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De Pasquale G, Mancin S, Matteucci S, Cattani D, Pastore M, Franzese C, Scorsetti M, Mazzoleni B. Nutritional prehabilitation in head and neck cancer: A systematic review of literature. Clin Nutr ESPEN 2023; 58:326-334. [PMID: 38057023 DOI: 10.1016/j.clnesp.2023.10.033] [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: 07/17/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND/SCOPE Malnutrition is a common problem among patients with head and neck cancer and can have adverse effects on overall health and treatment outcomes. Nutritional and physical prehabilitation are potential strategies to optimize the nutritional status of these patients. This systematic review aimed to identify and describe prehabilitative interventions that can promote an improvement in nutritional status. METHODS A systematic review of the literature was conducted in the databases PubMed/Medline, Embase, CINAHL, Scopus and on the platform Web of Science and in Cochrane Library. The selected studies concern adults with head and neck tumours, not malnourished at the time of diagnosis, who undergo nutritional or physical prehabilitation. RESULTS Out of 1369 results, 7 studies were included. Multimodal prehabilitation interventions that combine nutritional counseling, oral nutritional supplements, and swallowing exercises to prevent dysphagia have shown positive outcomes in maintaining caloric intake, body weight, swallowing ability, and a reduced incidence of fibrosis in the upper gastrointestinal tract, as well as improving quality of life. CONCLUSION Despite the limited number of clinical studies available in the literature, the results suggest that nutritional and physical prehabilitation interventions have a positive effect on the nutritional status and clinical outcomes of patients with head and neck cancer, helping mitigate the risk of malnutrition and improve general well-being.
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Affiliation(s)
| | - Stefano Mancin
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
| | | | - Daniela Cattani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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2
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Late-onset swallowing outcomes post-treatment for head and neck cancer in a UK-based population. J Laryngol Otol 2023; 137:293-300. [PMID: 35317872 PMCID: PMC9975761 DOI: 10.1017/s0022215122000834] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adverse swallowing outcomes following head and neck squamous cell carcinoma treatment in the context of late-onset post-radiotherapy changes can occur more than five years post-treatment. METHODS A retrospective study was conducted utilising patient records from March 2013 to April 2015. Patients were categorised into 'swallow dysfunction' and 'normal swallow' groups. Quality of life was investigated using the MD Anderson Dysphagia Inventory and EuroQol questionnaires. RESULTS Swallow dysfunction was seen in 77 (51 per cent) of 152 patients. Twenty-eight patients (36 per cent) in the swallow dysfunction group reported symptoms in year five. Swallow dysfunction was associated with stage IV head and neck squamous cell carcinoma (p < 0.001) and radiotherapy (p < 0.001). MD Anderson Dysphagia Inventory global scores showed significant differences between swallow dysfunction and normal swallow groups (p = 0.01), and radiotherapy and surgery groups (p = 0.03), but there were no significant differences between these groups in terms of MD Anderson Dysphagia Inventory composite or EuroQol five-dimensions instrument scores. CONCLUSION One-third of head and neck squamous cell carcinoma survivors with swallow dysfunction still show symptoms at more than five years post-surgery, a point at which they are typically discharged.
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3
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The role of the speech and language therapist in the rehabilitation of speech, swallowing, voice and trismus in people diagnosed with head and neck cancer. Br Dent J 2022; 233:801-805. [DOI: 10.1038/s41415-022-5145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022]
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4
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Paleri V, Hardman J, Brady G, George A, Kerawala C. Transoral Robotic Surgery for Residual and Recurrent Oropharyngeal Cancers. Otolaryngol Clin North Am 2021; 53:1091-1108. [PMID: 33127041 DOI: 10.1016/j.otc.2020.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Transoral robotic surgery (TORS) is a well-established treatment option for treatment-naïve oropharyngeal cancer. For residual, recurrent, and new primary oropharyngeal tumors emerging in previously irradiated fields, the global experience of management with TORS is limited. This article discusses current concepts on this topic, offers a deeper insight into the transoral anatomy for these cases, and covers the specific complexities of resections in the various subsites of the oropharynx. It provides practical tips on reconstruction, recovery, and rehabilitation as well as offering a synthesis of the current evidence and exploring future trends.
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Affiliation(s)
- Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; The Institute of Cancer Research, Brompton Road, London SW3 6JJ, UK.
| | - John Hardman
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; North London, UK
| | - Grainne Brady
- Department of Speech, Language and Swallowing, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Ajith George
- University Hospitals North Midlands, North Staffordshire, England; Keele University Medical School, Staffordshire, UK
| | - Cyrus Kerawala
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK; University of Winchester, Winchester, UK
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5
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Changing paradigms in the treatment of residual/recurrent head and neck cancer: implications for dysphagia management. Curr Opin Otolaryngol Head Neck Surg 2020; 28:165-171. [DOI: 10.1097/moo.0000000000000620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Lang K, ElShafie RA, Akbaba S, Koschny R, Bougatf N, Bernhardt D, Welte SE, Adeberg S, Häfner M, Kargus S, Plinkert PK, Debus J, Rieken S. Percutaneous Endoscopic Gastrostomy Tube Placement in Patients with Head and Neck Cancer Treated with Radiotherapy. Cancer Manag Res 2020; 12:127-136. [PMID: 32021429 PMCID: PMC6955619 DOI: 10.2147/cmar.s218432] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background and aim The primary aim of our study was to evaluate percutaneous endoscopic gastrostomy (PEG) tube placement depending on body weight and body mass index in patients undergoing radiotherapy (RT) for head and neck cancer (HNC). A secondary aim was to evaluate the course of weight change following PEG placement. Methods We retrospectively reviewed the medical records of 186 patients with HNC undergoing radiotherapy (RT) or chemoradiotherapy (CRT) at our institution between January 2010 and August 2017. Initial weight and nutritional intake were analyzed prior to RT initiation and then followed throughout treatment until completion. Based on these data, the indication of PEG placement was determined. Medical records were also reviewed to analyze PEG-related acute toxicities. Results A total of 186 patients met inclusion criteria. Patients were most commonly male (n=123, 66.1%) with squamous cell carcinoma (n=164, 88.2%). Patients who had dysphagia prior to treatment initiation as well as patients with a BMI <18.5 kg/m2 needed PEG placement earlier during the treatment course. Low-grade toxicities related to PEG insertion were observed in 10.7% patients, with peristomal pain and redness adjacent to the PEG tube insertion site being most common. High-grade toxicities, such as peritonitis and organ injury, were found in 4.9% of patients. Conclusion Underweight patients and those with preexisting dysphagia should be closely screened during RT for weight loss and decreased oral intake. For weight loss greater than 4.5% during the treatment of HNC, early PEG-tube placement should be considered. Further prospective studies are needed to confirm these findings, and delineate a scoring system for timing of PEG use (prophylactic vs reactive) as well as assess the quality of life in patients with HNC who receive PEG placement.
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Affiliation(s)
- Kristin Lang
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany
| | - Rami A ElShafie
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany
| | - Sati Akbaba
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany
| | - Ronald Koschny
- Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Stefan E Welte
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Matthias Häfner
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Steffen Kargus
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
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Patterson JM. Late Effects of Organ Preservation Treatment on Swallowing and Voice; Presentation, Assessment, and Screening. Front Oncol 2019; 9:401. [PMID: 31165044 PMCID: PMC6536573 DOI: 10.3389/fonc.2019.00401] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/29/2019] [Indexed: 11/23/2022] Open
Abstract
The prevalence of head and neck cancer (HNC) survivors is on the rise. Treatments for HNC can have a major deleterious impact on functions such as swallowing and voice. Poor functional outcomes are strongly correlated with distress, low quality of life, difficulties returning to work and socializing. Furthermore, dysphagia can have serious medical consequences such as malnutrition, dehydration, and pneumonia. A conservative estimate of the percentage of survivors living with dysphagia in the long-term is between 50 and 60%. Evidence is emerging that functions can worsen over time, sometimes several years following treatment due to radiation-associated fibrosis, neuropathy, intractable edema, and atrophy. Muscles lose their strength, pliability, stamina, and range, speed, precision, and initiation of movements necessary for swallowing and voice functions. Late treatment effects can go unrecognized, and may only be identified when there is a medical complication such as hospitalization for aspiration pneumonia. In the routine healthcare setting methods of evaluation include a detailed case history, a thorough clinical examination and instrumental assessments. Interventions for late treatment effects are limited and it is imperative that patients at risk are identified as early as possible. This paper considers the role of screening tests in monitoring swallowing and detecting aspiration in the long-term. Further work is indicated for addressing this pressing and increasingly common clinical problem.
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Affiliation(s)
- J M Patterson
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- Speech and Language Therapy Department, City Hospitals Sunderland Foundation Trust, Sunderland, United Kingdom
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8
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Paleri V, Patterson J, Rousseau N, Moloney E, Craig D, Tzelis D, Wilkinson N, Franks J, Hynes AM, Heaven B, Hamilton D, Guerrero-Urbano T, Donnelly R, Barclay S, Rapley T, Stocken D. Gastrostomy versus nasogastric tube feeding for chemoradiation patients with head and neck cancer: the TUBE pilot RCT. Health Technol Assess 2019; 22:1-144. [PMID: 29650060 DOI: 10.3310/hta22160] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Approximately 9000 new cases of head and neck squamous cell cancers (HNSCCs) are treated by the NHS each year. Chemoradiation therapy (CRT) is a commonly used treatment for advanced HNSCC. Approximately 90% of patients undergoing CRT require nutritional support via gastrostomy or nasogastric tube feeding. Long-term dysphagia following CRT is a primary concern for patients. The effect of enteral feeding routes on swallowing function is not well understood, and the two feeding methods have, to date (at the time of writing), not been compared. The aim of this pilot randomised controlled trial (RCT) was to compare these two options. METHODS This was a mixed-methods multicentre study to establish the feasibility of a RCT comparing oral feeding plus pre-treatment gastrostomy with oral feeding plus as-required nasogastric tube feeding in patients with HNSCC. Patients were recruited from four tertiary centres treating cancer and randomised to the two arms of the study (using a 1 : 1 ratio). The eligibility criteria were patients with advanced-staged HNSCC who were suitable for primary CRT with curative intent and who presented with no swallowing problems. MAIN OUTCOME MEASURES The primary outcome was the willingness to be randomised. A qualitative process evaluation was conducted alongside an economic modelling exercise. The criteria for progression to a Phase III trial were based on a hypothesised recruitment rate of at least 50%, collection of outcome measures in at least 80% of those recruited and an economic value-of-information analysis for cost-effectiveness. RESULTS Of the 75 patients approached about the trial, only 17 consented to be randomised [0.23, 95% confidence interval (CI) 0.13 to 0.32]. Among those who were randomised, the compliance rate was high (0.94, 95% CI 0.83 to 1.05). Retention rates were high at completion of treatment (0.94, 95% CI 0.83 to 1.05), at the 3-month follow-up (0.88, 95% CI 0.73 to 1.04) and at the 6-month follow-up (0.88, 95% CI 0.73 to 1.04). No serious adverse events were recorded in relation to the trial. The qualitative substudy identified several factors that had an impact on recruitment, many of which are amenable to change. These included organisational factors, changing cancer treatments and patient and clinician preferences. A key reason for the differential recruitment between sites was the degree to which the multidisciplinary team gave a consistent demonstration of equipoise at all patient interactions at which supplementary feeding was discussed. An exploratory economic model generated from published evidence and expert opinion suggests that, over the 6-month model time horizon, pre-treatment gastrostomy tube feeding is not a cost-effective option, although this should be interpreted with caution and we recommend that this should not form the basis for policy. The economic value-of-information analysis indicates that additional research to eliminate uncertainty around model parameters is highly likely to be cost-effective. STUDY LIMITATIONS The recruitment issues identified for this cohort may not be applicable to other populations undergoing CRT. There remains substantial uncertainty in the economic evaluation. CONCLUSIONS The trial did not meet one of the three criteria for progression, as the recruitment rate was lower than hypothesised. Once patients were recruited to the trial, compliance and retention in the trial were both high. The implementation of organisational and operational measures can increase the numbers recruited. The economic analysis suggests that further research in this area is likely to be cost-effective. FUTURE WORK The implementation of organisational and operational measures can increase recruitment. The appropriate research question and design of a future study needs to be identified. More work is needed to understand the experiences of nasogastric tube feeding in patients undergoing CRT. TRIAL REGISTRATION Current Controlled Trials ISRCTN48569216. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospital, London, UK.,Division of Clinical Studies, Institute of Cancer Research, London, UK.,Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Joanne Patterson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eoin Moloney
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dimitrios Tzelis
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilkinson
- Biostatistics Research group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy Franks
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Marie Hynes
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Ben Heaven
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - David Hamilton
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Rachael Donnelly
- Department of Radiation Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stewart Barclay
- Department of Restorative Dentistry, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah Stocken
- Biostatistics Research group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Patient adherence to swallowing exercises in head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2018; 25:175-181. [PMID: 28266944 DOI: 10.1097/moo.0000000000000356] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW A younger population and improved treatments for head and neck cancer (HNC) mean that more people are now living longer with the consequences of treatment, including long-term swallowing problems (dysphagia). Exercises aim to improve swallowing function, however highly variable adherence rates are currently reported, with no standard measure of adherence. RECENT FINDINGS Measuring adherence to swallowing exercises depends on the definition of 'adherence', the tools used to measure adherence, and the acceptable threshold that is used to constitute adherence or nonadherence. Particular barriers to swallowing exercise adherence include the burden of treatment, the commitment required to undertake a home-based exercise programme and the difficulty in motivating patients to exercise before swallowing problems have become apparent. Findings from the wider literature on general exercise interventions highlight the importance of external and patient-related factors on adherence, including patient beliefs, social support, self-regulation and goal setting. SUMMARY Key barriers and motivators to adherence are presented, which will have implications for the design of future swallowing exercise interventions. The relevance of behaviour change theory in facilitating adherence is highlighted, with ongoing studies used to exemplify how behaviour change components and analysis of patient beliefs can be incorporated into intervention development.
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Swallowing after transoral surgery for oropharyngeal cancer: comparison with primary chemoradiotherapy outcomes. Curr Opin Otolaryngol Head Neck Surg 2018; 25:101-107. [PMID: 28106661 DOI: 10.1097/moo.0000000000000340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Survival equipoise is recognized between the contemporary surgical and oncological approaches to oropharyngeal squamous cell carcinoma treatment. Primary transoral surgery (TOS) options have emerged that utilize either laser or robotic techniques. Our review presents an overview of the evidence available for swallowing outcomes following TOS approaches and compares these with outcomes following primary oncological management. RECENT FINDINGS Meta-analysis of swallow outcomes following TOS or (chemo)radiotherapy is not possible given the heterogeneity of the available data. There are suggestions of less swallowing impairment following primary TOS, but the favourable selection of patients to these case series must be considered. SUMMARY Minimizing swallowing impairment following oropharyngeal squamous cell carcinoma treatment, while ensuring oncological efficacy, should be a priority for head and neck healthcare providers. Primary TOS may offer an advantage to patients, but only through a team approach that considers how adjuvant oncological therapy could be tailored to individuals. High-quality clinical trials are in progress that will inform future practice.
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