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Pauloski BR, Nitschke T, Schultz S, Bloedel S, Amman A, Kessler L, Lisowski K. Association of Tongue Strength and Maximum Incisal Opening with Oral Intake in Persons with Head and Neck Cancer Treated with Radiotherapy: A Retrospective Study. Dysphagia 2024; 39:726-734. [PMID: 38446254 DOI: 10.1007/s00455-023-10653-3] [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: 09/28/2023] [Accepted: 11/20/2023] [Indexed: 03/07/2024]
Abstract
Persons treated with radiotherapy (RT) for cancer of the head and neck (HNC) may experience limited oral intake at treatment completion. The purpose of this retrospective study was to examine the contributions of tongue strength and maximum incisal opening (MIO) to oral intake in a cohort of veterans treated for HNC. Medical records of veterans diagnosed with HNC treated with RT who were seen by the Speech Pathology Service prior to and throughout treatment per usual care were reviewed for this study; eighty-two records met the inclusion criteria for analysis. Tongue strength in kPa, MIO in mm, feeding tube status at completion of RT, and food and liquid consistencies consumed at completion of RT were among the data abstracted from the records. Most veterans (67%) did not have a feeding tube present at the completion of RT and reported drinking thin liquids (84.2%) at treatment completion. Eighteen percent reported including all food consistencies in their diet at the end of treatment. Both MIO and tongue strength decreased after treatment. Greater tongue strength during RT and larger MIO at the completion of RT were predictive of improved functional outcomes for oral intake at the end of treatment. This study provides evidence of the importance of increasing tongue strength and MIO during treatment with RT, and supports an important focus for intervention by speech-language pathologists.
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Affiliation(s)
- Barbara Roa Pauloski
- Department of Communication Sciences and Disorders, College of Health Professions and Sciences, University of Wisconsin Milwaukee, 2400 E. Hartford Avenue, Suite 840, Milwaukee, WI, 53211, USA.
- Clement J. Zablocki Veterans Administration Medical Center, Research Speech Pathologist, WOC, 5000 National Avenue, Room 8300, Building 111, Milwaukee, WI, 53295, USA.
| | - Terilynn Nitschke
- Clement J. Zablocki Veterans Administration Medical Center, Speech-Language Pathologist, 5000 National Avenue, Room 8300, Building 111, Milwaukee, WI, 53295, USA
| | - Stephanie Schultz
- Clement J. Zablocki Veterans Administration Medical Center, Speech-Language Pathologist, 5000 National Avenue, Room 8300, Building 111, Milwaukee, WI, 53295, USA
| | - Suzi Bloedel
- Clement J. Zablocki Veterans Administration Medical Center, Speech-Language Pathologist, 5000 National Avenue, Room 8300, Building 111, Milwaukee, WI, 53295, USA
| | - Adrienne Amman
- Clement J. Zablocki Veterans Administration Medical Center, Speech-Language Pathologist, 5000 National Avenue, Room 8300, Building 111, Milwaukee, WI, 53295, USA
| | - Laura Kessler
- Clement J. Zablocki Veterans Administration Medical Center, Speech-Language Pathologist, 5000 National Avenue, Room 8300, Building 111, Milwaukee, WI, 53295, USA
| | - Kara Lisowski
- Clement J. Zablocki Veterans Administration Medical Center, Speech-Language Pathologist, 5000 National Avenue, Room 8300, Building 111, Milwaukee, WI, 53295, USA
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Paim ÉD, Sugueno LA, Martins VB, Zanella VG, Macagnan FE. Electrical Stimulation for Treatment of Dysphagia Post Head Neck Cancer: A Systematic Review and Meta-Analysis. Int Arch Otorhinolaryngol 2024; 28:e339-e349. [PMID: 38618607 PMCID: PMC11008950 DOI: 10.1055/s-0043-1761175] [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: 11/13/2022] [Indexed: 04/16/2024] Open
Abstract
Introduction Dysphagia induced by radiotherapy in the head and neck region comprises a challenging scenario and sometimes difficult rehabilitation due to the severity of the adverse effects. Some resources such as electrical stimulation have emerged as an alternative to complement the therapeutic process, but there is still no consensus on its use. Objective The purpose of the present study was to evaluate, through a meta-analysis, the effect of electrical stimulation on the rehabilitation of dysphagia generated after head and neck cancer treatment. Data Synthesis Four randomized controlled trials with a total of 146 participants were included. The age of the participants was 58.37 ± 1.8 years old and there was a predominance of males. The time to start the intervention ranged from 50.96 ± 40.12 months after cancer treatment. The intervention showed great heterogeneity regarding the positioning of the electrodes, parameters, duration of the stimulus, number of sessions, and intensity. No difference was identified in the following aspects: oral transit time, hyoid elevation, penetration and/or aspiration after electrostimulation. The quality of the evidence ranged from very low to moderate and high risk of bias. Conclusion In this meta-analysis, we found weak evidence for small and moderate swallowing benefits in patients after radiotherapy for head and neck cancer in short-term clinical trials.
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Affiliation(s)
- Émille Dalbem Paim
- Speech Therapy Department, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Lica Arakawa Sugueno
- Graduate Program in Human Communication, Faculdade de Ciências Médicas da Santa Casa de São Paulo, SP, Brazil
| | - Vera Beatris Martins
- Speech Therapy Department, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Virgilio Gonzales Zanella
- Head and Neck Surgery Department, Hospital Santa Rita, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Fabricio Edler Macagnan
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
- Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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Baudelet M, Van den Steen L, Duprez F, Goeleven A, Nuyts S, Nevens D, Vandenbruaene C, Massonet H, Vergauwen A, Vauterin T, Verstraete H, Wouters K, Vanderveken O, De Bodt M, Van Nuffelen G. Prophylactic Swallowing Therapy During Head-and-Neck Cancer Radiotherapy: Effect of Service-Delivery Mode and Overall Adherence Level on Swallowing Function and Muscle Strength-the PRESTO Trial. Dysphagia 2024; 39:267-281. [PMID: 37550571 PMCID: PMC10957706 DOI: 10.1007/s00455-023-10609-7] [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: 10/07/2022] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
Prophylactic swallowing exercises (PSE) during head-and-neck cancer (HNC) (chemo)radiotherapy (CRT) have a positive effect on swallowing function and muscle strength. Adherence rates to PSE are, however, moderate to low, undermining these effects. PRESTO already showed that the service-delivery mode (SDM), the way the exercises are offered, can influence adherence. The aim of this study was to investigate the effect of SDM on swallowing function and muscle strength during and post-CRT. In addition, the effect of overall adherence (OA), independent of SDM, was also investigated. A total of 148 HNC patients, treated with CRT, were randomly assigned to one of the three SDM's (paper-supported, app-supported, or therapist-supported PSE) and performed a 4-week PSE program. OA was calculated based on the percentage of completed exercises. Patients were divided into OA levels: the OA75+ and OA75- group performed respectively ≥ 75 and < 75% of the exercises. Swallowing function based on Mann Assessment of Swallowing Ability-Cancer (MASA-C), tongue and suprahyoid muscle strength during and up to 3 months after CRT were compared between the SDM's and OA levels. Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction was used. No significant differences were found between the three SDMs. Significant time effects were found: MASA-C scores decreased and muscle strength increased significantly during CRT. By the end of CRT, the OA75+ showed significantly better swallowing function compared to OA75-. Muscle strength gain was significantly higher in the OA75+ group. SDM had no impact on swallowing function and muscle strength; however, significant effects were shown for OA level. Performing a high level of exercise repetitions is essential to benefit from PSE.Trial registration ISRCTN, ISRCTN98243550. Registered December 21, 2018-retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search.
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Affiliation(s)
- Margot Baudelet
- Department of Radiation Oncology, University Hospital Ghent, 9000, Ghent, Belgium.
- Department of ENT, University Hospital Ghent, 9000 Ghent, Belgium.
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, University Hospital Ghent, 9000, Ghent, Belgium
- Faculty of Medicine and Health Sciences Ghent, University of Ghent, Ghent, Belgium
| | - Ann Goeleven
- Department of Head and Neck Surgery, Swallowing Clinic, University Hospital Leuven, Louvain, Belgium
- Faculty of Medicine, Department of Neurosciences, Research Group Experimental Oto-rhino-laryngology, KU Leuven, Louvain, Belgium
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, 3000 Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Daan Nevens
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium
- Iridium Network, Antwerp, Belgium
| | | | - Hanne Massonet
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Head and Neck Surgery, Swallowing Clinic, University Hospital Leuven, Louvain, Belgium
- Faculty of Medicine, Department of Neurosciences, Research Group Experimental Oto-rhino-laryngology, KU Leuven, Louvain, Belgium
| | - Alice Vergauwen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
| | | | - Hilde Verstraete
- Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium
- Iridium Network, Antwerp, Belgium
| | - Kristien Wouters
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Ghent, University of Ghent, Ghent, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Ghent, University of Ghent, Ghent, Belgium
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Tanaka A, Uemura H, Kimura T, Nishimura A, Aoki K, Otsuka S, Ueda K, Kitahara T. Evaluation of usefulness of tongue pressure measurement device for dysphagia associated with treatment of patients with head and neck cancer (ELEVATE). Medicine (Baltimore) 2023; 102:e33954. [PMID: 37390259 PMCID: PMC10313278 DOI: 10.1097/md.0000000000033954] [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: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Dysphagia is often caused by radiotherapy (RT) in patients with head and neck cancer (HNC), and reduced tongue pressure (TP) is often associated with swallowing dysfunction in the oral stage. However, the evaluation of dysphagia by measuring TP has not yet been established in HNC patients. Herein, we conducted a clinical trial to evaluate the usefulness of TP measurement using a TP-measuring device as an objective indicator of dysphagia induced by RT in HNC patients. METHODS AND ANALYSIS This ELEVATE trial is a prospective, single-center, single-arm, non-blind, non-randomized trial to evaluate the usefulness of a TP measurement device for dysphagia associated with the treatment of HNC. Eligible participants include patients with oropharyngeal or hypopharyngeal cancer (HPC) undergoing RT or chemoradiotherapy (CRT). The TP measurements are conducted before, during, and after RT. The primary endpoint is the change in the maximum TP values from before RT to 3 months after RT. Moreover, as secondary endpoints, the correlation between the maximum TP value and the findings of video-endoscopic and video-fluoroscopic examinations of swallowing will be analyzed at each evaluation point, as well as changes in the maximum TP value from before RT to during RT and at 0, 1, and 6 months after RT. DISCUSSION This trial aimed to investigate the usefulness of evaluation by measuring TP for dysphagia associated with HNC treatment. We expect that an easier evaluation for dysphagia will improve rehabilitation programs for dysphagia. Overall, we expect this trial to contribute to the improvement of patients' quality of life (QOL).
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Affiliation(s)
- Akihisa Tanaka
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hirokazu Uemura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Takahiro Kimura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Ari Nishimura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kumiko Aoki
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Shintaro Otsuka
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Keita Ueda
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
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Diaz-Saez MC, Gil-Martínez A, Gadotti IC, Navarro-Fernández G, Gil-Castillo J, Beltran-Alacreu H. Reliability and Responsiveness of a Novel Device to Evaluate Tongue Force. Life (Basel) 2023; 13:life13051192. [PMID: 37240837 DOI: 10.3390/life13051192] [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: 03/13/2023] [Revised: 04/21/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Measurements of tongue force are important in clinical practice during both the diagnostic process and rehabilitation progress. It has been shown that patients with chronic temporomandibular disorders have less tongue strength than asymptomatic subjects. Currently, there are few devices to measure tongue force on the market, with different limitations. That is why a new device has been developed to overcome them. The objectives of the study were to determine the intra- and inter-rater reliability and the responsiveness of a new low-cost device to evaluate tongue force in an asymptomatic population. MATERIALS AND METHODS Two examiners assessed the maximal tongue force in 26 asymptomatic subjects using a developed prototype of an Arduino device. Each examiner performed a total of eight measurements of tongue force in each subject. Each tongue direction was measured twice (elevation, depression, right lateralization, and left lateralization) in order to test the intrarater reliability. RESULTS The intrarater reliability using the new device was excellent for the measurements of the tongue force for up (ICC > 0.94), down (ICC > 0.93) and right (ICC > 0.92) movements, and good for the left movement (ICC > 0.82). The SEM and MDC values were below 0.98 and 2.30, respectively, for the intrarater reliability analysis. Regarding the inter-rater reliability, the ICC was excellent for measuring the tongue up movements (ICC = 0.94), and good for all the others (down ICC = 0.83; right ICC = 0.87; and left ICC = 0.81). The SEM and MDC values were below 1.29 and 3.01, respectively, for the inter-rater reliability. CONCLUSIONS This study showed a good-to-excellent intra- and inter-reliability and good responsiveness in the new device to measure different directions of tongue force in an asymptomatic population. This could be a new, more accessible tool to consider and add to the assessment and treatment of different clinical conditions in which a deficit in tongue force could be found.
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Affiliation(s)
- Marta Carlota Diaz-Saez
- Physiotherapy Department, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, C/La Salle, 28023 Madrid, Spain
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, C/La Salle, 28023 Madrid, Spain
- Programa de Doctorado en Medicina y Cirugía, Universidad Autónoma de Madrid, C/Francisco Tomás y Valiente 5, 28049 Madrid, Spain
| | - Alfonso Gil-Martínez
- Physiotherapy Department, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, C/La Salle, 28023 Madrid, Spain
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, C/La Salle, 28023 Madrid, Spain
- Hospital Universitario La Paz-Carlos III. Institute for Health Research (IdiPaz), Paseo la Castellana, 261, 28046 Madrid, Spain
| | - Inae Caroline Gadotti
- Department of Physical Therapy, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11865 SW 26th St Suite H3, Miami, FL 33199, USA
| | - Gonzalo Navarro-Fernández
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, C/La Salle, 28023 Madrid, Spain
| | - Javier Gil-Castillo
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Av. Doctor Arce, 37, 28002 Madrid, Spain
| | - Hector Beltran-Alacreu
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physical Therapy and Nursing, Universidad de Castilla-La Mancha, Avenida de Carlos III s/n, 45071 Toledo, Spain
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Kao NH, Iyer NG, Chua A, Nagadia RH. Early quality of life outcomes after surgery in head and neck cancer survivors with EORTC QLQ-C30 and EORTC QLQ-HN35 in an Asian tertiary centre. Support Care Cancer 2022; 30:4537-4546. [PMID: 35119518 DOI: 10.1007/s00520-022-06871-4] [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: 06/20/2021] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The objective of the study was to evaluate the quality of life (QOL) of head and neck cancer survivors after surgical treatment and to identify patients' main concerns. The study also aims to establish pre-treatment reference values particularly for the Asian patient. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and Head and Neck module (EORTC QLQ-HN35) were used for objective evaluation. METHODS Patients planned for elective surgery for head and neck cancers were enrolled in the study. The questionnaires were completed at pre-treatment and at 6 months after surgery. Results were compared with previously published reference values. RESULTS One hundred forty patients completed both questionnaires. Locally advanced tumour and extent of surgery (tracheostomy (p<0.01), surgical flap (p<0.01)) were associated with lower global health scores. Adjuvant treatment was also a contributory factor (p<0.01). Dysphagia and social eating was a primary concern within our population. CONCLUSION Surgical treatment of head and neck cancers is safe, but there is poor QOL in the early post-treatment period especially with eating. Previously published data suggested improvement after a year.
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Affiliation(s)
- Nern Hoong Kao
- Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
| | - N Gopalakrishna Iyer
- Department of Head and Neck Surgery, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Alice Chua
- Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Rahul Harshad Nagadia
- Department of Head and Neck Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.,Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, 5 Second Hospital Avenue, Singapore, 168938, Singapore.,Department of Dental Medicine, Karolinska Institute, 17177, Stockholm, Sweden
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Change in Nutritional Status and Dysphagia after Resection of Head and Neck Cancer. Nutrients 2021; 13:nu13072438. [PMID: 34371947 PMCID: PMC8308483 DOI: 10.3390/nu13072438] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 01/18/2023] Open
Abstract
Nutritional status is well-known to influence patient recovery after resection of head and neck cancer (HNC). The influence of preoperative nutritional status on dysphagia was assessed in patients who underwent surgical resection of HNC along with the assessment of nutritional status during the acute and subacute phases. Eighty-six patients underwent surgical resection and dysphagia assessments (repetitive saliva-swallowing test, water-swallowing test, and functional oral intake scale) and had their tongue pressure assessed five times (before surgery, after 1–2 weeks, and 1, 2, and 3 months after surgery). The nutritional status was assessed according to the body mass index, total protein, and albumin. The prognostic nutritional index was calculated from preoperative data, and the subjects were classified into three groups: Low-risk, Attention and High-risk groups. After surgery, the nutritional status index values were low, and the High-risk group showed significantly lower values in comparison to the other two groups. The water-swallowing test and functional oral intake scale findings were worse than they had been preoperatively until 2 months after surgery, and a significant correlation was noted between the postoperative nutritional status and the presence of dysphagia. The results indicated that the preoperative nutritional status of HNC patients influenced their ability to ingest/swallow, which in turn influenced their nutritional status after HNC resection.
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Dysphagia, trismus and speech impairment following radiation-based treatment for advanced stage oropharyngeal carcinoma: a one-year prospective evaluation. Eur Arch Otorhinolaryngol 2021; 279:1003-1027. [PMID: 34043065 DOI: 10.1007/s00405-021-06870-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/04/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective was to assess swallowing, mouth opening and speech function during the first year after radiation-based treatment (RT(+)) after introduction of a dedicated preventive rehabilitation program for stage III-IV oropharyngeal carcinoma (OPC). METHODS Swallowing, mouth opening and speech function were collected before and at six- and twelve-month follow-up after RT(+) for OPC as part of ongoing prospective assessments by speech-language pathologists . RESULTS Objective and patient-perceived function deteriorated until 6 months and improved until 12 months after treatment, but did not return to baseline levels with 25%, 20% and 58% of the patients with objective dysphagia, trismus and speech problems, respectively. Feeding tube dependency and pneumonia prevalence was low. CONCLUSION Despite successful implementation, a substantial proportion of patients still experience functional limitations after RT(+) for OPC, suggesting room for improvement of the current rehabilitation program. Pretreatment sarcopenia seems associated with worse functional outcomes and might be a relevant new target for rehabilitation strategies.
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Late radiation effects in survivors of head and neck cancer: State of the science. Crit Rev Oncol Hematol 2021; 162:103335. [PMID: 33992801 DOI: 10.1016/j.critrevonc.2021.103335] [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: 02/01/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 01/15/2023] Open
Abstract
Head and neck squamous cell carcinoma is one of the most common neoplasms. Radiotherapy (RT) plays an essential role in the management of such cases. Despite advances in the technique, hyposalivation, xerostomia, dysphagia, trismus, radiation caries, and osteoradionecrosis remain significant late complications of RT. The aim of this narrative review was to summarize and update the main findings related to late side effects of radiotherapy in survivors of head and neck cancer (HNC). Such effects limit the ability to speak, ingest food and medications, and breathe and also exert a negative impact on social well-being and quality of life. This review highlights research in the field for both researchers and clinicians, assisting in the prevention and management of these adverse conditions. The findings can contribute to improving preventive management and multidisciplinary interventions for HNC patients.
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Course of Self-Reported Dysphagia, Voice Impairment and Pain in Head and Neck Cancer Survivors. BIOLOGY 2021; 10:biology10020144. [PMID: 33670412 PMCID: PMC7918686 DOI: 10.3390/biology10020144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Head and neck cancer (HNC)-specific symptoms have a substantial impact on health-related quality of life. The aim of this study was to determine whether self-reported dysphagia, voice problems and pain of HNC patients changed over time and whether specific clinical or sociodemographic variables were associated with these symptoms. METHODS HNC patients (n = 299) in an outpatient setting answered questionnaires (Eating Assessment Tool-10; questions from the EORTC QLQ-C30 and EORTC H&N35) on dysphagia, voice problems and pain, collected with the software "OncoFunction" at three different timepoints (t1-t3) after diagnosis. The mean score changes from t1 to t3 were expressed in terms of effect sizes d. The impact of sociodemographic and clinical factors on the course of the variables was tested with multivariate analyses of variance. RESULTS Dysphagia, voice impairment and pain in HNC survivors significantly improved over a period of approximately 14 months after diagnosis. Tumor site, stage, treatment modality, occupational state and ECOG state were significantly correlated with self-reported functional outcome. The pain level of the HNC patients was rather low. CONCLUSIONS Patients suffer from functional impairments after HNC treatment, but an improvement in self-reported symptoms could be demonstrated within this time period.
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Effects of Transcutaneous Neuromuscular Electrical Stimulation on Swallowing Disorders: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2020; 99:701-711. [PMID: 32209833 PMCID: PMC7343179 DOI: 10.1097/phm.0000000000001397] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the efficacy of transcutaneous neuromuscular electrical stimulation on swallowing disorders. DESIGN MEDLINE/PubMed, Embase, CENTRAL, Web of science, and PEDro were searched from their earliest record to August 1, 2019. All randomized controlled trials and quasi-randomized controlled trial were identified, which compared the efficacy of neuromuscular electrical stimulation plus traditional therapy with traditional therapy in swallowing function. The Grading of Recommendations Assessment, Development and Evaluation approach was applied to evaluate the quality of evidence. RESULTS Eight randomized controlled trials and three quasi-randomized controlled trials were included. These studies demonstrated a significant, moderate pooled effect size (standard mean difference = 0.62; 95% confidence interval = 0.06 to 1.17). Studies stimulating suprahyoid muscle groups revealed a negative standard mean difference of 0.17 (95% confidence interval = -0.42, 0.08), whereas large effect size was observed in studies stimulating the infrahyoid muscle groups (standard mean difference = 0.89; 95% confidence interval = 0.47 to 1.30) and stimulating the suprahyoid and infrahyoid muscle groups (standard mean difference = 1.4; 95% confidence interval = 1.07 to 1.74). Stimulation lasting 45 mins or less showed a large, significant pooled effect size (standard mean difference = 0.89; 95% confidence interval = 0.58 to 1.20). The quality of evidences was rated as low to very low. CONCLUSIONS There is no firm evidence to conclude on the efficacy of neuromuscular electrical stimulation on swallowing disorders. Larger-scale and well-designed randomized controlled trials are needed to reach robust conclusions.
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Van den Steen L, Baudelet M, Tomassen P, Bonte K, De Bodt M, Van Nuffelen G. Effect of tongue-strengthening exercises on tongue strength and swallowing-related parameters in chronic radiation-associated dysphagia. Head Neck 2020; 42:2298-2307. [PMID: 32352198 DOI: 10.1002/hed.26179] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/04/2020] [Accepted: 04/03/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Radiation-associated dysphagia (RAD) is highly prevalent in head and neck cancer (HNC) patients, with insufficient tongue strength (TS) as a characteristic of this disabling complication. The effects of tongue-strengthening exercises (TSE) on TS, swallowing, and quality of life (QoL) have not been studied in this population. METHODS A prospective phase 2 study using an 8 weeks during TSE protocol was carried out in 15 patients with chronic RAD. Outcome parameters were maximal isometric pressure (MIP), TS during swallowing (Pswal), swallowing function, and QoL. All parameters were evaluated at baseline, after 4 and 8 weeks of training, and 4 weeks after the last training session. RESULTS MIP increased significantly, without detraining effects. Pswal did not increase significantly, but relevant effect sizes were measured. Swallowing function ameliorated, but did not result in increased functional oral intake, self-reported outcome or QoL. CONCLUSION TSE in patients with RAD results in increased strength and swallowing function.
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Affiliation(s)
- Leen Van den Steen
- Department of Otolaryngology-Head and Neck Surgery, Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Department of ENT, Head and Neck Surgery and Communication Disorders, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Margot Baudelet
- Department of ENT, Head and Neck Surgery and Communication Disorders, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Peter Tomassen
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katrien Bonte
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Marc De Bodt
- Department of Otolaryngology-Head and Neck Surgery, Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Department of ENT, Head and Neck Surgery and Communication Disorders, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology-Head and Neck Surgery, Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Department of ENT, Head and Neck Surgery and Communication Disorders, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Adaptations to Oral and Pharyngeal Swallowing Function Induced by Injury to the Mylohyoid Muscle. Dysphagia 2020; 35:814-824. [PMID: 31897608 DOI: 10.1007/s00455-019-10087-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 12/18/2019] [Indexed: 01/05/2023]
Abstract
Muscle injury is a frequent side effect of radiation treatment for head and neck cancer. To understand the pathophysiology of injury-related dysfunction, we investigated the effects of a single muscle injury to the mylohyoid on oropharyngeal swallowing function in the rat. The mylohyoid protects the airway from food/liquid via hyolaryngeal elevation and plays an active role during both oral and pharyngeal swallowing. We hypothesized (1) that fibrosis to the mylohyoid alters swallowing bolus flow and licking patterns and (2) that injury to the mylohyoid changes normal activity of submental, laryngeal, and pharyngeal muscles during swallowing. A chilled cryoprobe was applied to the rat mylohyoid muscle to create a localized injury. One and two weeks after injury, swallowing bolus transit was assessed via videofluoroscopy and licking behavior via an electrical lick sensor. The motor activity of five swallow-related muscles was analyzed immediately after injury using electromyography (EMG). Comparisons were made pre- and post-injury. Fibrosis was confirmed in the mylohyoid at 2 weeks after injury by measuring collagen content. One week after injury, bolus size decreased, swallowing rate reduced, and licking patterns were altered. Immediately post-injury, there was a significant depression in mylohyoid and thyropharyngeus EMG amplitudes during swallowing. Our results demonstrated that injury to the mylohyoid is sufficient to cause changes in deglutition. These disruptions in oral and pharyngeal swallowing were detected prior to long-term fibrotic changes, including delays in tongue movement, alterations in bolus flow, and changes in sensorimotor function. Therefore, injuring a single important swallowing muscle can have dramatic clinical effects.
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