef

Title: Prophylactic Swallow Therapy for Patients with Head and Neck Cancer Undergoing Chemoradiotherapy: A Randomized Trial
Authors: Barbara Pisano Messing
Elizabeth C. Ward
Cathy L. Lazarus
Melissa Kim
Xian Zhou
Jessica Silinonte
Dorothy Gold
Karen Harrer
Karen Ulmer
Samantha Merritt
Geoffrey Neuner
Marshall Levine
Ray Blanco
John Saunders
Joseph Califano
Publication date: 01-08-2017
Publisher: Springer US
Published in: Dysphagia / Issue 4/2017
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-017-9790-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prophylactic Swallow Therapy for Patients with Head and Neck Cancer Undergoing Chemoradiotherapy: A Randomized Trial

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2017

The Anxiety Level of Caregivers of Neurological Patients with Dysphagia

Swallowing Function After Continuous Neuromuscular Electrical Stimulation of the Submandibular Region Evaluated by High-Resolution Manometry

First Step in Telehealth Assessment: A Randomized Controlled Trial to Investigate the Effectiveness of an Electronic Case History Form for Dysphagia

Swallowing Disorders in Schizophrenia

Cross-Cultural Translation, Adaptation and Reliability of the Danish M. D. Andeson Dysphagia Inventory (MDADI) in Patients with Head and Neck Cancer

Effects of Esophageal Acidification on Troublesome Symptoms: An Approach to Characterize True Acid GERD in Dysphagic Neonates