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Xinou E, Chryssogonidis I, Kalogera-Fountzila A, Panagiotopoulou-Mpoukla D, Printza A. Longitudinal Evaluation of Swallowing with Videofluoroscopy in Patients with Locally Advanced Head and Neck Cancer After Chemoradiation. Dysphagia 2018; 33:691-706. [DOI: 10.1007/s00455-018-9889-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
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52
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Mayadevi M, Thankappan K, Limbachiya SV, Vidhyadharan S, Villegas B, Ouyoung M, Balasubramanian D, Menon JR, Sinha U, Iyer S. Interdisciplinary Telemedicine in the Management of Dysphagia in Head and Neck. Dysphagia 2018; 33:474-480. [PMID: 29404691 DOI: 10.1007/s00455-018-9876-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 01/23/2018] [Indexed: 11/29/2022]
Abstract
The study considered the feasibility and impact of interdisciplinary telemedicine discussions in the management of post-treatment dysphagia in patients with head and neck tumors. This is a retrospective analysis of patients with persistent dysphagia after treatment for head and neck pathology, at an institute in India. The cases were discussed in the telemedicine meeting conducted between host institute and a second unit in the United States. A monthly meeting was organized, using an internet-based video conference system. The ongoing swallowing problems and management were presented, and through discussions, a plan for further management was formulated and carried out. The Functional Oral Intake Scale (FOIS) was measured before and after the implementation of the plan. Twenty-six patients were discussed, out of which, 22 were head and neck malignancies. The recommendations concurred with that of the host unit in 18, differed for three and additive in five patients. The pre-treatment mean FOIS was 1.46 with a standard deviation of 0.989 and post-treatment mean improved to 3.92 with a standard deviation of 1.809 (p < 0.0001). The present study supports the success of an interdisciplinary telemedicine meeting to manage difficult cases of dysphagia in head and neck. The outcome in terms of the FOIS score improved significantly after implementing them. In addition to the direct patient benefits, the meeting helped to facilitate interdepartmental collaboration between two units treating similar sets of patients across the globe, in specialized clinical areas like dysphagia management.
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Affiliation(s)
- Mydhili Mayadevi
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India.
| | - Shashikant Vishnubhai Limbachiya
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India
| | - Sivakumar Vidhyadharan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India
| | - Brenda Villegas
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of USC, University of Southern California, Los Angeles, USA
| | - Melody Ouyoung
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of USC, University of Southern California, Los Angeles, USA
| | - Deepak Balasubramanian
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India
| | - Jayakumar R Menon
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India
| | - Uttam Sinha
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of USC, University of Southern California, Los Angeles, USA
| | - Subramania Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, AIMS Ponekkara PO, Kochi, Kerala, India
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Benedict PA, Ruiz R, Verma A, Dion GR, Oh P, Wang B, Ahmed OH, Hiwatashi N, Bing R, Victor K, Hu KS, Johnson A, Branski RC, Amin MR. The effects of concurrent chemoradiation therapy to the base of tongue in a preclinical model. Laryngoscope 2017; 128:1783-1790. [PMID: 29280493 DOI: 10.1002/lary.27033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/16/2017] [Accepted: 11/06/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To develop a clinically relevant model of oropharyngeal concurrent chemoradiation therapy (CCRT) in order to quantify the effects of CCRT on tongue function and structure. CCRT for advanced oropharyngeal cancer commonly leads to tongue base dysfunction and dysphagia. However, no preclinical models currently exist to study the pathophysiology of CCRT-related morbidity, thereby inhibiting the development of targeted therapeutics. STUDY DESIGN Animal model. METHODS Twenty-one male Sprague-Dawley rats were randomized into three groups: 2 week (2W), 5 month (5M), and control (C). The 2W and 5M animals received cisplatin, 5-fluorouracil, and five fractions of 7 Gy to the tongue base; the C animals received no intervention. In vivo tongue strength and displacement, as well as hyoglossus muscle collagen content, were assessed. Analyses were conducted 2 weeks or 5 months following completion of CCRT in the 2W and 5M groups, respectively. RESULTS Peak tetanic and twitch tongue forces were significantly reduced in both 2W and 5M animals compared to controls (tetanic: P = .0041, P = .0089, respectively; twitch: P = .0201, P = .0020, respectively). Twitch half-decay time was prolonged in 2W animals compared to controls (P = .0247). Tongue displacement was significantly reduced across all testing parameters in 5M animals compared to both the C and 2W groups. No differences in collagen content were observed between experimental groups. CONCLUSIONS The current study is the first to describe a preclinical model of CCRT to the head and neck with an emphasis on clinical relevance. Tongue strength decreased at 2 weeks and 5 months post-CCRT. Tongue displacement increased only at 5 months post-CCRT. Fibrosis was not detected, implicating alternative causative factors for these findings. LEVEL OF EVIDENCE NA Laryngoscope, 1783-1790, 2018.
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Affiliation(s)
- Peter A Benedict
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
| | - Ryan Ruiz
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
| | - Avanti Verma
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
| | - Gregory R Dion
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York.,Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, U.S.A
| | - Philmo Oh
- Department of Radiation Oncology, New York University School of Medicine, New York, New York
| | - Binhuan Wang
- Department of Population Heath, Division of Biostatistics, New York University School of Medicine, New York, New York
| | - Omar H Ahmed
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
| | - Nao Hiwatashi
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
| | - Renjie Bing
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
| | - Kristen Victor
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
| | - Kenneth S Hu
- Department of Radiation Oncology, New York University School of Medicine, New York, New York
| | - Aaron Johnson
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
| | - Ryan C Branski
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York
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Collins A, Burns CL, Ward EC, Comans T, Blake C, Kenny L, Greenup P, Best D. Home-based telehealth service for swallowing and nutrition management following head and neck cancer treatment. J Telemed Telecare 2017; 23:866-872. [DOI: 10.1177/1357633x17733020] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Following (chemo)radiotherapy (C/RT) for head and neck cancer (HNC), patients return to hospital for regular outpatient reviews with speech pathology (SP) and nutrition and dietetics (ND) for acute symptom monitoring, nutritional management, and swallowing and communication rehabilitation. The aim of the current study was to determine the feasibility of a home-based telehealth model for delivering SP and ND reviews, to provide patients with more convenient access to these appointments. Methods Service outcomes, costs, and consumer satisfaction were examined across 30 matched participants: 15 supported via the standard model of care (SMOC), and 15 via the home-based telehealth model of care (TMOC). Results All patients were successfully managed via telehealth. The TMOC was more efficient, with a reduced number ( p < 0.003) and duration ( p < 0.01) of appointments required until discharge. Significant patient cost savings ( p = 0.002) were reported for the TMOC due to decreased travel requirements. While staff costs were reduced, additional telehealth equipment levies resulted in a lower but non-significant overall cost difference to the health service when using the TMOC. High satisfaction was reported by all participants attending the TMOC. Discussion The findings support the feasibility of a home-based telehealth model for conducting SP and ND reviews post C/RT for HNC.
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Affiliation(s)
- Annette Collins
- Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Australia
| | - Clare L Burns
- Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Australia
- Centre for Research Excellence in Telehealth, The University of Queensland, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Australia
- Centre for Research Excellence in Telehealth, The University of Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Australia
| | - Tracy Comans
- Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Australia
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Claire Blake
- Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Australia
| | - Lizbeth Kenny
- Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Australia
- Central Integrated Regional Cancer Services, Queensland Health, Australia
- School of Medicine, The University of Queensland, Australia
| | - Phil Greenup
- Telehealth Support Unit, Health Improvement Unit, Australia
| | - Daniel Best
- Telehealth Support Unit, Health Improvement Unit, Australia
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Shaw SM, Martino R, Mahdi A, Sawyer FK, Mathur S, Hope A, Agur AM. Architecture of the Suprahyoid Muscles: A Volumetric Musculoaponeurotic Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:2808-2818. [PMID: 28973130 DOI: 10.1044/2017_jslhr-s-16-0277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 05/13/2017] [Indexed: 05/28/2023]
Abstract
PURPOSE Suprahyoid muscles play a critical role in swallowing. The arrangement of the fiber bundles and aponeuroses has not been investigated volumetrically, even though muscle architecture is an important determinant of function. Thus, the purpose was to digitize, model in three dimensions, and quantify the architectural parameters of the suprahyoid muscles to determine and compare their relative functional capabilities. METHOD Fiber bundles and aponeuroses from 11 formalin-embalmed specimens were serially dissected and digitized in situ. Data were reconstructed in three dimensions using Autodesk Maya. Architectural parameters were quantified, and data were compared using independent samples t-tests and analyses of variance. RESULTS Based on architecture and attachment sites, suprahyoid muscles were divided into 3 groups: anteromedial, superolateral, and superoposterior. Architectural parameters differed significantly (p < .05) across muscles and across the 3 groups, suggesting differential roles in hyoid movement during swallowing. When activated simultaneously, anteromedial and superoposterior muscle groups could work together to elevate the hyoid. CONCLUSIONS The results suggest that the suprahyoid muscles can have individualized roles in hyoid excursion during swallowing. Muscle balance may be important for identifying and treating hyolaryngeal dysfunction in patients with dysphagia.
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Affiliation(s)
- Stephanie M Shaw
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
| | - Rosemary Martino
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Ontario, Canada
- Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Ontario, Canada
| | - Ali Mahdi
- Department of Surgery, Division of Anatomy, University of Toronto, Ontario, Canada
| | - Forrest Kip Sawyer
- Department of Surgery, Division of Anatomy, University of Toronto, Ontario, Canada
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Ontario, Canada
| | - Andrew Hope
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Anne M Agur
- Department of Surgery, Division of Anatomy, University of Toronto, Ontario, Canada
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Prophylactic Swallow Therapy for Patients with Head and Neck Cancer Undergoing Chemoradiotherapy: A Randomized Trial. Dysphagia 2017; 32:487-500. [PMID: 28444488 PMCID: PMC5515964 DOI: 10.1007/s00455-017-9790-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/15/2017] [Indexed: 11/14/2022]
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.
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Govender R, Wood CE, Taylor SA, Smith CH, Barratt H, Gardner B. Patient Experiences of Swallowing Exercises After Head and Neck Cancer: A Qualitative Study Examining Barriers and Facilitators Using Behaviour Change Theory. Dysphagia 2017; 32:559-569. [PMID: 28424898 PMCID: PMC5515965 DOI: 10.1007/s00455-017-9799-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/08/2017] [Indexed: 12/02/2022]
Abstract
Poor patient adherence to swallowing exercises is commonly reported in the dysphagia literature on patients treated for head and neck cancer. Establishing the effectiveness of exercise interventions for this population may be undermined by patient non-adherence. The purpose of this study was to explore the barriers and facilitators to exercise adherence from a patient perspective, and to determine the best strategies to reduce the barriers and enhance the facilitators. In-depth interviews were conducted on thirteen patients. We used a behaviour change framework and model [Theoretical domains framework and COM-B (Capability–opportunity–motivation-behaviour) model] to inform our interview schedule and structure our results, using a content analysis approach. The most frequent barrier identified was psychological capability. This was highlighted by patient reports of not clearly understanding reasons for the exercises, forgetting to do the exercises and not having a system to keep track. Other barriers included feeling overwhelmed by information at a difficult time (lack of automatic motivation) and pain and fatigue (lack of physical capability). Main facilitators included having social support from family and friends, the desire to prevent negative consequences such as long-term tube feeding (reflective motivation), having the skills to do the exercises (physical capability), having a routine or trigger and receiving feedback on the outcome of doing exercises (automatic motivation). Linking these findings back to the theoretical model allows for a more systematic selection of theory-based strategies that may enhance the design of future swallowing exercise interventions for patients with head and neck cancer.
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Affiliation(s)
- Roganie Govender
- Research Department of Behavioural Science & Health, University College London, London, UK. .,University College London Hospital, Head and Neck Cancer Centre, London, UK.
| | - Caroline E Wood
- UCL Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Christina H Smith
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Helen Barratt
- Department of Applied Health Research, University College London, London, UK
| | - Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK.,Department of Epidemiology & Public Health, University College London, London, UK
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Govender R, Smith CH, Gardner B, Barratt H, Taylor SA. Improving swallowing outcomes in patients with head and neck cancer using a theory-based pretreatment swallowing intervention package: protocol for a randomised feasibility study. BMJ Open 2017; 7:e014167. [PMID: 28348190 PMCID: PMC5372094 DOI: 10.1136/bmjopen-2016-014167] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The incidence of head and neck cancer (HNC) in the UK is rising, with an average of 31 people diagnosed daily. Patients affected by HNC suffer significant short-term and long-term post-treatment morbidity as a result of dysphagia, which affects daily functioning and quality of life (QOL). Pretreatment swallowing exercises may provide additional benefit over standard rehabilitation in managing dysphagia after primary HNC treatments, but uncertainty about their effectiveness persists. This study was preceded by an intervention development phase to produce an optimised swallowing intervention package (SIP). The aim of the current study is to assess the feasibility of this new intervention and research processes within a National Health Service (NHS) setting. METHOD AND ANALYSIS A two-arm non-blinded randomised controlled feasibility study will be carried out at one tertiary referral NHS centre providing specialist services in HNC. Patients newly diagnosed with stage III and IV disease undergoing planned surgery and/or chemoradiation treatments will be eligible. The SIP will be delivered pre treatment, and a range of swallowing-related and QOL measures will be collected at baseline, 1, 3 and 6 months post-treatment. Outcomes will test the feasibility of a future randomised controlled trial (RCT), detailing rate of recruitment and patient acceptance to participation and randomisation. Salient information relating to protocol implementation will be collated and study material such as the case report form will be tested. A range of candidate outcome measures will be examined for suitability in a larger RCT. ETHICS AND DISSEMINATION Ethical approval was obtained from an NHS Research Ethics Committee. Findings will be published open access in a peer-reviewed journal, and presented at relevant conferences and research meetings. TRIAL REGISTRATION NUMBER ISRCTN40215425; Pre-results.
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Affiliation(s)
- Roganie Govender
- University College London Hospital, Head & Neck Cancer Centre, London, UK
- Department of Behavioural Science & Health, University College London, London, UK
| | - Christina H Smith
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Benjamin Gardner
- Department of Behavioural Science & Health, University College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK
| | - Helen Barratt
- Department of Applied Health Research, NIHR CLAHRC North Thames, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
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Burns CL, Ward EC, Hill AJ, Kularatna S, Byrnes J, Kenny LM. Randomized controlled trial of a multisite speech pathology telepractice service providing swallowing and communication intervention to patients with head and neck cancer: Evaluation of service outcomes. Head Neck 2017; 39:932-939. [PMID: 28225567 DOI: 10.1002/hed.24706] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/04/2016] [Accepted: 12/09/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to present our evaluation of a new speech pathology telepractice service supporting the swallowing and communication management of patients with head and neck cancer. METHODS A multicenter randomized controlled trial was conducted within a large public cancer service. Referrals from speech pathologists at 3 regional sites (spoke sites) were managed by a specialist clinician from a cancer center (hub site) either via standard care (phone/email support/appointments at the hub site) or a newly established telepractice service (online consultation between the hub site and spoke site). RESULTS Eighty-two referrals (39 for standard care and 43 for telepractice care) were managed. Service efficiency favoring the telepractice model was reported with a significant reduction in the number (p = .004) and duration (p = .024) of contact events required to manage the referrals. Higher consumer and clinician satisfaction was also reported for the telepractice service. CONCLUSION A speech pathology telepractice service benefits both the patient and health provider through higher service efficiency and treatment satisfaction. © 2017 Wiley Periodicals, Inc. Head Neck 39: 932-939, 2017.
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Affiliation(s)
- Clare L Burns
- Speech Pathology and Audiology Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South, Brisbane, Queensland, Australia
| | - Anne J Hill
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, Queensland, Australia
| | - Sanjeewa Kularatna
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Lizbeth M Kenny
- Central Integrated Regional Cancer Services, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Govender R, Smith CH, Taylor SA, Barratt H, Gardner B. Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises. BMC Cancer 2017; 17:43. [PMID: 28068939 PMCID: PMC5223405 DOI: 10.1186/s12885-016-2990-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/09/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dysphagia is a significant side-effect following treatment for head and neck cancers, yet poor adherence to swallowing exercises is frequently reported in intervention studies. Behaviour change techniques (BCTs) can be used to improve adherence, but no review to date has described the techniques or indicated which may be more associated with improved swallowing outcomes. METHODS A systematic review was conducted to identify behavioural strategies in swallowing interventions, and to explore any relationships between these strategies and intervention effects. Randomised and quasi-randomised studies of head and neck cancer patients were included. Behavioural interventions to improve swallowing were eligible provided a valid measure of swallowing function was reported. A validated and comprehensive list of 93 discrete BCTs was used to code interventions. Analysis was conducted via a structured synthesis approach. RESULTS Fifteen studies (8 randomised) were included, and 20 different BCTs were each identified in at least one intervention. The BCTs identified in almost all interventions were: instruction on how to perform the behavior, setting behavioural goals and action planning. The BCTs that occurred more frequently in effective interventions, were: practical social support, behavioural practice, self-monitoring of behaviour and credible source for example a skilled clinician delivering the intervention. The presence of identical BCTs in comparator groups may diminish effects. CONCLUSIONS Swallowing interventions feature multiple components that may potentially impact outcomes. This review maps the behavioural components of reported interventions and provides a method to consistently describe these components going forward. Future work may seek to test the most effective BCTs, to inform optimisation of swallowing interventions.
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Affiliation(s)
- Roganie Govender
- University College London, Health Behaviour Research Centre & University College London Hospital, Head & Neck Cancer Centre, Ground Floor Central, 250 Euston Road, London, NW1 2PQ UK
| | - Christina H. Smith
- Division of Psychology & Language Sciences University College London, London, UK
| | - Stuart A. Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Helen Barratt
- Department of Applied Health Research, University College London, London, UK
| | - Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK & UCL Department of Epidemiology & Public Health, University College London, London, UK
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Patterns of dysphagia and acute toxicities in patients with head and neck cancer undergoing helical IMRT±concurrent chemotherapy. Oral Oncol 2017; 64:1-8. [DOI: 10.1016/j.oraloncology.2016.11.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/20/2016] [Indexed: 12/20/2022]
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Adherence to a Prophylactic Swallowing Therapy Program During (Chemo) Radiotherapy: Impact of Service-Delivery Model and Patient Factors. Dysphagia 2016; 32:279-292. [DOI: 10.1007/s00455-016-9757-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/26/2016] [Indexed: 11/25/2022]
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63
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Prophylactic exercises among head and neck cancer patients during and after swallowing sparing intensity modulated radiation: adherence and exercise performance levels of a 12-week guided home-based program. Eur Arch Otorhinolaryngol 2016; 274:1129-1138. [PMID: 27812787 PMCID: PMC5281645 DOI: 10.1007/s00405-016-4367-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/31/2016] [Indexed: 12/03/2022]
Abstract
The background and purpose of this paper is to investigate adherence, exercise performance levels and associated factors in head and neck cancer (HNC) patients participating in a guided home-based prophylactic exercise program during and after treatment [swallowing sparing intensity modulated radiation therapy (SW-IMRT)]. Fifty patients were included in the study. Adherence was defined as the percentage of patients who kept up exercising; exercise performance level was categorized as low: ≤1, moderate: 1–2, and high: ≥2 time(s) per day, on average. Associations between 6- and 12-week exercise performance levels and age, gender, tumour site and stage, treatment, intervention format (online or booklet), number of coaching sessions, and baseline HNC symptoms (EORTC-QLQ-H&N35) were investigated. Adherence rate at 6 weeks was 70% and decreased to 38% at 12 weeks. In addition, exercise performance levels decreased over time (during 6 weeks: 34% moderate and 26% high; during 12 weeks: 28% moderate and 18% high). The addition of chemotherapy to SW-IMRT [(C)SW-IMRT] significantly deteriorated exercise performance level. Adherence to a guided home-based prophylactic exercise program was high during (C)SW-IMRT, but dropped afterwards. Exercise performance level was negatively affected by chemotherapy in combination with SW-IMRT.
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Abstract
Oropharyngeal dysphagia is a frequent consequence of several medical aetiologies, and even considered part of the normal ageing process. Early and accurate identification provides the opportunity for early implementation of dysphagia treatments. This Review describes the current state of the evidence related to dysphagia therapies - focusing on treatments most clinically utilized and of current interest to researchers. Despite successes in select studies, the level of evidence to support the efficacy of these treatments remains limited. Heterogeneity exists across studies in both how interventions are administered and how their therapeutic value is assessed, thereby making it difficult to establish external validation. Future work needs to address these caveats. Also, to be most efficacious, dysphagia therapies need to account for influences from pre-morbid patient characteristics as these factors have potential to increase the risk of dysphagia and the resulting complications of aspiration, malnutrition and psychological burden. Dysphagia therapies therefore need to incorporate the medical aetiology that is at its root, the resulting swallow physiology captured from comprehensive clinical and/or instrumental assessments, and the existing needs and supports of patients.
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Affiliation(s)
- Rosemary Martino
- Departments of Speech Language Pathology, Rehabilitation Sciences Institute, and Otolaryngology-Head and Neck Surgery, University of Toronto, 160-500 University Avenue, Ontario M5G 1V7, Canada.,Krembil Research Institute, University Health Network, 399 Bathurst Street (MP 11-331), Toronto, Ontario M5T 2S8, Canada
| | - Timothy McCulloch
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, 600 Highland Avenue, Madison, Wisconsin 53792, USA
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Barnhart MK, Ward EC, Cartmill B, Robinson RA, Simms VA, Chandler SJ, Wurth ET, Smee RI. Pretreatment factors associated with functional oral intake and feeding tube use at 1 and 6 months post-radiotherapy (+/- chemotherapy) for head and neck cancer. EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF OTO-RHINO-LARYNGOLOGICAL SOCIETIES (EUFOS) : AFFILIATED WITH THE GERMAN SOCIETY FOR OTO-RHINO-LARYNGOLOGY - HEAD AND NECK SURGERY 2016. [PMID: 27498203 DOI: 10.1007/s00405-016-4241-9.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
A proportion of patients with head and neck cancer (HNC) experience significant swallowing difficulty during and post-radiotherapy/chemoradiotherapy (RT/CRT). Identifying patients during the pretreatment period who are anticipated to have compromised oral intake would allow for early and accurate patient education, and prioritisation of their management. Ascertaining a clear set of pretreatment predictors from the literature is challenging due to heterogeneity in study designs and patient cohorts, with minimal prospective data available (especially at 1-month post-treatment). The objectives of this study were to investigate which pretreatment factors predicted compromised oral intake and feeding tube use at 1 and 6 months post-RT/CRT. Prospective data were collected on 80 consecutive HNC patients receiving RT/CRT from 2011 to 2014. The primary outcome was to identify predictors of a modified diet at 1 and 6 months post-RT/CRT. Secondary outcomes were to identify predictors of feeding tube use at these time intervals, and <6 vs. >6 week duration of feeding tube use. Multivariate analysis revealed bilateral neck radiotherapy treatment was a strong predictor of modified diets at 1 month (p < 0.001), and T-stages T3/T4 a predictor of modified diets at 6 months (p = 0.03). Patients treated with concurrent CRT (p = 0.02) and bilateral neck treatment (p = 0.02) predicted feeding tube use at 1 month, and concurrent CRT predicted feeding tube use for >6 weeks (p = 0.04). Therefore, patients receiving bilateral neck treatment and/or CRT are at greatest risk of requiring modified diets and feeding tube use early post-treatment, and should be prioritised for intervention and ongoing support.
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Affiliation(s)
- Molly K Barnhart
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia. .,The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD, 4072, Australia.
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD, 4072, Australia.,Centre for Functioning and Health Research, Queensland Health, Buranda, QLD, 4102, Australia
| | - Bena Cartmill
- Centre for Functioning and Health Research, Queensland Health, Buranda, QLD, 4102, Australia.,Speech Pathology, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Rachelle A Robinson
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia
| | - Virginia A Simms
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia
| | - Sophie J Chandler
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia
| | - Elea T Wurth
- Simba Analytics, Melbourne, VIC, 3000, Australia
| | - Robert I Smee
- Comprehensive Cancer Centre, POWH, Randwick, NSW, 2031, Australia.,The Clinical Teaching School, University New South Wales, Kensington, NSW, Australia.,Acting Dir, Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, 2340, Australia
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Barnhart MK, Ward EC, Cartmill B, Robinson RA, Simms VA, Chandler SJ, Wurth ET, Smee RI. Pretreatment factors associated with functional oral intake and feeding tube use at 1 and 6 months post-radiotherapy (+/− chemotherapy) for head and neck cancer. Eur Arch Otorhinolaryngol 2016; 274:507-516. [DOI: 10.1007/s00405-016-4241-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022]
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67
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Finch E, Copley A, Cornwell P, Kelly C. Systematic Review of Behavioral Interventions Targeting Social Communication Difficulties After Traumatic Brain Injury. Arch Phys Med Rehabil 2016; 97:1352-65. [DOI: 10.1016/j.apmr.2015.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 11/08/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
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King SN, Dunlap NE, Tennant PA, Pitts T. Pathophysiology of Radiation-Induced Dysphagia in Head and Neck Cancer. Dysphagia 2016; 31:339-51. [PMID: 27098922 PMCID: PMC5340192 DOI: 10.1007/s00455-016-9710-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 04/08/2016] [Indexed: 11/25/2022]
Abstract
Oncologic treatments, such as curative radiotherapy and chemoradiation, for head and neck cancer can cause long-term swallowing impairments (dysphagia) that negatively impact quality of life. Radiation-induced dysphagia comprised a broad spectrum of structural, mechanical, and neurologic deficits. An understanding of the biomolecular effects of radiation on the time course of wound healing and underlying morphological tissue responses that precede radiation damage will improve options available for dysphagia treatment. The goal of this review is to discuss the pathophysiology of radiation-induced injury and elucidate areas that need further exploration.
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Affiliation(s)
- Suzanne N King
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, 511 South Floyd St MDR 616, Louisville, KY, 40202, USA
| | - Neal E Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, USA
| | - Paul A Tennant
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, USA
| | - Teresa Pitts
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, 511 South Floyd St MDR 616, Louisville, KY, 40202, USA.
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69
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Regan J, Walshe M, Timon C, McMahon BP. 'Endoflip® evaluation of pharyngo-oesophageal segment tone and swallowing in a clinical population: a total laryngectomy case series'. Clin Otolaryngol 2016; 40:121-9. [PMID: 25314664 DOI: 10.1111/coa.12337] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate safety of positioning and distending the functional lumen imaging probe in the pharyngo-oesophageal segment in adults with known pharyngo-oesophageal segment dysfunction and to obtain preliminary measurements of pharyngo-oesophageal segment distensibility and opening during swallowing in a clinical group. METHODS Prospective case series of ten adults post total laryngectomy (61-75 years) recruited from an outpatient ENT clinic. Functional lumen imaging probe was inserted trans-nasally, and the balloon was positioned in the pharyngo-oesophageal segment. Two 20-mL ramp distensions were completed, and subjects performed two dry and two 5-mL and 10-mL liquid swallows at a 12-mL balloon volume. Pharyngo-oesophageal segment distensibility was calculated from cross-sectional area (mm(2) ) and intraballoon pressure (mmHg) measures. During swallowing, extent (mm) and duration (secs) of pharyngo-oesophageal segment opening and intraballoon pressure drop (mmHg) were evaluated. RESULTS Functional lumen imaging probe could be passed through the pharyngo-oesophageal segment in seven subjects, all of whom completed the protocol. During distensions, pharyngo-oesophageal segment cross-sectional area increased significantly (19.47-148.3 mm(2) , P < 0.001), and intraballoon pressure increased significantly (15- to 20-mL balloon volume, P = 0.005). Pharyngo-oesophageal segment diameter (5.1 mm) increased during dry (7.4 mm), 5-mL (7.3 mm) and 10-mL (7.7 mm) liquid swallows (P = 0.018). Pharyngo-oesophageal segment opening duration varied across dry (1 s), 5-mL (0.8 s) and 10-mL (1.6 s) liquid swallows. Resting intraballoon pressure (25.5 mmHg) did not alter significantly during swallowing (P = 0.656). CONCLUSION Functional lumen imaging probe provides novel quantitative information regarding pharyngo-oesophageal segment distensibility and opening during swallowing in adults post total laryngectomy. No adverse events were observed in this first clinical study. Data were easy to acquire, and measures may direct candidacy for and establish effectiveness of interventions to alter pharyngo-oesophageal segment tone.
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Affiliation(s)
- J Regan
- Department of Speech & Language Therapy, Adelaide and Meath Hospital, Dublin, Ireland
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Samuel SR, Veluswamy SK, Maiya AG, Fernandes DJ, McNeely ML. Exercise-based interventions for cancer survivors in India: a systematic review. SPRINGERPLUS 2015; 4:655. [PMID: 26543789 PMCID: PMC4628608 DOI: 10.1186/s40064-015-1456-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/20/2015] [Indexed: 01/03/2023]
Abstract
Existing literature suggests that cancer survivors present with high rates of morbidity due to various treatment and disease induced factors. Research globally has shown exercise to be beneficial in improving treatment outcomes and quality of life. India has a high prevalence of cancer and not much is known about exercise interventions for cancer survivors in India. This review was planned to review the state of exercise based interventions for cancer survivors in India. A comprehensive literature search was performed in PubMed, CINAHL, EMBASE, Scopus, Cochrane Library, PEDro, IndMed, and Shoda Ganga. The search results were screened and data extracted by two independent reviewers. All eligible studies were assessed for methodological quality rating using Downs and Black checklist. Data was extracted using a pilot tested pro forma to summarize information on site and stage of cancer, type of exercise intervention and outcome measures. The review identified 13 studies, published from 1991 to 2013, after screening 4060 articles. Exercise interventions fell into one of three categories: (1) yoga-based, (2) physiotherapy-based and (3) speech therapy based interventions; and exclusively involved either breast or head and neck cancers. Studies were generally of low to moderate quality. A broad range of outcomes were found including symptoms, speech and swallowing, and quality of life and largely supported the benefits of exercise-based interventions. At present, research involving exercise-based rehabilitation interventions in India is limited in volume, quality and scope. With the growing burden of cancer in the country, there is an immediate need for research on exercise based interventions for cancer survivors within the sociocultural context of India.
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Affiliation(s)
- Stephen R Samuel
- Department of Physiotherapy, SOAHS, Manipal University, Manipal, India
| | - Sundar K Veluswamy
- Department of Physiotherapy, M S Ramaiah Medical College and Hospitals, MSR Nagar, MSR IT Post, Bangalore, 560054 Karnataka India
| | - Arun G Maiya
- Department of Physiotherapy, SOAHS, Manipal University, Manipal, India
| | - Donald J Fernandes
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal University, Manipal, India
| | - Margaret L McNeely
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta Canada
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71
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Murphy BA, Deng J. Advances in Supportive Care for Late Effects of Head and Neck Cancer. J Clin Oncol 2015; 33:3314-21. [PMID: 26351334 DOI: 10.1200/jco.2015.61.3836] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
As the population of head and neck cancer survivors increases, it has become increasingly important for health care providers to understand and manage late complications of therapy. Functional deficits can be categorized as general health deficits resulting in frailty or debility, head and neck-specific functional deficits such as swallowing and speech, and musculoskeletal impairment as a result of tumor and treatment. Of critical importance is the growing data indicating that swallow therapy and physical therapy may prevent or ameliorate long-term functional deficits. Oral health complications of head and neck therapy may manifest months or years after the completion of treatment. Patients with hyposalivation are at high risk for dental caries and thus require aggressive oral hygiene regimens and routine dental surveillance. Swallowing abnormalities, xerostomia, and poor dentition may result in dietary adaptations that may cause nutritional deficiencies. Identification and management of maladaptive dietary strategies are important for long-term health. Follow-up with primary care physicians for management of comorbidities such as diabetes and hyperlipidemia may help to limit late vascular complications caused by radiation therapy. Herein, we review late effects of head and neck cancer therapy, highlighting recent advances.
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Affiliation(s)
- Barbara A Murphy
- Barbara A. Murphy, Vanderbilt-Ingram Cancer Center; and Jie Deng, School of Nursing, Vanderbilt University, Nashville, TN.
| | - Jie Deng
- Barbara A. Murphy, Vanderbilt-Ingram Cancer Center; and Jie Deng, School of Nursing, Vanderbilt University, Nashville, TN
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72
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Brown TE, Crombie J, Spurgin AL, Tripcony L, Keller J, Hughes BGM, Dickie G, Kenny LM, Hodge RA. Improving guideline sensitivity and specificity for the identification of proactive gastrostomy placement in patients with head and neck cancer. Head Neck 2015; 38 Suppl 1:E1163-71. [DOI: 10.1002/hed.24184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 03/02/2015] [Accepted: 07/03/2015] [Indexed: 01/28/2023] Open
Affiliation(s)
- Teresa E. Brown
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Jane Crombie
- Department of Speech Pathology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Ann-Louise Spurgin
- Department of Speech Pathology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Lee Tripcony
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Jacqui Keller
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Brett G. M. Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine, University of Queensland; Queensland Australia
| | - Graeme Dickie
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Lizbeth Moira Kenny
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Robert A. Hodge
- Department of ENT/Head and Neck Surgery; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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73
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Govender R, Smith CH, Taylor SA, Grey D, Wardle J, Gardner B. Identification of behaviour change components in swallowing interventions for head and neck cancer patients: protocol for a systematic review. Syst Rev 2015; 4:89. [PMID: 26088597 PMCID: PMC4474547 DOI: 10.1186/s13643-015-0077-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/10/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Dysphagia (difficulty in swallowing) is a predictable consequence of head and neck cancer and its treatment. Loss of the ability to eat and drink normally has a devastating impact on quality of life for survivors of this type of cancer. Most rehabilitation programmes involve behavioural interventions that include swallowing exercises to help improve swallowing function. Such interventions are complex; consisting of multiple components that may influence outcomes. These interventions usually require patient adherence to recommended behaviour change advice. To date, reviews of this literature have explored whether variation in effectiveness can be attributed to the type of swallowing exercise, the use of devices to facilitate use of swallowing muscles, and the timing (before, during or after cancer treatment). This systematic review will use a behavioural science lens to examine the content of previous interventions in this field. It aims to identify (a) which behaviour change components are present, and (b) the frequency with which they occur in interventions deemed to be effective and non-effective. METHODS/DESIGN Clinical trials of behavioural interventions to improve swallowing outcomes in patients with head and neck cancers will be identified via a systematic and comprehensive search of relevant electronic health databases, trial registers, systematic review databases and Web of Science. To ascertain behaviour change intervention components, we will code the content for its theory basis, intervention functions and specific behaviour change techniques, using validated tools: the Theory Coding Scheme, Behaviour Change Wheel and Behaviour Change Technique Taxonomy v1. Study quality will be assessed for descriptive purposes only. Given the specialisation and focus of this review, a small yield of studies with heterogeneous outcome measures is anticipated. Therefore, narrative synthesis is considered more appropriate than meta-analysis. We will also compare the frequency of behavioural components in effective versus non-effective interventions, where effectiveness is indicated by statistically significant changes in swallowing outcomes. DISCUSSION This review will provide a synthesis of the behaviour change components in studies that currently represent best evidence for behavioural swallowing interventions for head and neck cancer patients. Results will provide some guidance on the choice of optimal behavioural strategies for the development of future interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015017048.
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Affiliation(s)
- Roganie Govender
- Head and Neck Cancer Centre, University College London Hospital and Health Behaviour Research Centre, University College London, 250 Euston Road, London, NW1 2PQ, UK.
| | - Christina H Smith
- Division of Psychology and Language Sciences, University College London, London, UK.
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK.
| | | | - Jane Wardle
- Health Behaviour Research Centre, University College London, London, UK.
| | - Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK. .,UCL Centre for Behaviour Change, University College London, London, UK.
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Rinkel RN, Verdonck-de Leeuw IM, Doornaert P, Buter J, de Bree R, Langendijk JA, Aaronson NK, Leemans CR. Prevalence of swallowing and speech problems in daily life after chemoradiation for head and neck cancer based on cut-off scores of the patient-reported outcome measures SWAL-QOL and SHI. Eur Arch Otorhinolaryngol 2015; 273:1849-55. [PMID: 26071622 PMCID: PMC4899484 DOI: 10.1007/s00405-015-3680-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 05/31/2015] [Indexed: 11/30/2022]
Abstract
The objective of this study is to assess swallowing and speech outcome after chemoradiation therapy for head and neck cancer, based on the patient-reported outcome measures Swallowing Quality of Life Questionnaire (SWAL-QOL) and Speech Handicap Index (SHI), both provided with cut-off scores. This is a cross-sectional study. Department of Otolaryngology/Head and Neck Surgery of a University Medical Center. Sixty patients, 6 months to 5 years after chemoradiation for head and neck squamous cell carcinoma. Swallowing Quality of Life Questionnaire (SWAL-QOL) and SHI, both validated in Dutch and provided with cut-off scores. Associations were tested between the outcome measures and independent variables (age, gender, tumor stage and site, and radiotherapy technique, time since treatment, comorbidity and food intake). Fifty-two patients returned the SWAL-QOL and 47 the SHI (response rate 87 and 78 %, respectively). Swallowing and speech problems were present in 79 and 55 %, respectively. Normal food intake was noticed in 45, 35 % had a soft diet and 20 % tube feeding. Patients with soft diet and tube feeding reported more swallowing problems compared to patients with normal oral intake. Tumor subsite was significantly associated with swallowing outcome (less problems in larynx/hypopharynx compared to oral/oropharynx). Radiation technique was significantly associated with psychosocial speech problems (less problems in patients treated with IMRT). Swallowing and (to a lesser extent) speech problems in daily life are frequently present after chemoradiation therapy for head and neck cancer. Future prospective studies will give more insight into the course of speech and swallowing problems after chemoradiation and into efficacy of new radiation techniques and swallowing and speech rehabilitation programs.
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Affiliation(s)
- Rico N Rinkel
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - Patricia Doornaert
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan Buter
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Remco de Bree
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen/University of Groningen, Groningen, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Nund R, Ward E, Scarinci N, Cartmill B. The Value of Qualitative Research in Dysphagia in the Head and Neck Cancer Population: What Can We Learn From the Survivors' Perspective? ACTA ACUST UNITED AC 2015. [DOI: 10.1044/sasd24.3.99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dysphagia is a common acute and long-term side effect of curative, non-surgical treatment for head and neck cancer (HNC). Despite what is known about dysphagia associated with HNC treatment in terms of its prevalence, severity, physiological characteristics, and the associated effects on quality of life (QoL), our understanding of the key factors which impact on HNC survivors is only just emerging. Whilst quantitative research studies have demonstrated that most people experience dysphagia in the early post-treatment period, and that many people continue to have ongoing swallowing issues for months and years following treatment, emerging qualitative research in this field has provided insights into the extent to which the presence of dysphagia impacts on the everyday lives of people with HNC. By exploring issues from the perspectives of people living with dysphagia, qualitative research has highlighted those factors that have the greatest impact on oral intake, raised issues for service provision, and highlighted the need for additional professional involvement and better long term supportive care.
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Affiliation(s)
- Rebecca Nund
- School of Health and Rehabilitation Sciences, The University of QueenslandBrisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health ServiceBrisbane, Queensland, Australia
| | - Elizabeth Ward
- School of Health and Rehabilitation Sciences, The University of QueenslandBrisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health ServiceBrisbane, Queensland, Australia
| | - Nerina Scarinci
- School of Health and Rehabilitation Sciences, The University of QueenslandBrisbane, Queensland, Australia
| | - Bena Cartmill
- Centre for Functioning and Health Research, Metro South Hospital and Health ServiceBrisbane, Queensland, Australia
- Department of Speech Pathology, Princess Alexandra HospitalBrisbane, Queensland, Australia
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76
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Son YR, Choi KH, Kim TG. Dysphagia in tongue cancer patients. Ann Rehabil Med 2015; 39:210-7. [PMID: 25932417 PMCID: PMC4414967 DOI: 10.5535/arm.2015.39.2.210] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/29/2014] [Indexed: 01/08/2023] Open
Abstract
Objective To identify risk factors for dysphagia in tongue cancer patients. Dysphagia is a common complication of surgery, radiotherapy, and chemotherapy in tongue cancer patients. Previous studies have attempted to identify risk factors for dysphagia in patients with head and neck cancer, but no studies have focused specifically on tongue cancer patients. Methods This study was conducted on 133 patients who were diagnosed with tongue cancer and who underwent a videofluoroscopy swallowing study (VFSS) between January 2007 and June 2012 at the Asan Medical Center. Data collected from the VFSS were analyzed retrospectively. Patients with aspiration were identified. Results Patients showed a higher incidence of inadequate tongue control, inadequate chewing, delayed oral transit time, aspiration or penetration, vallecular pouch and pyriform residue, and inadequate laryngeal elevation after surgery. Moreover, male gender, extensive tumor resection, a higher node stage, and more extensive lymph node dissection were major risk factors for aspiration in tongue cancer patients. Conclusion Tongue cancer patients have difficulties in the pharyngeal phase as well as the oral phase of swallowing. These difficulties can worsen after tongue cancer surgery. Gender, the extent of tumor resection, and lymph node metastasis affect swallowing in tongue cancer patients. Physicians should take these risk factors into account when administering swallowing therapy to tongue cancer patients.
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Affiliation(s)
- Yu Ri Son
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Gyun Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Rinkel RNPM, Verdonck-de Leeuw IM, de Bree R, Aaronson NK, Leemans CR. Validity of patient-reported swallowing and speech outcomes in relation to objectively measured oral function among patients treated for oral or oropharyngeal cancer. Dysphagia 2015; 30:196-204. [PMID: 25622807 DOI: 10.1007/s00455-014-9595-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 12/27/2014] [Indexed: 11/30/2022]
Abstract
The objective of this study was to test the construct validity of the patient-reported outcomes Swallowing Quality of Life Questionnaire (SWAL-QOL) and Speech Handicap Index (SHI) in relation to objectively measured oral function among patients treated for oral or oropharyngeal cancer. The study sample consisted of patients treated for oral or oropharyngeal cancer. Outcome measures were the SWAL-QOL and the SHI, and the Functional Rehabilitation Outcomes Grade (FROG), a test to measure oral and shoulder function. Spearman's rank correlation coefficient was used to test associations between the SHI and SWAL-QOL scales, and the FROG scales. During a study period of 3 months, 38 patients (21 males, 17 females; mean age 54 years) were included who visited the outpatient clinic for follow-up care 6-155 months after surgical treatment (n = 14) or combined surgery and radiotherapy (n = 24) for oral (n = 21) or oropharyngeal cancer (n = 17). Most SWAL-QOL and SHI scales (except the SWAL-QOL Fatigue scale) correlated significantly with one or more FROG oral function scales. None of the SWAL-QOL and SHI scales correlated significantly with the FROG shoulder function scale. These results support the construct validity of the SWAL-QOL and SHI questionnaires for assessing speech and swallowing problems in daily life that are moderately but significantly related to oral function. A multidimensional assessment protocol is recommended for use in clinical practice and for research purposes for measuring oral function and swallowing- and speech-related problems in daily life among head and neck cancer patients.
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Affiliation(s)
- R N P M Rinkel
- Department of Otolaryngology, Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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Yen TT, Lin CH, Jiang RS, Shih YT, Yen HR, Liang KL. Incidence of late-onset pneumonia in patients after treatment with radiotherapy for nasopharyngeal carcinoma: A nationwide population-based study. Head Neck 2014; 37:1756-61. [DOI: 10.1002/hed.23827] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ting-Ting Yen
- Department of Otolaryngology; Taichung Veterans General Hospital; Taichung Taiwan
- Graduate Institute of Natural Healing Sciences; Nanhua University; Chiayi Taiwan
| | - Ching-Heng Lin
- Department of Medical Research; Taichung Veterans General Hospital; Taichung Taiwan
| | - Rong-San Jiang
- Department of Otolaryngology; Taichung Veterans General Hospital; Taichung Taiwan
- School of Medicine; Chung Shan Medical University; Taichung Taiwan
| | - Yi-Ting Shih
- Department of Radiation Oncology; Saint Martin De Porres Hospital; Chiayi Taiwan
| | - Hung-Rong Yen
- Research Center for Traditional Chinese Medicine; Department of Medical Research and Department of Chinese Medicine; China Medical University Hospital; Taichung Taiwan
- School of Chinese Medicine; China Medical University; Taichung Taiwan
| | - Kai-Li Liang
- Department of Otolaryngology; Taichung Veterans General Hospital; Taichung Taiwan
- Graduate Institute of Natural Healing Sciences; Nanhua University; Chiayi Taiwan
- School of Medicine; National Yang-Ming Medical University; Taipei Taiwan
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79
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Barbon CEA, Steele CM. Efficacy of thickened liquids for eliminating aspiration in head and neck cancer: a systematic review. Otolaryngol Head Neck Surg 2014; 152:211-8. [PMID: 25358345 DOI: 10.1177/0194599814556239] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To appraise the current videofluoroscopic evidence on the reduction of aspiration using thickened liquids in the head and neck cancer population. DATA SOURCES Search terms relating to deglutition or dysphagia or swallow and neoplasms and oncology or head and neck cancer and viscosity or texture and apira or residu* were combined with honey or nectar, xerostomia, and respiratory aspiration using Boolean operators. REVIEW METHODS A multiengine literature search identified 337 nonduplicate articles, of which 6 were judged to be relevant. These underwent detailed review for study quality and qualitative synthesis. RESULTS The articles reviewed in detail predominantly described heterogeneous study samples with small sample sizes, making for difficult interpretation and generalization of results. Rates of aspiration were typically not reported by bolus consistency, despite the fact that a variety of stimulus consistencies was used during a videofluoroscopic swallowing study. Studies confirmed that aspiration is a major concern in the head and neck cancer population and reported a trend toward more frequent aspiration after (chemo)radiotherapy. CONCLUSION Overall, the literature on thickened liquids as an intervention to eliminate aspiration in the head and neck cancer population is limited. Because aspiration is known to be prevalent in the head and neck cancer population and thickened liquids are known to eliminate aspiration in other populations, it is important to determine the effectiveness of thickened liquids for reducing aspiration in the head and neck cancer population.
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Affiliation(s)
- Carly E A Barbon
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Catriona M Steele
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada Bloorview Research Institute, Toronto, Ontario, Canada
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Theurer JA, Yoo J, Nichols AC. Human papillomavirus-related oropharyngeal squamous cell carcinoma: a new context for dysphagia rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0058-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Application of the International Classification of Functioning, Disability and Health (ICF) to People with Dysphagia Following Non-surgical Head and Neck Cancer Management. Dysphagia 2014; 29:692-703. [DOI: 10.1007/s00455-014-9563-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
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