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Zuckerman M, Wang S, Kaneoka A, Coster WJ, Leonard R, Langmore SE, Pisegna JM. Conceptualizing Adult Dysphagia in the United States Within the International Classification of Functioning, Disability and Health (ICF). Arch Phys Med Rehabil 2024; 105:1008-1018. [PMID: 38072229 DOI: 10.1016/j.apmr.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/10/2023] [Accepted: 11/28/2023] [Indexed: 02/26/2024]
Abstract
Despite the well-documented safety concerns and effect on quality of life, there does not yet exist a wide-reaching framework that links the etiologies of swallowing disorders to the potential short- and long-term outcomes in the context of International Classification of Functioning, Disability and Health (ICF). This paper introduces an expert-reviewed conceptual framework to highlight common etiologies of dysphagia as well as integrate immediate outcomes of dysphagia with long-term outcomes of dysphagia in terms of medical problems, health-related quality of life, functional effect, and psychosocial features. It also outlines the potential cyclical nature of long-term dysphagia outcomes perpetuating the original dysphagia. This framework serves to inform clinicians of important dysphagic outcomes and to bring awareness to long-term outcomes that should be monitored by health care professionals, caregivers, or people with dysphagia.
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Affiliation(s)
- Melani Zuckerman
- Boston University Chobanian & Avedesian School of Medicine, 72 East Concord St, Boston, MA 02118, United States
| | - Shawn Wang
- Boston University Chobanian & Avedesian School of Medicine, 72 East Concord St, Boston, MA 02118, United States
| | - Asako Kaneoka
- The University of Tokyo Hospital Rehabilitation Center, Tokyo, Japan
| | - Wendy J Coster
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue, Boston, MA 02215, United States
| | - Rebecca Leonard
- University of California at Davis, Davis, CA 95616, United States
| | - Susan E Langmore
- Boston University Chobanian & Avedesian School of Medicine, 72 East Concord St, Boston, MA 02118, United States
| | - Jessica M Pisegna
- Boston Medical Center, 800 Harrison Ave, BCD Building, 5th Floor, Boston, MA 02118, United States; Department of Speech Language Pathology, Boston University, Sargent College, 635 Commonwealth Ave, Boston, MA 02215, United States.
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Guan C, Lu T, Liao Z, Rich E, Gong X, Lv Q, Li J. Nutritional Status and Incidence of Radiation-Induced Oral Mucositis in Nasopharyngeal Carcinoma Patients Treated with Chemoradiotherapy. Nutr Cancer 2024; 76:196-206. [PMID: 38113055 DOI: 10.1080/01635581.2023.2294523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
Malnutrition is prevalent among patients with nasopharyngeal carcinoma undergoing radiotherapy. This study examined the nutritional status and incidence of radiation-induced oral mucositis (RIOM) in patients with nasopharyngeal carcinoma. A retrospective analysis was conducted to compare the incidence of RIOM, Nutritional Risk Screening (NRS) 2002 score, weight, body mass index (BMI), and hemoglobin levels in 338 patients treated with induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) or treated with CCRT alone. The IC + CCRT group exhibited an increase in weight and BMI but a decrease in hemoglobin levels after IC compared with baseline (p < 0.001). Both groups showed differences in weight at Week 0 and BMI at Weeks 0-2 of radiotherapy (p < 0.05). The IC + CCRT group experienced an increase in NRS 2002 scores from Week 2 to Week 6 (p < 0.05). The hemoglobin levels of the IC + CCRT group were consistently lower throughout radiotherapy (p < 0.001). However, no significant difference was observed in the incidence of RIOM between the two groups (p = 0.246). Patients treated with IC + CCRT exhibited a higher nutritional risk during radiotherapy. Although the incidence of Grade III RIOM was high, no significant difference was found between the groups.
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Affiliation(s)
- Chunhong Guan
- NHC Key Laboratory of Personalized Diagnosis and Treatment for Nasopharyngeal Carcinoma, the Second Affiliated Hospital of Nanchang Medical College (Jiangxi Cancer Hospital), Nanchang, Jiangxi, China
- Jiangxi Key Laboratory of Translational Research for Cancer, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
| | - Tianzhu Lu
- NHC Key Laboratory of Personalized Diagnosis and Treatment for Nasopharyngeal Carcinoma, the Second Affiliated Hospital of Nanchang Medical College (Jiangxi Cancer Hospital), Nanchang, Jiangxi, China
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
| | - Zhaohui Liao
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
- Nursing School of Nanchang University, Nanchang, Jiangxi, China
- Clinical Training Center, Jiangxi Cancer Hospital, the Second Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Emily Rich
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Xiaochang Gong
- NHC Key Laboratory of Personalized Diagnosis and Treatment for Nasopharyngeal Carcinoma, the Second Affiliated Hospital of Nanchang Medical College (Jiangxi Cancer Hospital), Nanchang, Jiangxi, China
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
| | - Qiaoli Lv
- Jiangxi Key Laboratory of Translational Research for Cancer, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
| | - Jingao Li
- NHC Key Laboratory of Personalized Diagnosis and Treatment for Nasopharyngeal Carcinoma, the Second Affiliated Hospital of Nanchang Medical College (Jiangxi Cancer Hospital), Nanchang, Jiangxi, China
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
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Subih HS, Al-Shwaiyat EA, Al-Bayyari N, Obeidat BS, Abu-Farsakh F, Bawadi H. Dietary Intake Is Not Associated with Body Composition nor with Biochemical Tests but with Psychological Status of Cancer Patients Receiving Chemotherapy. Nutrients 2023; 15:5087. [PMID: 38140346 PMCID: PMC10746082 DOI: 10.3390/nu15245087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/21/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
Chemotherapy can negatively affect cancer patients' eating patterns, psychological status, body composition, and quality of life. In this study, we aimed to investigate the correlations between dietary intake/care and the psychological status of cancer patients treated with chemotherapy. An observational study was conducted on 75 participants during their first cycle of chemotherapy treatment, and they were followed up for three cycles. Each participant completed a reliable validated questionnaire, psychological questionnaire, quality of life questionnaire, and three-day food records. Dietary intake was considered adequate if there was an adherence of participants to dietary recommendations offered by the dietitian and was confirmed by ESHA analysis software (version 10.6.3). Seventy-five percent of participants had inadequate nutrition intake. All anthropometric measurements decreased after 2 months of chemotherapy regardless of patients' dietary intake. Approximately half of the participants reported depression and anxiety. There were significant differences between all nutrient intake levels when compared to the recommended dietary allowance except for fat, unsaturated fatty acids, and iron. Also, there were associations between nutritional intake and life quality and depression. In conclusion, poor dietary intake was associated with depression and insufficient macro- and micronutrient intake. Emotional and nutritional support from healthcare providers and family are highly necessary.
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Affiliation(s)
- Hadil S. Subih
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan;
| | - Esraa A. Al-Shwaiyat
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan;
| | - Nahla Al-Bayyari
- Department of Nutrition and Food Processing, Faculty of Al-Huson University College, Al-Balqa Applied University, Al-Salt 19117, Jordan
| | - Belal S. Obeidat
- Department of Animal Production, Faculty of Agriculture, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan;
| | - Fadi Abu-Farsakh
- Department of Oncology, King Hussein Cancer Center, Amman 11941, Jordan;
| | - Hiba Bawadi
- College of Health Sciences, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
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Spei ME, Bellos I, Samoli E, Benetou V. Post-Diagnosis Dietary Patterns among Cancer Survivors in Relation to All-Cause Mortality and Cancer-Specific Mortality: A Systematic Review and Meta-Analysis of Cohort Studies. Nutrients 2023; 15:3860. [PMID: 37686892 PMCID: PMC10490392 DOI: 10.3390/nu15173860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
The role of overall diet on longevity among cancer survivors (CS) needs further elucidation. We performed a systematic review of the literature and a meta-analysis of related cohort studies published up to October 2022 investigating post-diagnosis a priori (diet quality indices) and a posteriori (data-driven) dietary patterns (DPs) in relation to all-cause and cancer-specific mortality. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using random-effects meta-analyses comparing highest versus lowest categories of adherence to DPs. We assessed heterogeneity and risk of bias in the selected studies. A total of 19 cohort studies with 38,846 adult CS, some assessing various DPs, were included in the meta-analyses. Higher adherence to a priori DPs was associated with lower all-cause mortality by 22% (HR = 0.78, 95% CI: 0.73-0.83, I2 = 22.6%) among all CS, by 22% (HR = 0.78, 95% CI: 0.73-0.84, I2 = 0%) among breast CS and by 27% (HR = 0.73, 95% CI: 0.62-0.86, I2 = 41.4%) among colorectal CS. Higher adherence to a "prudent/healthy" DP was associated with lower all-cause mortality (HR = 0.79, 95% CI: 0.64-0.97 I2 = 49.3%), whereas higher adherence to a "western/unhealthy" DP was associated with increased all-cause mortality (HR = 1.48, 95% CI: 1.26-1.74, I2 = 0%) among all CS. Results for cancer-specific mortality were less clear. In conclusion, higher adherence to a "healthy" DP, either a priori or a posteriori, was inversely associated with all-cause mortality among CS. A "healthy" overall diet after cancer diagnosis could protect and promote longevity and well-being.
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Affiliation(s)
| | | | | | - Vassiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 115 27 Athens, Greece; (M.-E.S.); (I.B.); (E.S.)
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Sun F, Qiao J, Huang X, He Z, Dou Z. Characteristics of post-stroke dysphagia: A retrospective study based on FEES. Brain Behav 2023; 13:e3161. [PMID: 37475645 PMCID: PMC10454255 DOI: 10.1002/brb3.3161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 06/16/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE This study aims to examine the characteristics of dysphagia in stroke patients with different lesion sites and explore the factors that impact the duration of nasogastric tube after post-stroke dysphagia (PSD). METHODS Patients with PSD were screened for analysis. Stroke types and lesion sites were confirmed using MRI or CT scans. Included patients were categorized into two groups: supratentorial stroke group (including lobar and deep intracerebral stroke subgroups) and infratentorial stroke group (including brainstem and cerebellar stroke subgroups). Fiberoptic endoscopic evaluation of swallowing (FEES), Penetration-aspiration scale (PAS), Yale pharyngeal residue (PR) severity rating scale, Functional oral intake scale (FOIS), Murray secretion severity rating scale (MSS), laryngopharyngeal sensation, and vocal fold mobility were investigated to assess the swallowing function. RESULTS A total of 94 patients were included in the final analysis. Significant differences were found in PR scores (p < .001), PAS scores (p < .05), MSS scores (p < .05), and vocal fold mobility (p < .001) between infratentorial and supratentorial stroke groups. Moreover, lobar stroke showed significantly higher PR scores compared to the deep intracerebral stroke group (p < .05). Kaplan-Meier survival analysis indicated significant differences in the duration of nasogastric tube placement among the following groups: infratentorial versus supratentorial stroke, PAS ≤ 5 versus PAS > 5, PR ≥ 3 versus PR < 3, and normal vocal fold mobility versus vocal fold motion impairment group (p < .05). CONCLUSIONS The infratentorial stroke may lead to worse swallowing function as compared to a supratentorial stroke. Additionally, patients with infratentorial stroke, PAS > 5, PR ≥ 3, or vocal fold motion impairment may contribute to a longer duration of nasogastric tube placement.
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Affiliation(s)
- Fang Sun
- Clinical Medical College of Acupuncture‐Moxibustion and RehabilitationGuangzhou University of Chinese MedicineGuangzhouP. R. China
- Department of Rehabilitation MedicinePeople' Hospital of YangjiangGuangzhouP. R. China
| | - Jia Qiao
- Department of Rehabilitation MedicineThird Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Xiaoyan Huang
- Clinical Medical College of Acupuncture‐Moxibustion and RehabilitationGuangzhou University of Chinese MedicineGuangzhouP. R. China
- Department of Rehabilitation MedicineThird Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Zitong He
- Department of Rehabilitation MedicineThird Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
| | - Zulin Dou
- Clinical Medical College of Acupuncture‐Moxibustion and RehabilitationGuangzhou University of Chinese MedicineGuangzhouP. R. China
- Department of Rehabilitation MedicineThird Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouP. R. China
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Fernández Forné Á, García Anaya MJ, Segado Guillot SJ, Plaza Andrade I, de la Peña Fernández L, Lorca Ocón MJ, Lupiáñez Pérez Y, Queipo-Ortuño MI, Gómez-Millán J. Influence of the microbiome on radiotherapy-induced oral mucositis and its management: A comprehensive review. Oral Oncol 2023; 144:106488. [PMID: 37399707 DOI: 10.1016/j.oraloncology.2023.106488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/29/2023] [Indexed: 07/05/2023]
Abstract
Radiation-induced mucositis is the most common, debilitating and painful acute toxicity associated with active treatment in head and neck cancer area, severely affecting more than 65% of patients. Oral microbiota significantly changes during cancer therapy and appears to be involved on its pathophysiology. This review aims to present a comprehensive update of new etiopathogenic factors and treatments that may decrease the incidence of mucositis, mainly modifications of dietary interventions to modify microbiome. Despite advances in recent years, its management is mainly symptomatic opioid-based with variable results on different substances analyzed for its prevention. Immunonutrition seems to play a significant role, particularly the supplementation of compounds such as fatty acids, polyphenols or selected probiotics have shown to promote commensal bacteria diversity and reduced incidence of ulcerative mucositis. Modification of the microbiome is a promising preventive treatment for mucositis although its evidence is still scarce. Large studies are needed to demonstrate the efficacy of interventions on microbiome and its clinical impact on radiation-induced mucositis.
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Affiliation(s)
- África Fernández Forné
- Department of Radiation Oncology. Punta Europa University Hospital. Algeciras, Cádiz, Spain
| | - María Jesús García Anaya
- Department of Radiation Oncology, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | | | - Isaac Plaza Andrade
- Intercenter Clinical Unit of Medical Oncology, Regional and Virgen de la Victoria University Hospitals, Biomedical Research Institute of Malaga (IBIMA)-CIMES-UMA, University of Malaga, 29010 Málaga, Spain
| | | | - María Jesús Lorca Ocón
- Department of Radiation Oncology, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | - Yolanda Lupiáñez Pérez
- Department of Radiation Oncology, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | - María Isabel Queipo-Ortuño
- Intercenter Clinical Unit of Medical Oncology, Regional and Virgen de la Victoria University Hospitals, Biomedical Research Institute of Malaga (IBIMA)-CIMES-UMA, University of Malaga, 29010 Málaga, Spain; Department of Surgical Specialties, Biochemical and Immunology, Faculty of Medicine, University of Málaga, 29010 Malaga, Spain.
| | - Jaime Gómez-Millán
- Department of Radiation Oncology, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
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Semsar-Kazerooni K, Richardson K, Forest VI, Mlynarek A, Hier MP, Sadeghi N, Mascarella MA. Development and validation of the modified index of fragility in head and neck cancer surgery. J Otolaryngol Head Neck Surg 2023; 52:5. [PMID: 36703217 PMCID: PMC9878788 DOI: 10.1186/s40463-022-00607-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study aims to develop and validate, a clinically useful modified index of fragility (mIFG) to identify patients at risk of fragility and to predict postoperative adverse events. METHOD An observational study was performed using the American College of Surgeons National Surgical Quality Improvement Program database, from 2006 to 2018. All patients undergoing nonemergency head and neck cancer surgery were included. A seven-item index (mIFG) was developed using variables associated with frailty, cachexia, and sarcopenia, drawn from the literature (weight loss, low body mass index, dyspnea, diabetes, serum albumin, hematocrit, and creatinine). Multivariable logistic regression was used to model the association between mIFG, postoperative adverse events and death. A validation cohort was then used to ascertain the diagnostic accuracy of the mIFG. RESULTS A total of 23,438 cases were included (16,407 in the derivation group and 7031 in the validation group). There was a total of 4273 postoperative major adverse events (AE) and deaths, 1023 postoperative pulmonary complications and 1721 wound complications. Using the derivation cohort, the 7-item mIFG was independently associated with death, major AEs, pulmonary and wound complications, when controlling for significant covariates. The mIFG predicted death and major adverse events using the validation cohort with an accuracy of 0.70 (95% CI: 0.63-0.76) and 0.64 (95% CI: 0.63-0.66), respectively. The mIFG outperformed the modified Frailty index. CONCLUSION The modified index of fragility is a reliable and easily accessible tool to predict risk of postoperative adverse events and death in patients undergoing head and neck cancer surgery.
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Affiliation(s)
| | - Keith Richardson
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada
| | - Véronique-Isabelle Forest
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada
| | - Alex Mlynarek
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada
| | - Michael P. Hier
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada
| | - Nader Sadeghi
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada ,grid.63984.300000 0000 9064 4811Research Institute of the McGill University Health Center, Montreal, QC Canada
| | - Marco. A. Mascarella
- grid.63984.300000 0000 9064 4811Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, QC Canada ,grid.414980.00000 0000 9401 2774Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montréal, QC Canada ,grid.63984.300000 0000 9064 4811Research Institute of the McGill University Health Center, Montreal, QC Canada
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Weng W, Imaizumi M, Murono S, Zhu X. Expert-level aspiration and penetration detection during flexible endoscopic evaluation of swallowing with artificial intelligence-assisted diagnosis. Sci Rep 2022; 12:21689. [PMID: 36522385 PMCID: PMC9753025 DOI: 10.1038/s41598-022-25618-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Flexible endoscopic evaluation of swallowing (FEES) is considered the gold standard in diagnosing oropharyngeal dysphagia. Recent advances in deep learning have led to a resurgence of artificial intelligence-assisted computer-aided diagnosis (AI-assisted CAD) for a variety of applications. AI-assisted CAD would be a remarkable benefit in providing medical services to populations with inadequate access to dysphagia experts, especially in aging societies. This paper presents an AI-assisted CAD named FEES-CAD for aspiration and penetration detection on video recording during FEES. FEES-CAD segments the input FEES video and classifies penetration, aspiration, residue in the vallecula, and residue in the hypopharynx based on the segmented FEES video. We collected and annotated FEES videos from 199 patients to train the network and tested the performance of FEES-CAD using FEES videos from other 40 patients. These patients consecutively underwent FEES between December 2016 and August 2019 at Fukushima Medical University Hospital. FEES videos were deidentified, randomized, and rated by FEES-CAD and laryngologists with over 15 years of experience in performing FEES. FEES-CAD achieved an average Dice similarity coefficient of 98.6[Formula: see text]. FEES-CAD achieved expert-level accuracy performance on penetration (92.5[Formula: see text]), aspiration (92.5[Formula: see text]), residue in the vallecula (100[Formula: see text]), and residue in the hypopharynx (87.5[Formula: see text]) classification tasks. To the best of our knowledge, FEES-CAD is the first CNN-based system that achieves expert-level performance in detecting aspiration and penetration.
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Affiliation(s)
- Weihao Weng
- Graduate School of Computer Scicence and Engineering, The University of Aizu, Aizuwakamatsu, 965-8580, Japan
| | - Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, Fukushima, 960-1295, Japan.
| | - Shigeyuki Murono
- Department of Otolaryngology, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Xin Zhu
- Graduate School of Computer Scicence and Engineering, The University of Aizu, Aizuwakamatsu, 965-8580, Japan.
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Montoro-Huguet MA. Dietary and Nutritional Support in Gastrointestinal Diseases of the Upper Gastrointestinal Tract (I): Esophagus. Nutrients 2022; 14:nu14224819. [PMID: 36432505 PMCID: PMC9697263 DOI: 10.3390/nu14224819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
The esophagus is the centerpiece of the digestive system of individuals and plays an essential role in transporting swallowed nutrients to the stomach. Diseases of the esophagus can alter this mechanism either by causing anatomical damage that obstructs the lumen of the organ (e.g., peptic, or eosinophilic stricture) or by generating severe motility disorders that impair the progression of the alimentary bolus (e.g., severe dysphagia of neurological origin or achalasia). In all cases, nutrient assimilation may be compromised. In some cases (e.g., ingestion of corrosive agents), a hypercatabolic state is generated, which increases resting energy expenditure. This manuscript reviews current clinical guidelines on the dietary and nutritional management of esophageal disorders such as severe oropharyngeal dysphagia, achalasia, eosinophilic esophagitis, lesions by caustics, and gastroesophageal reflux disease and its complications (Barrett's esophagus and adenocarcinoma). The importance of nutritional support in improving outcomes is also highlighted.
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Affiliation(s)
- Miguel A. Montoro-Huguet
- Unit of Gastroenterology, Hepatology & Nutrition, University Hospital San Jorge, 22005 Huesca, Spain;
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- Aragón Health Sciences Institute (IACS), 50009 Zaragoza, Spain
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10
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McCarter K, Baker AL, Wolfenden L, Wratten C, Bauer J, Beck AK, Forbes E, Carter G, Leigh L, Oldmeadow C, Britton B. Smoking and other health factors in patients with head and neck cancer. Cancer Epidemiol 2022; 79:102202. [PMID: 35749925 DOI: 10.1016/j.canep.2022.102202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Information on smoking and other health factors in head and neck cancer (HNC) patients throughout treatment, follow-up and survivorship is limited. This study explores patterns of multiple health factors during radiotherapy (RT) and naturalistic long-term follow-up in a convenience sample of patients with HNC. METHODS Smoking, alcohol use and depression were measured at baseline, 4 and 12 weeks post RT for a sub-group of 99 patients who participated in a randomised controlled trial and completed long-term follow-up. These factors plus healthy eating, physical activity and fatigue are also reported from the long-term follow-up component. Smoking was measured by self-report and biochemically, whilst all other variables were by self-report. Where variables were assessed at multiple time points logistic mixed effects regression models determined within-person changes over time. RESULTS There were important discrepancies between self-reported (4-7%) and biochemically verified (13-29%) rates of smoking. Rates of smoking and hazardous alcohol intake were significantly increased at follow-up compared to baseline. Depression rates were observed to be higher at end of RT compared to baseline. At long-term follow-up, fatigue was common and co-occurred with suboptimal healthy eating and hazardous alcohol use. CONCLUSION Clinically important levels of smoking and alcohol consumption post RT in this sample suggest possible targets for intervention beyond treatment into long-term follow-up of patients.
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Affiliation(s)
- Kristen McCarter
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, New South Wales, Australia.
| | - Amanda L Baker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Chris Wratten
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Judith Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Alison K Beck
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia
| | - Erin Forbes
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Gregory Carter
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Lucy Leigh
- CREDITSS-Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, Newcastle, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; CREDITSS-Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, Newcastle, Australia
| | - Ben Britton
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
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Rangira D, Najeeb H, Shune SE, Namasivayam-MacDonald A. Understanding Burden in Caregivers of Adults With Dysphagia: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:486-501. [PMID: 34962832 DOI: 10.1044/2021_ajslp-21-00249] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION A previous review suggested that dysphagia is negatively associated with burden in caregivers of community-dwelling older adults. Other literature suggests similar patterns of burden may be found across adult patient populations. The current study, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted to determine the impact of dysphagia on caregivers of adults, regardless of etiology. METHOD Five electronic databases were searched using terms based on a review by Namasivayam-MacDonald and Shune (2018) but included all adults rather than only older adults. Searches were limited to English-language empirical studies discussing caregiver burden, included caregivers of adult care recipients, had some care recipients with dysphagia, did not include palliative care, and published in a peer-reviewed journal. RESULTS The search yielded 1,112 unique abstracts, of which 17 were accepted. Across studies, caregiver burden was found to increase due to dysphagia in care recipients. Commonly reported dysphagia-related causes of burden included changes in meal preparation, disruption in lifestyle, effects on social life, lack of support, insertion of feeding tubes, and fear of aspiration. In general, dysphagia-related caregiver burden was a common experience across caregivers, regardless of patient population, caregiver age, and relationship between caregiver and care recipient. Meta-analyses suggest 71% of caregivers of adults with dysphagia experience some degree of burden. CONCLUSIONS These findings support that dysphagia negatively impacts caregiver burden and suggests sources of burden that clinicians can address within dysphagia management to support caregivers. However, more research is needed to better delineate sources of burden, especially those specific to various dysphagia etiologies, to better meet the needs of our patients.
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Affiliation(s)
- Daniella Rangira
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Hiba Najeeb
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Samantha E Shune
- Communication Disorders and Sciences Program, University of Oregon, Eugene
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12
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Bhatia R, Holtan S, Jurdi NE, Prizment A, Blaes A. Do Cancer and Cancer Treatments Accelerate Aging? Curr Oncol Rep 2022; 24:1401-1412. [PMID: 35796942 PMCID: PMC9606015 DOI: 10.1007/s11912-022-01311-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW This review focuses on describing the mechanisms and clinical manifestations that underlie accelerated aging associated with cancer and its treatment. RECENT FINDINGS The direct and indirect effects of cancer and its treatment are associated with late occurrence of comorbidities that happen earlier or more frequently in cancer survivors compared to cancer-free individuals, otherwise known as accelerated aging. Use of senolytics and dietary and exercise interventions including prehabilitation, caloric restriction, and rehabilitation are currently under investigation to reverse or decelerate the aging process and will be covered in this review. Further research on how to decelerate or reverse aging changes associated with cancer and its treatment will be of paramount importance as the number of cancer survivors continues to grow.
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Affiliation(s)
- Roma Bhatia
- grid.38142.3c000000041936754XMassachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA
| | - Shernan Holtan
- grid.17635.360000000419368657Division of Hematology, Oncology and Transplantation, University of Minnesota, 425 E River Pkwy, Minneapolis, MN 55455 USA
| | - Najla El Jurdi
- grid.17635.360000000419368657Division of Hematology, Oncology and Transplantation, University of Minnesota, 425 E River Pkwy, Minneapolis, MN 55455 USA
| | - Anna Prizment
- grid.17635.360000000419368657Division of Hematology, Oncology and Transplantation, University of Minnesota, 425 E River Pkwy, Minneapolis, MN 55455 USA
| | - Anne Blaes
- grid.17635.360000000419368657Division of Hematology, Oncology and Transplantation, University of Minnesota, 425 E River Pkwy, Minneapolis, MN 55455 USA
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13
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Kok A, van der Lugt C, Leermakers-Vermeer MJ, de Roos NM, Speksnijder CM, de Bree R. Nutritional interventions in patients with head and neck cancer undergoing chemoradiotherapy: Current practice at the Dutch Head and Neck Oncology centres. Eur J Cancer Care (Engl) 2021; 31:e13518. [PMID: 34637563 PMCID: PMC9285387 DOI: 10.1111/ecc.13518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 05/10/2021] [Accepted: 09/24/2021] [Indexed: 12/21/2022]
Abstract
Objective To assess variations in nutritional interventions during chemoradiotherapy (CRT) among the Dutch Head and Neck Oncology centres (HNOCs). Methods An online questionnaire about nutritional interventions and dietetic practices was sent to 14 oncology dietitians of the HNOCs. Results The response rate was 93%. The number of scheduled dietetic consultations varied from two to seven during CRT. Most centres (77%) reported using a gastrostomy for tube feeding in the majority of patients. Gastrostomies were placed prophylactically upon indication (39%) or in all patients (15%), reactive (15%), or both (31%). For calculating energy requirements, 54% of the dietitians used the Food and Agriculture Organization/World Health Organization and United Nations University (FAO/WHO/UNU) formula and 77% uses 1.2–1.5 g/kg body weight for calculating protein requirements. Almost half of the centres (46%) reported to remove the gastrostomy between 8 and 12 weeks after CR. Most centres (92%) reported to end dietary treatment within 6 months after CRT. Conclusion This study shows substantial variation in dietetic practice, especially in the use of a gastrostomy for tube feeding, between the HNOCs. There is a need for concise dietetic guidelines.
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Affiliation(s)
- Annemieke Kok
- Department of Dietetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carlijn van der Lugt
- Department of Dietetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Marja J Leermakers-Vermeer
- Department of Dietetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicole M de Roos
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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14
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de Oliveira Faria S, Hurwitz G, Kim J, Liberty J, Orchard K, Liu G, Barbera L, Howell D. Identifying Patient-Reported Outcome Measures (PROMs) for Routine Surveillance of Physical and Emotional Symptoms in Head and Neck Cancer Populations: A Systematic Review. J Clin Med 2021; 10:jcm10184162. [PMID: 34575271 PMCID: PMC8470145 DOI: 10.3390/jcm10184162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
The aims of this review were to identify symptoms experienced by head and neck cancer (HNC) patients and their prevalence, as well as to compare symptom coverage identified in HNC specific patient-reported outcome measures (PROMs). Searches of Ovid Medline, Embase, PsychInfo, and CINAHL were conducted to identify studies. The search revealed 4569 unique articles and identified 115 eligible studies. The prevalence of reported symptoms was highly variable among included studies. Variability in sample size, timing of the assessments, and the use of different measures was noted across studies. Content mapping of commonly used PROMs showed variability and poor capture of prevalent symptoms, even though validation studies confirmed satisfactory reliability and validity. This suggests limitations of some of the tools in providing an accurate and comprehensive picture of the patient's symptoms and problems.
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Affiliation(s)
- Sheilla de Oliveira Faria
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
- Correspondence: ; Tel.: +55-11-3061-8278
| | - Gillian Hurwitz
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Jaemin Kim
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Jacqueline Liberty
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Kimberly Orchard
- Cancer Care Ontario, Toronto, ON M5G 2L7, Canada; (G.H.); (J.K.); (J.L.); (K.O.)
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Dalla Lana School of Public Health, Toronto, ON M5T 3M7, Canada
- Temerty Faculty of Medicine, Toronto, ON M5S 1A8, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Lisa Barbera
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
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15
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Ihara Y, Tashimo Y, Nozue S, Iizumi Y, Fukunishi Y, Saito Y, Shimane T, Takahashi K. Changes in Oral Function and Quality of Life in Tongue Cancer Patients Based on Resected Area. Asian Pac J Cancer Prev 2021; 22:2549-2557. [PMID: 34452570 PMCID: PMC8629473 DOI: 10.31557/apjcp.2021.22.8.2549] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: Treatment of tongue cancer caused oral morbidities such as oral dryness, and dysphagia. The purpose of this study is to examine the time course of oral function and QOL based on resected area for patients after tongue cancer resection. Methods: 31 patients who underwent tongue cancer resection at the Showa University Head and Neck Oncology Center. The participants were divided into two groups; 24 participants in partial/hemi glossectomy group (PG), and seven in subtotal/total glossectomy group (TG). Participants were evaluated swallowing function (FOIS and MASA-C), tongue pressure (TP: kPa), BMI, whole body muscle mass (kg), and QOL evaluation (EORTC QLQ-C30, H & N35). Participants were measured at baseline (before surgical treatment), 1, 3, and 6 months after surgical treatment (1M, 3M, and 6M). Results: At baseline, tongue pressure and FOIS score of PG were significant higher than that of TG. At 1M, TP, MASA-C, and FOIS score of PG were significant higher than that of TG. At 3M, TP, MASA-C, and FOIS score of PG were significant higher than that of TG. At 6M, TP and MASA-C were significantly higher than that of TG. QOL measurements did not noted any significant difference between groups before 6M. At 6M, Some QOL measurements of TG related tongue function (Swallowing, Senses, Speech, Social contact) were significantly lower than PG. Conclusions: The resected area had significant effects on oral morbidities and feeding function. It is necessary to develop more effective rehabilitation methods to improve patients QOL who had functional impairment remained.
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Affiliation(s)
- Yoshiaki Ihara
- Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, School of Dentistry, Showa University, Tokyo, Japan
| | - Yuichi Tashimo
- Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, School of Dentistry, Showa University, Tokyo, Japan.,Head and Neck Oncology Center, Showa University Hospital, Tokyo, Japan
| | - Shinji Nozue
- Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, School of Dentistry, Showa University, Tokyo, Japan
| | - Yoshiki Iizumi
- Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, School of Dentistry, Showa University, Tokyo, Japan
| | - Yuma Fukunishi
- Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, School of Dentistry, Showa University, Tokyo, Japan
| | - Yoshiro Saito
- Head and Neck Oncology Center, Showa University Hospital, Tokyo, Japan
| | - Toshikazu Shimane
- Head and Neck Oncology Center, Showa University Hospital, Tokyo, Japan
| | - Koji Takahashi
- Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, School of Dentistry, Showa University, Tokyo, Japan
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16
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Silva NMF, Carvalho IRDA, Lopes LP, Menezes TM, Guandalini VR, Capuzzo RDC. Evolution of Nutritional Status in Patients with Advanced Head and Neck Cancer Undergoing Surgical Treatment or Organ Preservation Protocol. Nutr Cancer 2021; 74:852-859. [PMID: 34080516 DOI: 10.1080/01635581.2021.1931367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We sought to evaluate the evolution of the nutritional status of patients with advanced cancer of the upper aerodigestive tract undergoing surgical treatment (SURG) or organ preservation protocol (OP). Evaluations were conducted at the beginning and end of treatment, including weight, body composition and Patient-Generated Subjective Global Assessment (PG-SGA). Each group was comprised of 29 patients. Initially, malnutrition rates were 65.5% and 51.7% in the SURG and OP groups, respectively. At the end, the values went to 55.1% in SURG and 79.3% in OP. In the OP, there was a reduction in weight (P = 0.001), fat mass (P = 0.006), fat free mass (P = 0.002), and muscle mass (P = 0.005) and an increase in scores of the PG-SGA (P = 0.008). The same was not observed in SURG, except for the weight decrease (P = 0.025). Malnutrition was prevalent in both treatment groups and patients in OP were at greater risk of nutritional decline.
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17
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Malnutrition screening in head and neck cancer patients with oropharyngeal dysphagia. Clin Nutr ESPEN 2021; 44:348-355. [PMID: 34330489 DOI: 10.1016/j.clnesp.2021.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIMS Malnutrition in head and neck cancer (HNC) patients is associated with increased morbidity and mortality. The purpose of this study is two-fold: to identify the risk of malnutrition in patients with oropharyngeal dysphagia (OD) secondary to HNC, and to determine the relationship between the risk of malnutrition versus tumor characteristics, treatment modality, time interval (between the end of oncological treatment and swallowing assessment date), level of oral intake, body mass index (BMI), aspiration, pharyngeal pooling, and OD-related quality of life (QoL). METHODS The Short Nutritional Assessment Questionnaire (SNAQ) was used to screen patients for the risk of malnutrition. Patients underwent a standardized swallowing examination protocol including an endoscopic evaluation of swallowing. RESULTS Seventy-five dysphagic HNC patients were included. Forty-eight percent of the patients presented a high risk of malnutrition using SNAQ. The majority of the patients (81.3%) was on a total oral diet. Moreover, BMI did not appear to be a reliable measure to screen for malnutrition as a normal BMI was often associated with an increased risk of malnutrition on the SNAQ. In contrast, patients who were underweight or overweight did not show an association with a high risk of malnutrition. With the exception of BMI, no other patient and tumor characteristics were found to be associated with the risk of malnutrition. CONCLUSIONS This study emphasizes the importance of early nutritional screening in dysphagic HNC patients, as almost half of these patients presented a high risk of malnutrition. Malnutrition screening using SNAQ can identify HNC patients with OD who are at risk of malnutrition and subsequently need to be referred to a dietician for additional nutritional assessment, diagnosis of malnutrition, and nutritional support, even when their BMI is within normal range.
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18
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Chen J, Hua Y, Su L, Wang C, Zhang H, Ye J, Song X, Li R, Tian J, Zhang W, Hong J. The effect of psychological condition before radiotherapy on prognosis in 390 patients initially treated for nasopharyngeal carcinoma. Support Care Cancer 2021; 29:5967-5972. [PMID: 33765206 DOI: 10.1007/s00520-021-06130-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 03/04/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE To explore whether anxiety and depression are prognostic indexes for overall survival in patients with nasopharyngeal carcinoma (NPC) who underwent intensity-modulated radiotherapy (IMRT). METHODS Clinical data were collected for NPC patients who underwent IMRT. Anxiety and depression were investigated before radiotherapy by using the Hospital Anxiety and Depression Scale (HADS). The survival rate was calculated by the Kaplan-Meier method, and survival curves were compared among patients with different levels of anxiety and depression. The Cox risk regression model was used to screen the factors affecting survival. RESULTS A total of 390 initially treated NPC patients were included in the study. Among them, 166 patients suffered from anxiety, and 95 patients suffered from depression before radiotherapy. The 5-year overall survival rates for patients with and without anxiety before radiotherapy were 71.6% and 81.8% (χ2 = 5.31, P = 0.021), respectively. The 5-year overall survival rates for patients with and without depression before radiotherapy were 74.3% and 78.1% (χ2 = 0.05, P = 0.82), respectively. Cox regression analysis indicated clinical stages (HR = 3.982, 95% CI: 2.365~6.705), anxiety (HR = 1.832, 95% CI: 1.140~2.944), and gender (HR = 0.555, 95% CI: 0.313~0.984) as independent prognostic factors. CONCLUSION Anxiety before radiotherapy is associated with poor prognosis in NPC patients.
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Affiliation(s)
- Jinmei Chen
- The Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.,Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
| | - Yangjingling Hua
- The Graduate School, Fujian Medical University, Fuzhou, Fujian, China
| | - Li Su
- The Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.,Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
| | - Caihong Wang
- The Graduate School, Fujian Medical University, Fuzhou, Fujian, China
| | - Hairong Zhang
- The Graduate School, Fujian Medical University, Fuzhou, Fujian, China
| | - Jinru Ye
- The Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiurong Song
- The Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Rong Li
- The Graduate School, Fujian Medical University, Fuzhou, Fujian, China
| | - Jun Tian
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Weijian Zhang
- The Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jinsheng Hong
- The Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China. .,Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China.
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19
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Karsten RT, Hilgers FJM, van der Molen L, van Sluis K, Smeele LE, Stuiver MM. The Timed Swallowing Proficiency for Eating and Drinking (SPEAD) Test: Development and Initial Validation of an Instrument to Objectify (Impaired) Swallowing Capacity in Head and Neck Cancer Patients. Dysphagia 2021; 36:1072-1087. [PMID: 33459852 DOI: 10.1007/s00455-020-10240-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
Objective swallowing outcomes measure the physical swallowing function, while subjective outcomes measure swallowing perception. A test for swallowing capacity, measuring the ingestion of all consistencies is currently not available. Therefore, the Swallowing Proficiency for Eating And Drinking (SPEAD) test was developed. It entails the timed ingestion of thin liquid, thick liquid and solid. In this study, its feasibility, reliability and validity were evaluated in patients with dysphagia after treatment for head and neck cancer (HNC) and healthy participants. Thirty-eight HNC patients and forty healthy participants were enrolled in this study and performed the SPEAD test three times. Video recordings of the test were evaluated three times by one observer, and once by three additional observers, to assess test-retest, intra-rater and inter-rater reliability. Validity was assessed by calculating effect sizes for the difference between results of patients and healthy participants and by evaluating correlations with objective (e.g., videofluoroscopy and functional oral intake scale) and subjective (e.g., SWAL-QOL) swallowing outcomes. Test-retest, intra-rater and inter-rater reliability of ingestion duration was good to excellent. All hypotheses with regard to magnitude and direction of correlations were confirmed, supporting construct validity of the test. Our initial results suggest that the SPEAD test reliably measures the transport capacity of the upper digestive tract (in grams per second) and that this test can be useful to objectively evaluate and monitor the (safe) swallowing capacity in HNC patients, in both research as well as daily clinical practice.
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Affiliation(s)
- R T Karsten
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - F J M Hilgers
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Amsterdam Center for Language and Communication/ACLC-Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - L van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Amsterdam Center for Language and Communication/ACLC-Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - K van Sluis
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L E Smeele
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - M M Stuiver
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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20
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Crary MA. Dysphagia and Head and Neck Cancer. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Karsten RT, Ter Beek LC, Jasperse B, van Alphen MJA, Peeters JM, van der Molen L, Hilgers FJM, Stuiver MM, Smeele LE. MRI Assessment of Swallow Muscle Activation with the Swallow Exercise Aid and with Conventional Exercises in Healthy Volunteers: An Explorative Biomechanical Study. Dysphagia 2020; 36:41-53. [PMID: 32200444 DOI: 10.1007/s00455-020-10108-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
Swallowing muscle strength exercises are effective in restoring swallowing function. In order to perform the exercises with progressive load, the swallow exercise aid (SEA) was developed. Precise knowledge on which muscles are activated with swallowing exercises, especially with the SEA, is lacking. This knowledge would aid in optimizing the training program to target the relevant swallowing muscles, if necessary. Three healthy volunteers performed the three SEA exercises (chin tuck against resistance, jaw opening against resistance and effortful swallow) and three conventional exercises [conventional effortful swallow (cES), Shaker and Masako] in supine position inside an MRI scanner. Fast muscle functional MRI scans (generating quantitative T2-maps) were made immediately before and after the exercises. Median T2 values at rest and after exercise were compared to identify activated muscles. After the three SEA exercises, the suprahyoid, infrahyoid, sternocleidomastoid, and lateral pterygoid muscles showed significant T2 value increase. After the Shaker, the lateral pterygoid muscles did not show such an increase, but the three other muscle groups did. The cES and Masako caused no significant increase in any of these muscle groups. During conventional (Shaker) exercises, the suprahyoid, infrahyoid, and sternocleidomastoid muscles are activated. During the SEA exercises, the suprahyoid, infrahyoid, sternocleidomastoid, and lateral pterygoid muscles are activated. The findings of this explorative study further support the potential of the SEA to improve swallowing rehabilitation.
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Affiliation(s)
- Rebecca T Karsten
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Leon C Ter Beek
- Department of Medical Physics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bas Jasperse
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten J A van Alphen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | | | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Frans J M Hilgers
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Martijn M Stuiver
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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22
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Aylward A, Park J, Abdelaziz S, Hunt JP, Buchmann LO, Cannon RB, Rowe K, Snyder J, Deshmukh V, Newman M, Wan Y, Fraser A, Smith K, Lloyd S, Hitchcock Y, Hashibe M, Monroe MM. Individualized prediction of late-onset dysphagia in head and neck cancer survivors. Head Neck 2020; 42:708-718. [PMID: 32031294 DOI: 10.1002/hed.26039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/28/2019] [Accepted: 12/03/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Limited data exist regarding which head and head and neck cancer (HNC) survivors will suffer from long-term dysphagia. METHODS From a population-based cohort of 1901 Utah residents with HNC and ≥3 years follow-up, we determined hazard ratio for dysphagia, aspiration pneumonia, or gastrostomy associated with various risk factors. We tested prediction models with combinations of factors and then assessed discrimination of our final model. RESULTS Cancer site in the hypopharynx, advanced tumor classification, chemoradiation, preexisting dysphagia, stroke, dementia, esophagitis, esophageal spasm, esophageal stricture, gastroesophageal reflux, thrush, or chronic obstructive pulmonary disease were associated with increased risk of long-term dysphagia. Our final prediction tool gives personalized risk calculation for diagnosis of dysphagia, aspiration pneumonia, or gastrostomy tube placement at 5, 10, and 15 years after HNC based on 18 factors. CONCLUSION We developed a clinically useful risk prediction tool to identify HNC survivors most at risk for dysphagia.
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Affiliation(s)
- Alana Aylward
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Jihye Park
- Cancer Control and Population Science, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Sarah Abdelaziz
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Jason P Hunt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Luke O Buchmann
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Richard B Cannon
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, Utah
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, Utah
| | | | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Yuan Wan
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ken Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Shane Lloyd
- Department of Radiation Oncology, Radiation Oncology, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ying Hitchcock
- Department of Radiation Oncology, Radiation Oncology, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Mia Hashibe
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, Salt Lake City, Utah
| | - Marcus M Monroe
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah
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Pisegna JM, Kaneoka A, Coster WJ, Leonard R, Langmore SE. Residue Ratings on FEES: Trends for Clinical Application of Residue Measurement. Dysphagia 2020; 35:834-842. [DOI: 10.1007/s00455-019-10089-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 12/30/2019] [Indexed: 12/01/2022]
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Rivelsrud MC, Kirmess M, Hartelius L. Cultural adaptation and validation of the Norwegian version of the swallowing quality of life questionnaire (SWAL-QOL). Health Qual Life Outcomes 2019; 17:179. [PMID: 31805954 PMCID: PMC6896756 DOI: 10.1186/s12955-019-1248-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 11/21/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction Oropharyngeal dysphagia (OD) is a disorder that can have devastating and long lasting effects on a person’s medical, mental and psychosocial well-being, thus negatively impacting quality of life. There is currently no validated dysphagia-specific quality of life instrument in Norway. This project aims to evaluate the psychometric properties of the culturally adapted Norwegian version of SWAL-QOL (Nor-SWAL-QOL). Methods The original SWAL-QOL was translated into Norwegian according the international translation guidelines. A group of 102 persons with OD and a group of 123 healthy controls were recruited to assess the validity and reliability of the Nor-SWAL-QOL. Correlation analysis of the Nor-SWAL-QOL and the Short Form 36 (SF-36) and correlation analysis of OD group and control group Nor-SWAL-QOL subscale scores were computed to determine convergent, discriminant, and known-groups validity which help comprise construct validity. Internal consistency, test-retest reliability and intraclass correlation coefficient (ICC) were computed for reliability. Results Convergent and discriminant validity was demonstrated between Nor-SWAL-QOL subscales and SF-36 domains, and distinguished between persons with and those without oropharyngeal dysphagia on all subscales and on the symptom frequency battery (p < 0.001). Additionally, the Nor-SWAL-QOL differentiated between symptom severity levels within the OD group; those requiring food and liquid modifications and those who are tube fed and not tube fed. Nor-SWAL-QOL showed good reliability with adequate internal consistency (Cronbach’s α ≥0.70), test-retest reliability (Spearman’s rho values 0.68–0.90) and ICC values (0.67–0.89) for all subscales and for the symptom frequency battery. Conclusion Access to valid and reliable dysphagia-specific QoL outcome measures for health care practitioners, dysphagia clinicians and researchers is necessary for comprehensive assessment and treatment outcome measures. The Nor-SWAL-QOL exhibits sufficient psychometric properties for implementation in the Norwegian population.
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Affiliation(s)
- Maribeth Caya Rivelsrud
- University of Gothenburg, Gothenburg, Sweden. .,Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1453, Bjørnemyr, Norway.
| | - Melanie Kirmess
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1453, Bjørnemyr, Norway.,Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Lena Hartelius
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1453, Bjørnemyr, Norway.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Long-term efficacy and toxicity of concurrent chemoradiotherapy with nedaplatin and S-1 for head and neck squamous cell carcinoma. Auris Nasus Larynx 2019; 46:882-888. [DOI: 10.1016/j.anl.2018.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 12/15/2018] [Accepted: 12/26/2018] [Indexed: 11/23/2022]
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Tashimo Y, Ihara Y, Yuasa K, Nozue S, Saito Y, Katsuta H, Shimane T, Takahashi K. Acute Stage Longitudinal Change of Quality of Life from Pre- to 3 Months after Surgical Treatment in Head and Neck Cancer Patients. Asian Pac J Cancer Prev 2019; 20:3129-3136. [PMID: 31653164 PMCID: PMC6982687 DOI: 10.31557/apjcp.2019.20.10.3129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Head and neck cancer (HNC) patients experience various posttreatment side effects that decrease quality of life (QOL). Some previous study reported that QOL of HHC patients were returned baseline (before treatment) after a year post treatment. However, acute stage longitudinal changes of QOL in HNC patients remains unclear. This point might be important for early reintegration of HNC patients. This study aimed to investigate the acute stage longitudinal change of the relationship between QOL and oral function in HNC patients had surgery. METHODS 45 HNC patients (23 men) scheduled for surgical treatment were enrolled in this study. Primary tumor sites were 22 tongue, 5 maxilla, 4 mandible, 3 pharynx and others. Weight, body mass index (BMI), whole body soft lean mass (SLM), and skeletal muscle mass (SMM) were evaluated as muscle mass-related measurements. Lip closure force (LC) and tongue pressure (TP) were evaluated as oral function measurements. Feeding function was evaluated using the Functional Oral Intake Scale (FOIS). QOL was assessed using the European Organization for Research and Treatment of Cancer QOL Questionnaire QLQ-C30 and H&N 35. Measures were evaluated at pre-surgical treatment (PT), and 1 month (1M) and 3 months (3M) after surgery. The change of QOL parameters and relationships between measurements were assessed. RESULTS For QOL assessments, role functioning, fatigue, speech problems, trouble with social eating, trouble with social contact, and opening mouth significantly decreased from PT to 1M, but significantly increased from 1M to 3M. Weight, BMI, SLM, SMM, LC, TP, and FOIS demonstrated significant relationships with QOL from PT to 1M. Meanwhile, from 1M to 3M, weight, BMI, SLM, SMM, LC, and FOIS showed significant relationships with QOL assessments. CONCLUSIONS Both oral function and muscle mass-related measurements significantly affected QOL in HNC patients.
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Affiliation(s)
- Yuichi Tashimo
- Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, Showa University, School of Dentistry, Tokyo, Japan
| | - Yoshiaki Ihara
- Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, Showa University, School of Dentistry, Tokyo, Japan
| | - Ken Yuasa
- Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, Showa University, School of Dentistry, Tokyo, Japan
| | - Shinji Nozue
- Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, Showa University, School of Dentistry, Tokyo, Japan
| | - Yoshiro Saito
- Head and Neck Oncology Center, Showa University Hospital, Tokyo, Japan
| | - Hideyuki Katsuta
- Head and Neck Oncology Center, Showa University Hospital, Tokyo, Japan
| | - Toshikazu Shimane
- Head and Neck Oncology Center, Showa University Hospital, Tokyo, Japan
| | - Koji Takahashi
- Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, Showa University, School of Dentistry, Tokyo, Japan
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Li X, Zhou J, Chu C, You Q, Zhong R, Rao Z, Hu W. Home enteral nutrition may prevent myelosuppression of patients with nasopharyngeal carcinoma treated by concurrent chemoradiotherapy. Head Neck 2019; 41:3525-3534. [PMID: 31301097 DOI: 10.1002/hed.25861] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/16/2019] [Accepted: 06/18/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study is to assess the effect of home enteral nutrition (HEN) on the myelosuppression of patients with nasopharyngeal cancer (NPC) during the course of concurrent chemoradiotherapy (CCRT). METHODS A total of 18 outpatients with NPC administered oral nutritional supplementation intervention at home during the course of CCRT were designated as the HEN group, whereas 36 patients with NPC who had previously completed CCRT were retrospectively included as the control group. Patient Generated Subjective Global Assessment, body mass index (BMI), and blood test were evaluated prior to CCRT. During the course of CCRT, blood test was assessed every 2 weeks. RESULTS In male patients, hemoglobin (HB) and red blood cell were decreased (P < .05) in both HEN and control group after CCRT, whereas white blood cell (WBC) started to decrease since week 2 of CCRT in the control group but maintained in the HEN group which was significantly higher than the control (5.05 ± 1.29 vs 3.77 ± 1.5, P < .05). In female patients, HB and WBC were reduced in control group during CCRT, whereas these indicators also maintained in the HEN group. Surprisingly, all patients with lower BMI (<24 kg/m2 ) had a significant increase in platelet (PLT) after CCRT (200.78 ± 58.03 vs 253.00 ± 69.82, P < .05), while had steady HB and WBC values in the HEN group. At the end of CCRT, WBC and PLT of the HEN group were both higher than those in the control group (5.21 ± 1.07 vs 3.37 ± 1.52), (253.00 ± 69.82 vs 165.57 ± 59.56) (P < .05 for both). Our findings suggest that HEN is effective in preventing myelosuppression during CCRT for patients with NPC. CONCLUSION Our findings suggest that HEN is effective in preventing myelosuppression during CCRT for patients with NPC.
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Affiliation(s)
- Xuemei Li
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Jidan Zhou
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Ci Chu
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Qian You
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Renming Zhong
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiyong Rao
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Wen Hu
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
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Aylward A, Abdelaziz S, Hunt JP, Buchmann LO, Cannon RB, Lloyd S, Hitchcock Y, Hashibe M, Monroe MM. Rates of Dysphagia-Related Diagnoses in Long-Term Survivors of Head and Neck Cancers. Otolaryngol Head Neck Surg 2019; 161:643-651. [PMID: 31184260 DOI: 10.1177/0194599819850154] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate long-term prevalence of new dysphagia-related diagnoses in a large cohort of head and neck cancer survivors. STUDY DESIGN Retrospective cohort. SETTING Population based. SUBJECTS AND METHODS In total, 1901 adults diagnosed with head and neck cancer between 1997 and 2012 with at least 3 years of follow-up were compared with 7796 controls matched for age, sex, and birth state. Prevalence of new dysphagia-related diagnoses and procedures and hazard ratio compared to controls were evaluated in patients 2 to 5 years and 5 years and beyond after diagnosis. Risk factors for the development of these diagnoses were analyzed. RESULTS Prevalence of new diagnosis and hazard ratio compared to controls remained elevated for all diagnoses throughout the time periods investigated. The rate of aspiration pneumonia was 3.13% at 2 to 5 years, increasing to 6.75% at 5 or more years, with hazard ratios of 9.53 (95% confidence interval [CI], 5.08-17.87) and 12.57 (7.17-22.04), respectively. Rate of gastrostomy tube placement increased from 2.82% to 3.32% with hazard ratio remaining elevated from 51.51 (13.45-197.33) to 35.2 (7.81-158.72) over the same time period. The rate of any dysphagia-related diagnosis or procedure increased from 14.9% to 26% with hazard ratio remaining elevated from 3.32 (2.50-4.42) to 2.12 (1.63-2.75). Treatment with radiation therapy and age older than 65 years were associated with increased hazard ratio for dysphagia-related diagnoses. CONCLUSION Our data suggest that new dysphagia-related diagnoses continue to occur at clinically meaningful levels in long-term head and neck cancer survivors beyond 5 years after diagnosis.
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Affiliation(s)
- Alana Aylward
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Sarah Abdelaziz
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Jason P Hunt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Luke O Buchmann
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Richard B Cannon
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Shane Lloyd
- Department of Radiation Oncology, Radiation Oncology, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Ying Hitchcock
- Department of Radiation Oncology, Radiation Oncology, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Mia Hashibe
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marcus M Monroe
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine and Huntsman Cancer Institute, Salt Lake City, Utah, USA
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Kamal M, Barrow MP, Lewin JS, Estrella A, Gunn GB, Shi Q, Hofstede TM, Rosenthal DI, Fuller CD, Hutcheson KA. Modeling symptom drivers of oral intake in long-term head and neck cancer survivors. Support Care Cancer 2019; 27:1405-1415. [PMID: 30218187 PMCID: PMC6408256 DOI: 10.1007/s00520-018-4434-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/20/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE This study examined the relationship between self-reported symptom severity and oral intake in long-term head and neck cancer (HNC) survivors. METHODS An observational survey study with retrospective chart abstraction was conducted. HNC patients who had completed an MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) questionnaire and also had clinician graded oral intake ratings (Functional Oral Intake Scale [FOIS]) were included. Correlation coefficients were computed. FOIS scores were regressed on MDASI-HN symptom items using stepwise backwards elimination for multivariate models. RESULTS One hundred and fifty-two survey pairings were included in the analysis (median 44 months follow-up, range 7-198). Per FOIS, 28% of survivors maintained a total oral diet with no restrictions, 67% reported a restricted oral diet (without tube), 3% were partially tube-dependent with some oral intake, and 2% were NPO. Of the 22 symptom items, the most severe items in decreasing order were dry mouth, difficulty swallowing\chewing, problems with mucus, tasting food, and choking/coughing. Significant bivariate correlations, after Bonferroni correction for multiple comparisons, were present for 8 of 22 symptoms with FOIS. On multivariate analysis, symptom severity for difficulty swallowing and problems with teeth/gums remained significantly associated with FOIS. CONCLUSIONS Oral intake in HNC survivorship is a multidimensional issue and functional outcome that is impacted not only by dysphagia but also by dental status. Symptom drivers of oral intake likely differ in acute survivorship. Nonetheless, these findings highlight the lack of specificity in this end point and also the need for multidisciplinary supportive care to optimize oral intake in survivors.
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Affiliation(s)
- Mona Kamal
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Martha P Barrow
- Departments of Head and Neck Surgery Unit 1445, The University of Texas MD Anderson Cancer Center, P. O. Box 301402, Houston, TX, 77030, USA
| | - Jan S Lewin
- Departments of Head and Neck Surgery Unit 1445, The University of Texas MD Anderson Cancer Center, P. O. Box 301402, Houston, TX, 77030, USA
| | - Alicia Estrella
- Departments of Head and Neck Surgery Unit 1445, The University of Texas MD Anderson Cancer Center, P. O. Box 301402, Houston, TX, 77030, USA
| | - G Brandon Gunn
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Quiling Shi
- Departments of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Theresa M Hofstede
- Departments of Head and Neck Surgery Unit 1445, The University of Texas MD Anderson Cancer Center, P. O. Box 301402, Houston, TX, 77030, USA
| | - David I Rosenthal
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton David Fuller
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Katherine A Hutcheson
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Departments of Head and Neck Surgery Unit 1445, The University of Texas MD Anderson Cancer Center, P. O. Box 301402, Houston, TX, 77030, USA.
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Shapira-Galitz Y, Shoffel-Havakuk H, Halperin D, Lahav Y. Association Between Laryngeal Sensation, Pre-swallow Secretions and Pharyngeal Residue on Fiberoptic Endoscopic Examination of Swallowing. Dysphagia 2019; 34:548-555. [DOI: 10.1007/s00455-019-10001-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 03/14/2019] [Indexed: 12/22/2022]
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Grandazzi G, Roussel LM, Cuny F, Morlais F, Launay L, Babin E. Impact of head and neck cancer on partner's sociability. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:165-168. [PMID: 30878512 DOI: 10.1016/j.anorl.2019.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION "Sociability" is defined as the range of experiences linking the subject to others. This is the first study to focus specifically on the impact of head and neck cancer on the sociability of patients' partners. METHOD Data were collected via a dedicated questionnaire sent to patients' partners. The main endpoint was partner's self-assessment of the impact of the patient's disease on the partner's everyday life. The impact on sociability was analyzed with respect to: the circle of friends (friendship environment), unknown environment, known outside environment, necessary environment, and solitary activities. RESULTS Two hundred and seventy partners responded. Their everyday activities were impacted by the patient's disease in 71.5% of cases. The friendship environment was badly affected in 46.4% of cases. The unknown environment was affected in 44.0% of cases. Social practices related to the known outside environment were affected in 67.8% of cases, and the necessary environment in 26.0%; the number of solitary activities increased in 35.6% of cases. Social impact on patients' partners was thus considerable.
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Affiliation(s)
- G Grandazzi
- Inserm/Université de Caen U1086, cancers et préventions, 14000 Caen, France
| | - L-M Roussel
- Inserm/Université de Caen U1086, cancers et préventions, 14000 Caen, France; CHU de Caen, service ORL et chirurgie cervico-faciale, 14000 Caen, France.
| | - F Cuny
- CHU de Caen, service ORL et chirurgie cervico-faciale, 14000 Caen, France
| | - F Morlais
- Inserm/Université de Caen U1086, cancers et préventions, 14000 Caen, France
| | - L Launay
- Inserm/Université de Caen U1086, cancers et préventions, 14000 Caen, France
| | - E Babin
- Inserm/Université de Caen U1086, cancers et préventions, 14000 Caen, France; CHU de Caen, service ORL et chirurgie cervico-faciale, 14000 Caen, France
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Chan KMK, Chan HKW, Siu JYL, Pu D, Nund RL, Ward EC. Impact of Head and Neck Cancer Treatment on Survivors' Mealtime Experience. Laryngoscope 2018; 129:1572-1578. [DOI: 10.1002/lary.27501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Karen M. K. Chan
- Swallowing Research Laboratory, Division of Speech and Hearing Sciences; University of Hong Kong; Pokfulam Hong Kong
| | - Herman K. W. Chan
- Swallowing Research Laboratory, Division of Speech and Hearing Sciences; University of Hong Kong; Pokfulam Hong Kong
| | - Jerry Y. L. Siu
- Swallowing Research Laboratory, Division of Speech and Hearing Sciences; University of Hong Kong; Pokfulam Hong Kong
| | - Dai Pu
- Swallowing Research Laboratory, Division of Speech and Hearing Sciences; University of Hong Kong; Pokfulam Hong Kong
| | - Rebecca L. Nund
- School of Health and Rehabilitation Sciences; University of Queensland; St. Lucia Queensland Australia
| | - Elizabeth C. Ward
- School of Health and Rehabilitation Sciences; University of Queensland; St. Lucia Queensland Australia
- Centre for Functioning and Health Research; Queensland Health; Brisbane Queensland Australia
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Qualizza M, Bressan V, Rizzuto A, Stevanin S, Bulfone G, Cadorin L, Ghirotto L. Listening to the voice of patients with head and neck cancer: A systematic review and meta‐synthesis. Eur J Cancer Care (Engl) 2018; 28:e12939. [DOI: 10.1111/ecc.12939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 12/23/2022]
Affiliation(s)
| | - Valentina Bressan
- Department of Otolaryngology/Head and Neck Surgery University Hospital Santa Maria della Misericordia, Azienda Sanitaria Universitaria Integrata di Udine Via Pozzuolo Udine Italy
| | - Antonio Rizzuto
- Department of Otolaryngology/Head and Neck Surgery University Hospital Santa Maria della Misericordia, Azienda Sanitaria Universitaria Integrata di Udine Via Pozzuolo Udine Italy
| | | | | | - Lucia Cadorin
- Continuing Education Centre CRO Aviano National Cancer Institute Aviano, Pordenone Italy
| | - Luca Ghirotto
- Arcispedale Santa Maria Nuova—IRCCS Reggio Emilia Italy
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Kufeldt J, Viehrig M, Schweikert D, Fritsche A, Bamberg M, Adolph M. Treatment of malnutrition decreases complication rates and shortens the length of hospital stays in a radiation oncology department. Strahlenther Onkol 2018; 194:1049-1059. [DOI: 10.1007/s00066-018-1360-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/17/2018] [Indexed: 01/16/2023]
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Patterson JM, McColl E, Carding PN, Wilson JA. Swallowing beyond six years post (chemo)radiotherapy for head and neck cancer; a cohort study. Oral Oncol 2018; 83:53-58. [PMID: 30098779 DOI: 10.1016/j.oraloncology.2018.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/10/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The objective of this prospective study is to report on long-term swallowing outcomes in a group of head and neck cancer patients following (chemo) radiotherapy treatment, assess for changes over time and identify any predictor variables of outcome. MATERIALS AND METHODS 42 survivors were assessed on four swallowing measures and followed up from pre-treatment to six years post 3D (chemo) radiotherapy. Measures included a swallowing specific QOL questionnaire, penetration-aspiration scale, dietary restrictions and a timed water swallow test. RESULTS At six years, 71% reported swallowing difficulties on the questionnaire. One fifth of patients had aspiration, with a raised risk of chest infection. Seven percent required a laryngectomy for a dysfunctional larynx. Despite this, half the group reported having a normal diet. There was variation in the pattern of change between one and six years. A significant deterioration was only observed in the timed water swallow test (p < 0.0001). Larger radiotherapy volume predicted this outcome. None of the variables tested predicted outcome for the other three swallow measures. CONCLUSION Patients continue to report swallowing difficulties at six years, with a proportion having persistent aspiration. Further work on identifying the risk factors associated with aspiration tolerance, aspiration pneumonia, prevention and management is warranted. Long-term dysphagia remains a significant and serious concern following (chemo) radiotherapy for HNC and swallowing outcomes should continue to be monitored over time.
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Affiliation(s)
- J M Patterson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK; Speech & Language Therapy Dept., Sunderland Royal Hospital, Sunderland, UK.
| | - E McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - P N Carding
- School of Allied and Public Health, Australian Catholic University, Brisbane, Australia
| | - J A Wilson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Ihara Y, Crary MA, Madhavan A, Gregorio DC, Im I, Ross SE, Carnaby GD. Dysphagia and Oral Morbidities in Chemoradiation-Treated Head and Neck Cancer Patients. Dysphagia 2018; 33:739-748. [PMID: 29619560 DOI: 10.1007/s00455-018-9895-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/29/2018] [Indexed: 12/13/2022]
Abstract
This study prospectively evaluated relationships between oral morbidities and swallowing ability in head/neck cancer patients following chemoradiation therapy (CRT) and at 3 months following CRT. Thirty patients with confirmed head/neck cancer undergoing chemoradiation were assessed with a battery of swallowing measures and measures of oral morbidities related to chemoradiation (xerostomia, mucositis, pain, taste/smell, oral moisture). All measures were completed at baseline (within the first week of CRT), at 6 weeks (end of treatment), and at 3 months following chemoradiation. Descriptive and univariate statistics were used to depict change over time in swallowing and each oral morbidity. Correlation analyses evaluated relationships between swallowing function and oral morbidities at each time point. Most measures demonstrated significant negative change at 6 weeks with incomplete recovery at 3 months. At 6 weeks, mucositis ratings, xerostomia, and retronasal smell intensity demonstrated significant inverse relationships with swallowing function. In addition, oral moisture levels demonstrated significant positive relationships with swallowing function. At 3 months, mucositis ratings maintained a significant, inverse relationship with swallow function. Taste and both orthonasal and retronasal smell intensity ratings demonstrated inverse relationships with measures of swallow function. Swallow functions and oral morbidities deteriorate significantly following CRT with incomplete recovery at 3 months post treatment. Furthermore, different patterns of relationships between swallow function measures and oral morbidities were obtained at the 6-week versus the 3-month assessment point suggesting that different mechanisms may contribute to the development versus the maintenance of dysphagia over the trajectory of treatment in these patients.
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Affiliation(s)
- Yoshiaki Ihara
- Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, 3280 Progress Drive, Suite 500, Orlando, FL, 32826, USA.,Division of Oral Rehabilitation Medicine, Department of Special Needs Dentistry, School of Dentistry, Showa University, Tokyo, Japan
| | - Michael A Crary
- Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, 3280 Progress Drive, Suite 500, Orlando, FL, 32826, USA.
| | - Aarthi Madhavan
- Department of Communication Sciences and Disorders, College of Health and Human Performance, The Pennsylvania State University, University Park, PA, USA
| | - David C Gregorio
- Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, 3280 Progress Drive, Suite 500, Orlando, FL, 32826, USA
| | - Ikjae Im
- Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, 3280 Progress Drive, Suite 500, Orlando, FL, 32826, USA.,Graduate Program in Speech-Language Therapy, Chonbuk National University, Jeonju, Republic of Korea
| | - Sarah E Ross
- Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, 3280 Progress Drive, Suite 500, Orlando, FL, 32826, USA
| | - Giselle D Carnaby
- Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, 3280 Progress Drive, Suite 500, Orlando, FL, 32826, USA
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37
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Crowder SL, Douglas KG, Yanina Pepino M, Sarma KP, Arthur AE. Nutrition impact symptoms and associated outcomes in post-chemoradiotherapy head and neck cancer survivors: a systematic review. J Cancer Surviv 2018; 12:479-494. [DOI: 10.1007/s11764-018-0687-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
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38
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Body Weight Status, Clinical Factors, and Short-term Outcomes Among Head and Neck Radiation Oncology Patients. TOP CLIN NUTR 2018. [DOI: 10.1097/tin.0000000000000128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Caillet P, Liuu E, Raynaud Simon A, Bonnefoy M, Guerin O, Berrut G, Lesourd B, Jeandel C, Ferry M, Rolland Y, Paillaud E. Association between cachexia, chemotherapy and outcomes in older cancer patients: A systematic review. Clin Nutr 2017; 36:1473-1482. [DOI: 10.1016/j.clnu.2016.12.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 11/13/2016] [Accepted: 12/08/2016] [Indexed: 12/11/2022]
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40
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Jin T, Li KX, Li PJ, Huang S, Chen XZ, Chen M, Hu QY, Shi L, Chen YY. An evaluation of nutrition intervention during radiation therapy in patients with locoregionally advanced nasopharyngeal carcinoma. Oncotarget 2017; 8:83723-83733. [PMID: 29137377 PMCID: PMC5663549 DOI: 10.18632/oncotarget.19381] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the effectiveness of nutrition intervention during radiation for patients with locoregionally advanced (III-IVa) nasopharyngeal carcinoma (NPC). Materials and Methods We retrospectively reviewed 117 patients with locoregionally advanced (III-IVa) NPC treated between December 2015 and March 2016 in Zhejiang Cancer Hospital. All the patients underwent radical chemo-radiotherapy. First, all the patients were divided into the nutrition intervention group and the control group, depending on whether they accepted nutrition intervention. Repeated measures were used to analyze the change of nutritional indicators before, during, and after radiation therapy and to simultaneously compare the difference in nutritional status between the two groups at the same time point. Subsequently, the 117 patients were divided into the malnourished group (weight loss > 5%) and the non-malnourished group (weight loss ≤ 5%) according to whether their weight loss was over 5% of their body weight during radiotherapy. Chi-square tests and logistic regression analysis were used to explore the influence factors for the weight loss. Results The repeated measures showed that all indicators including weight, body mass index (BMI), albumin, pre-albumin(PA), and prognostic nutritional index (PNI) dramatically declined in both groups compared with their levels before radiation therapy (All p < 0.001). However, there was no significant difference between the intervention and non-intervention groups regarding the mean values of nutritional indicators at the same time point, that before, during, and after radiation therapy, except BMI (All p > 0.05). Logistic regression analysis revealed grade ≥ 3 radiation-induced oral mucositis as the prognostic factor for a poor nutrition status (odds ratio, OR = 3.232, p = 0.021, confidence interval, CI [1.198, 8.820]). Besides this, patients with a decrease of >15% in pre-albumin level were more likely to be malnourished (OR = 2.442, p = 0.041, CI [1.036, 5.757]). Similar to that observed in our former analysis, we did not find that existing nutrition intervention can significantly improve nutritional status (OR = 1.217, p = 0.704, CI [0.042, 3.348]). Conclusions Our study shows that the nutritional status of the patients gradually declined during treatment. We concluded that grade ≥ 3 radiation-induced oral mucositis would aggravate the extent of malnutrition during radiation therapy in patients with locoregionally advanced NPC. Pre-albumin level was a predictive marker for weight loss in patients with NPC. However, current nutrition intervention during radiation therapy can't significantly reverse nutritional status.
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Affiliation(s)
- Ting Jin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Kai-Xin Li
- Department of Radiation Oncology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian 362000, People's Republic of China
| | - Pei-Jing Li
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Shuang Huang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Xiao-Zhong Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Ming Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Qiao-Ying Hu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Lei Shi
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Yuan-Yuan Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang 310022, People's Republic of China
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Trachootham D, Chingsuwanrote P, Yoosadiang P, Mekkriangkrai D, Ratchawong T, Buraphacheep N, Kijanukul S, Saekhow S, Pongpitchayadej O, Vongvachvasin K, Sittikornpaiboon P, Tuntipopipat S. Partial Substitution of Glucose with Xylitol Suppressed the Glycolysis and Selectively Inhibited the Proliferation of Oral Cancer Cells. Nutr Cancer 2017; 69:862-872. [PMID: 28718681 DOI: 10.1080/01635581.2017.1339097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Suitable diet for cancer survivors remains an unresolved challenge. Increased glucose utilization is a hallmark of various cancers. Therefore, alternative carbohydrate supplying normal tissue but retarding cancer growth is needed. This study investigated the effect of sugar alcohols on the proliferation of oral cancer cells compared to nontransformed cells and explored the mechanism. Six oral squamous cell carcinoma (CAL-27, FaDu, SCC4, SCC9, SCC15, and SCC25) and one nontransformed oral keratinocyte (OKF6/TERT2) lines were cultured in media containing 1 mg/ml glucose and 5.8 mg/ml xylitol or sorbitol, yielding equal energy input to control group (4.5 mg/ml glucose). Partial substitution of glucose with sugar alcohols especially xylitol significantly suppressed proliferation of oral cancer but not nontransformed cells. Despite the addition of isocaloric quantities of the sugars, cancer cells exposed to low glucose plus xylitol had retarded ATP generation and decreased activity of phosphofructokinase (PFK), the rate-limiting enzyme in glycolysis. Furthermore, D-xylulose, its key metabolic intermediate, enhanced the anticancer effect of xylitol. These findings suggested a selective anticancer activity of xylitol and the potential mechanism involving inhibition of glucose utilization. Partial substitution of glucose with xylitol may be a proper nutrient for oral cancer survivors, deserving further investigation in animal and clinical settings.
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Affiliation(s)
| | - Pimjai Chingsuwanrote
- b Siriraj Center of Excellence for Stem Cell Research, Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | | | | | | | | | | | - Sumrit Saekhow
- h Vichaivej, Nongkhaem Hospital , Nongkhaem, Bangkok , Thailand
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Bressan V, Bagnasco A, Aleo G, Catania G, Zanini MP, Timmins F, Sasso L. The life experience of nutrition impact symptoms during treatment for head and neck cancer patients: a systematic review and meta-synthesis. Support Care Cancer 2017; 25:1699-1712. [DOI: 10.1007/s00520-017-3618-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/06/2017] [Indexed: 02/02/2023]
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43
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Predictors for Weight Loss in Head and Neck Cancer Patients Undergoing Radiotherapy: A Systematic Review. Cancer Nurs 2017; 38:E37-45. [PMID: 25730590 DOI: 10.1097/ncc.0000000000000231] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Head and neck cancer patients are at high risk of weight loss because of their disease process and the treatment of their disease. Recognition of predictors for weight loss may be able to give proactive or reactive nutritional treatment to patients at risk. OBJECTIVE The aim of this study is to identify the independent risk factors for head and neck cancer patients developing weight loss undergoing radiotherapy. METHODS A comprehensive literature search was performed on January 2014. Articles reporting studies of the predictors for weight loss in head and neck cancer patients undergoing radiotherapy were included. These studies were published between 1982 and 2014. Study quality was assessed using a modified quality assessment tool that was designed previously for an observational study. The effects of studies were combined with the study quality score using a best-evidence synthesis model. RESULTS Twenty-two observational studies involving 6159 patients were included. There was strong evidence for 3 predictors, including advanced tumor stage, a higher body mass index before treatment, and the use of concurrent chemoradiotherapy. We also identified 8 moderate evidence predictors and 30 limited evidence predictors. CONCLUSION The scientific literature to date indicates that patients with advanced tumor stage, or a higher body mass index before treatment, or the use of concurrent chemotherapy are at high risk to have weight loss during radiotherapy. IMPLICATIONS FOR PRACTICE These data provide evidence to guide healthcare professionals in admitting patients who will have weight loss and choosing an optimal prophylactic strategy.
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Meyer TK, Pisegna JM, Krisciunas GP, Pauloski BR, Langmore SE. Residue influences quality of life independently of penetration and aspiration in head and neck cancer survivors. Laryngoscope 2016; 127:1615-1621. [PMID: 27861932 DOI: 10.1002/lary.26387] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Dysphagia is one of the most significant side effects of the treatment of head and neck cancer. Residue and aspiration are two indicators of dysphagia, but aspiration is historically the only indicator of interest, because it may impact health outcomes. Clinicians have anecdotally used residue as another marker of swallowing dysfunction, but it is understudied. This project investigated the impact of aspiration versus residue on function and quality of life (QoL) in these patients. STUDY DESIGN Observational study. METHODS A total of 168 head and neck cancer survivors with moderate to severe dysphagia were enrolled in a randomized clinical trial comparing two swallow therapy interventions. Data at time of entry were used for the current study. A modified barium swallow study was done to compute Penetration-Aspiration Scale (PAS) scores, percentage oral residue, and percentage pharyngeal residue with three bolus consistencies (5 mL thin, nectar, and pudding). The Performance Status Scale (PSS) and the Head Neck Cancer Inventory (HNCI) questionnaires were administered. Data were analyzed to determine associations between aspiration and residue estimates with function and QoL scores. RESULTS Worsening aspiration and residue estimates were all correlated with decreased scores on the PSS functional scales (r = -0.190 to -0.324, P ≤ .031). However, only increasing residue estimates were significantly related to decreased patient-perceived QoL on the HNCI (r = -.178 to -.194, P < .046). This effect was more pronounced with oral versus pharyngeal residue. CONCLUSIONS In this group of head and neck cancer survivors, penetration/aspiration and residue show independent effects. PAS affects functional status only, but residue affects both functional status and QoL. This study supports that residue should be considered a primary measurement of swallowing function and be a target for identification, treatment, and evaluation of swallowing. LEVEL OF EVIDENCE 2c. Laryngoscope, 127:1615-1621, 2017.
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Affiliation(s)
- Tanya K Meyer
- Department of Otolaryngology, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Jessica M Pisegna
- Department of Otolaryngology, Boston University, Boston, Massachusetts, U.S.A
| | - Gintas P Krisciunas
- Department of Otolaryngology, Boston University, Boston, Massachusetts, U.S.A
| | - Barbara R Pauloski
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, U.S.A
| | - Susan E Langmore
- Department of Otolaryngology, Boston University, Boston, Massachusetts, U.S.A
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45
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Roussel LM, Micault E, Peyronnet D, Blanchard D, Guarnieri S, Choussy O, Géry B, Béquignon A, Joubert C, Parienti JJ, Babin E. Intensive nutritional care for patients treated with radiotherapy in head and neck cancer: a randomized study and meta-analysis. Eur Arch Otorhinolaryngol 2016; 274:977-987. [DOI: 10.1007/s00405-016-4278-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/19/2016] [Indexed: 11/30/2022]
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46
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NUTRISCORE: A new nutritional screening tool for oncological outpatients. Nutrition 2016; 33:297-303. [PMID: 27751743 DOI: 10.1016/j.nut.2016.07.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study was to design a new nutritional screening tool (NUTRISCORE) to detect nutritional risk in outpatients with cancer. METHODS A multicenter, cross-sectional study was conducted. We randomly selected outpatients receiving onco-specific, palliative, or symptomatic treatment for malignant neoplasms (including solid tumors and hematologic malignancies). These patients were assessed using the NUTRISCORE tool, the Malnutrition Screening Tool (MST), and the Patient-Generated Subjective Global Assessment (PG-SGA) to detect risk for malnutrition. The new tool included questions regarding the cancer site and active treatment. Sensitivity, specificity, and positive and negative predictive values were calculated for NUTRISCORE and MST using the PG-SGA as a reference method. RESULTS We evaluated 394 patients. According to NUTRISCORE, 22.6% were at risk for malnutrition. The MST detected a risk in 28.2%, and the PG-SGA found that 19% were malnourished or at nutritional risk. Using the PG-SGA as a reference method, the MST had a sensitivity of 84% and a specificity of 85.6%, whereas NUTRISCORE exceeded these values, at 97.3% sensitivity and 95.9% specificity. The better performance of NUTRISCORE as compared with MST was confirmed by the receiver operating characteristic curve analysis, with area under the curve values of 0.95 (95% confidence interval, 0.92-0.98) for NUTRISCORE and 0.84 (95% confidence interval, 0.79-0.89) for the MST. CONCLUSIONS NUTRISCORE has been found to be a novel, fast, and valid nutritional screening tool for outpatients with cancer. Its simplicity and high level of accuracy in detecting nutritional risk facilitates its applicability.
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Microvascular head and neck reconstruction after (chemo)radiation. Curr Opin Otolaryngol Head Neck Surg 2016; 24:83-90. [DOI: 10.1097/moo.0000000000000243] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Bressan V, Stevanin S, Bianchi M, Aleo G, Bagnasco A, Sasso L. The effects of swallowing disorders, dysgeusia, oral mucositis and xerostomia on nutritional status, oral intake and weight loss in head and neck cancer patients: A systematic review. Cancer Treat Rev 2016; 45:105-19. [DOI: 10.1016/j.ctrv.2016.03.006] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 02/07/2023]
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49
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Wirth R, Dziewas R, Beck AM, Clavé P, Hamdy S, Heppner HJ, Langmore S, Leischker AH, Martino R, Pluschinski P, Rösler A, Shaker R, Warnecke T, Sieber CC, Volkert D. Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging 2016; 11:189-208. [PMID: 26966356 PMCID: PMC4770066 DOI: 10.2147/cia.s97481] [Citation(s) in RCA: 268] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies.
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Affiliation(s)
- Rainer Wirth
- Department for Internal Medicine and Geriatrics, St Marien-Hospital Borken, Borken, Germany; Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Anne Marie Beck
- Department of Nutrition and Health, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de enfermadades Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, University of Manchester, Salford Royal Hospital, Salford, UK
| | - Hans Juergen Heppner
- Department of Geriatrics, Witten- Herdecke University, Schwelm, Germany; Helios Clinic Schwelm, Schwelm, Germany
| | - Susan Langmore
- Department of Speech, Language and Hearing Sciences, Boston University School of Medicine, Boston, MA, USA
| | | | - Rosemary Martino
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
| | - Petra Pluschinski
- Department of Phoniatrics and Pediatric Audiology, University of Marburg, Marburg, Germany
| | - Alexander Rösler
- Department of Geriatrics, Marien Hospital Hamburg, Hamburg, Germany
| | - Reza Shaker
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tobias Warnecke
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Cornel Christian Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany; Department of General Internal Medicine and Geriatrics, St John of God Hospital Regensburg, Regensburg, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
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50
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Dysphagia and Head and Neck Cancer. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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