1
|
Charters E, Ricketts V, Sharman AR, Clark J. Systematic review of adherence to swallow and trismus exercises during radiation therapy for head and neck cancer. Head Neck 2024. [PMID: 38895913 DOI: 10.1002/hed.27849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/06/2024] [Accepted: 06/08/2024] [Indexed: 06/21/2024] Open
Abstract
Understanding the barriers and facilitators for prophylactic swallowing and trismus exercises for patients undergoing radiation to the head and neck may help exercise adherence. The analysis reviews all published reports of exercise adherence with a critical appraisal following PRISMA guidelines. A total of 137 potential papers were identified; 20 studies met the inclusion criteria. The most commonly reported facilitators for swallowing and trismus exercises were regular clinician contact and online resources to reinforce instructions, set goals, and manage radiation toxicities. Social support and perceived benefit from exercises were also reported to be of help. The most common barriers to exercise were radiation toxicities, anxiety, feeling overwhelmed with information, and not understanding the reason for the exercises. Understanding facilitators and barriers to adherence is critical when designing exercise interventions for patients undergoing radiation for head and neck cancer.
Collapse
Affiliation(s)
- Emma Charters
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Virginia Ricketts
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Ashleigh R Sharman
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Govender R, Gilbody N, Simson G, Haag R, Robertson C, Stuart E. Post-Radiotherapy Dysphagia in Head and Neck Cancer: Current Management by Speech-Language Pathologists. Curr Treat Options Oncol 2024; 25:703-718. [PMID: 38691257 PMCID: PMC11222272 DOI: 10.1007/s11864-024-01198-0] [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] [Accepted: 03/08/2024] [Indexed: 05/03/2024]
Abstract
OPINION STATEMENT Dysphagia, difficulty in eating and drinking, remains the most common side effect of radiotherapy treatment for head and neck cancer (HNC) with devastating consequences for function and quality of life (QOL). Over the past decade, 5-year survival has improved due to multiple factors including treatment advances, reduction in smoking, introduction of the human papillomavirus (HPV) vaccine and more favourable prognosis of HPV-related cancers. Increased prevalence of HPV-positive disease, which tends to affect younger individuals, has led to an elevated number of people living for longer with the sequelae of cancer and its treatment. Symptoms are compounded by late effects of radiotherapy which may lead to worsening of dysphagia for some long-term survivors or new-onset dysphagia for others. Speech-language pathology (SLP) input remains core to the assessment and management of dysphagia following HNC treatment. In this article, we present current SLP management of dysphagia post-radiotherapy. We discuss conventional treatment approaches, the emergence of therapy adjuncts and current service delivery models. The impact of adherence on therapy outcomes is highlighted. Despite treatment advancements, patients continue to present with dysphagia which is resistant to existing intervention approaches. There is wide variation in treatment programmes, with a paucity of evidence to support optimal type, timing and intensity of treatment. We discuss the need for further research, including exploration of the impact of radiotherapy on the central nervous system (CNS), the link between sarcopenia and radiotherapy-induced dysphagia and the benefits of visual biofeedback in rehabilitation.
Collapse
Affiliation(s)
- Roganie Govender
- Head & Neck Academic Centre& UCL Division of Surgery & Interventional ScienceGround Floor Central, University College London Hospital, 250 Euston Road, London, NW1 2PQ, UK.
| | - Nicky Gilbody
- North Middlesex University Hospital NHS Trust, London, UK
| | | | | | - Ceri Robertson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Emma Stuart
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| |
Collapse
|
3
|
Manduchi B, Fitch MI, Ringash JG, Howell D, Hutcheson KA, Martino R. The Acceptability of Behavioural Swallowing Interventions for Head and Neck Cancer Patients During Radiotherapy: A Qualitative Study Exploring Experiences of Clinical Trial Speech-Language Pathologists. Dysphagia 2024; 39:412-423. [PMID: 37914886 DOI: 10.1007/s00455-023-10625-7] [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: 05/06/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023]
Abstract
The PRO-ACTIVE randomized clinical trial offers 3 swallowing therapies to Head and Neck Cancer (HNC) patients during radiotherapy (RT) namely: reactive, proactive low- ("EAT-RT" only) and high-intensity ("EAT-RT + exercises"). Understanding the experiences of the trial Speech-Language Pathologists (SLPs) will be useful to inform clinical implementation. This study assessed SLP opinions of acceptability and clinical feasibility of the 3 trial therapies. 8 SLPs from 3 Canadian PRO-ACTIVE trial sites participated in individual interviews. Using a qualitative approach, data collection and thematic analysis were guided by the Theoretical Framework of Acceptability. Member checking was conducted through a follow-up focus group with willing participants. Seven themes were derived: intervention coherence, burden, barriers/facilitators, self-efficacy, attitude, ethicality, and perceived effectiveness. SLPs felt all 3 therapies had potential benefit yet perceived more advantages of proactive therapies compared to reactive. Compared to exercises, SLPs particularly endorsed the EAT-RT component. A major barrier was keeping patients motivated, which was impacted by acute toxicity and sometimes conflicting instructions from the healthcare team. Strategies utilized by to overcome barriers included: scaling exercises and/or diet up/down according to the changing patient needs and communicating therapy goals with healthcare team. A model was derived describing the perceived acceptability of the swallowing therapies according to SLPs, based on the interconnection of main themes. Proactive therapies were perceived as more acceptable to trial SLPs, for facilitating patient engagement. The perceived acceptability of the swallowing therapies was related to seven interconnected aspects of providers' experience. These findings will inform the implementation and potential uptake of the PRO-ACTIVE swallowing therapies in clinical practice.
Collapse
Affiliation(s)
- Beatrice Manduchi
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.
- The Swallowing Lab, University of Toronto, Toronto, ON, Canada.
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jolie G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosemary Martino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- The Swallowing Lab, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| |
Collapse
|
4
|
Kok A, Passchier E, May AM, Jager-Wittenaar H, Veenhof C, de Bree R, Stuiver MM, Speksnijder CM. Expectations and Experiences of Participating in a Supervised and Home-Based Physical Exercise Intervention in Patients with Head and Neck Cancer during Chemoradiotherapy: A Qualitative Study. Curr Oncol 2024; 31:885-899. [PMID: 38392060 PMCID: PMC10887739 DOI: 10.3390/curroncol31020066] [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: 12/22/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: Chemoradiotherapy (CRT) for head and neck cancer (HNC) is associated with severe toxicity resulting in fatigue and weight loss, including loss of skeletal muscle mass. Exercise interventions might positively affect physical fitness and quality of life. Sufficient adherence and compliance rates are necessary for optimal effects. This study aimed to gain insight into expectations and experiences and factors influencing adherence, retention and compliance of HNC patients participating in exercise intervention during CRT. (2) Methods: Consecutive participants were invited for semi-structured interviews, conducted pre- and post-intervention. A deductive approach was used to identify themes and factors influencing adherence, retention and compliance. (3) Results: Thematic saturation was reached after interviewing 14 patients pre-intervention. Five themes were identified: planning and time management, treatment toxicity, motivation to exercise, exercise intervention and supervision by a physiotherapist. The intensity of the treatment schedule and treatment toxicity were important barriers. Facilitators mentioned were physical and emotional benefits, social support as well as the simplicity and home-based setting of the intervention. (4) Conclusions: A personalised approach, considering the individual facilitators and barriers of HNC patients, is important to increase adherence, retention and compliance to exercise intervention and to reap the optimal effects of the program.
Collapse
Affiliation(s)
- Annemieke Kok
- Department of Dietetics, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Ellen Passchier
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Center for Quality of Life and Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Anne M. May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands;
| | - Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, 9747 AS Groningen, The Netherlands
- Research Unit Experimental Anatomy, Department Physiotherapy and Human Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Cindy Veenhof
- Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands;
- Research Group Innovation of Human Movement Care, HU University of Applied Sciences, 3584 CS Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Martijn M. Stuiver
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Center for Quality of Life and Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Caroline M. Speksnijder
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| |
Collapse
|
5
|
Kariveda RR, Tran A, Velu PS, Jabbour N, Pisegna JM, Tracy LF. Impact of Patient Factors on Attendance at Remote Telehealth Swallow Therapy. Dysphagia 2024:10.1007/s00455-023-10654-2. [PMID: 38273158 DOI: 10.1007/s00455-023-10654-2] [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: 09/28/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024]
Abstract
In-person swallow therapy is a primary and effective treatment for dysphagia. However, remote telehealth is now a widely utilized component of healthcare delivery for therapeutic interventions. This study evaluates potential factors influencing attendance at telehealth swallow therapy. Retrospective review of 308 patients referred for telehealth swallow therapy from April 2020-November 2021 included patient referral diagnosis, diagnostic swallowing evaluations, and sociodemographic information including age, race, health insurance, interpreter use, and socioeconomic status. Univariable and multivariable analyses compared patient and appointment factors for those who attended telehealth swallow therapy with those who did not attend. Overall, 71.8% of patients attended at least one telehealth swallow therapy appointment while 28.2% did not attend any. The most common referral diagnoses were "Cancer" (19.2%) and "Dysphagia Unspecified" (19.2%). Patients diagnosed with "Cancer" and "Muscle Tension" were significantly less likely to attend telehealth swallow therapy compared to those with "Dysphagia Unspecified," "Globus," and "Gastroesophageal Reflux Disease/Laryngopharyngeal Reflux" after adjusting for covariates. Lower socioeconomic status (p = 0.023), no interpreter use (p < 0.001), and more diagnostic evaluations (p = 0.001) correlated with higher telehealth swallow therapy attendance. Race and sex did not correlate with attendance. Most patients referred to telehealth swallow therapy attended at least one appointment. Patients with dysphagia associated with cancer and muscle tension, those with higher socioeconomic status, interpreter use, and fewer diagnostic swallowing evaluations were less likely to attend telehealth swallow therapy. Future research should investigate and compare attendance and efficacy of telehealth swallow therapy with in-person therapy.
Collapse
Affiliation(s)
- Rohith R Kariveda
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Audrey Tran
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Preetha S Velu
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
| | - Nicolette Jabbour
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA
| | - Jessica M Pisegna
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA
| | - Lauren F Tracy
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 830 Harrison Avenue, Boston, MA, 02118, USA
| |
Collapse
|
6
|
Hulse K, Li LQ, Lowit A, Maguire R, Douglas C. Digital health in head and neck cancer: a systematic review. J Laryngol Otol 2023; 137:1312-1325. [PMID: 37078528 DOI: 10.1017/s0022215123000695] [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] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Digital health tools are increasingly being recognised as effective interventions in monitoring chronic health conditions. This systematic review addressed how digital health is currently utilised in patients with head and neck cancer as an adjunct to care. METHOD Studies of the development or evaluation of an eHealth, telemedicine or telemonitoring tool were eligible. A narrative synthesis was performed as per Preferred Reporting Items for Systematic Review and Meta-Analyses reporting guidelines. RESULTS Twenty-nine studies of digital health tools in head and neck cancer were identified. Nine were randomised, controlled trials but most had concern of bias. Fourteen (48 per cent) of the interventions used multiple modes of delivery. The primary digital tool functions are symptom tracking and self-care, prehabilitation and rehabilitation, psychological support, and education, including decision aids. Most tools aimed to support patients during active cancer treatment. CONCLUSION There are a small number of digital health tools for head and neck cancer patients; however, there is a lack of well-designed randomised, controlled trials to demonstrate effectiveness.
Collapse
Affiliation(s)
- Kate Hulse
- ENT Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Lucy Qian Li
- ENT Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Anja Lowit
- Speech and Language Therapy Department, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, UK
| | - Roma Maguire
- Digital Health and Care, University of Strathclyde, Glasgow, Scotland, UK
| | - Catriona Douglas
- ENT Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| |
Collapse
|
7
|
Manduchi B, Fitch MI, Ringash JG, Howell D, Hutcheson KA, Martino R. Exploring the Acceptability of Behavioral Swallowing Interventions for Head and Neck Cancer Patients During Radiotherapy: A Qualitative Study of Patients' Experience. Dysphagia 2023:10.1007/s00455-023-10640-8. [PMID: 37991659 DOI: 10.1007/s00455-023-10640-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/29/2023] [Indexed: 11/23/2023]
Abstract
The PRO-ACTIVE randomized clinical trial offers 3 swallowing therapies to Head and Neck Cancer (HNC) patients during radiotherapy namely: reactive, proactive low- ("EAT-RT" only), and high-intensity ("EAT-RT + exercises"). Understanding the perceived acceptability of these interventions is important to inform eventual implementation into clinical practice. This study explored patients' perspectives using qualitative methodology. At 2 Canadian PRO-ACTIVE trial sites, 24 trial participants were recruited for individual semi-structured interviews, representing each of the 3 trial arms. Data collection and thematic analysis were guided by the Theoretical Framework of Acceptability (TFA). Member checking was conducted through follow-up focus groups. Seven themes were derived reflecting the TFA constructs. Overall, regardless of trial arm, patients reported a positive experience with therapy. Patients identified benefits of EAT-RT therapy, reporting that it provided meaningful feedback on diet progress and supported goal setting for oral intake. Patients who received proactive therapies valued the opportunity to set expectations early, build mealtime routine iteratively over time, and have an extended engagement with the SLP. Regardless of trial arm, patients agreed proactive therapy aligned with what they think is best and that therapy intensity should accommodate individual needs. This study identified the value to HNC patients of receiving swallowing interventions during RT and setting realistic expectations around swallowing. Compared to reactive care, proactive therapies were perceived helpful in consolidating habits early, establishing realistic expectations around swallowing and building an extended rapport with the SLP. These findings will inform the implementation of proactive versus reactive swallowing therapies in clinical practice.
Collapse
Affiliation(s)
- Beatrice Manduchi
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.
- The Swallowing Lab, University of Toronto, Toronto, ON, Canada.
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jolie G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology- Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosemary Martino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- The Swallowing Lab, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology- Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| |
Collapse
|
8
|
Vitale K, Powell WR, Krekeler BN, Yee J, Rogus-Pulia N. Stratifying Risk of Nonadherence in Lingual Strengthening Dysphagia Rehabilitation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2111-2127. [PMID: 37566883 PMCID: PMC10569446 DOI: 10.1044/2023_ajslp-22-00338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/14/2023] [Accepted: 04/27/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE Exercise-based treatments may improve swallowing safety and efficiency; yet, it is not clearly understood which factors predict nonadherence to recommended treatment protocols. The aim of this study was to construct an algorithm for stratifying risk of nonadherence to a lingual strengthening dysphagia treatment program. METHOD Using recursive partitioning, we created a classification tree built from a pool of sociodemographic, clinical, and functional status indicators to identify risk groups for nonadherence to an intensive lingual strengthening treatment program. Nonadherence, or noncompletion, was defined as not completing two or more follow-up sessions or a final session within 84 days. RESULTS The study cohort consisted of 243 Veterans enrolled in the Intensive Dysphagia Treatment program across six sites from January 2012 to August 2019. The overall rate of nonadherence in this cohort was 38%. The classification tree demonstrated good discriminate validity (C-statistic = 0.74) and contained eight groups from five variables: primary diagnosis, marital status, Penetration-Aspiration Scale (PAS) severity score, race/ethnicity, and age. Nonadherence risk was categorized as high (range: 69%-77%), intermediate (27%-33%), and low risk (≤ 13%-22%). CONCLUSIONS This study identified distinct risk groups for nonadherence to lingual strengthening dysphagia rehabilitation. Additional research is necessary to understand how these factors may drive nonadherence. With external validation and refinement through prospective studies, a clinically relevant risk stratification tool can be developed to identify patients who may be at high risk for nonadherence and provide targeted patient support to mitigate risk and provide for unmet needs.
Collapse
Affiliation(s)
- Kailey Vitale
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Otolaryngology, Boston Medical Center, MA
- Department of Otolaryngology-Head and Neck Surgery, Boston University Chobanian & Avedisian School of Medicine, MA
| | - W. Ryan Powell
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison
| | - Brittany N. Krekeler
- Department of Surgery-Otolaryngology, University of Wisconsin–Madison
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, OH
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, OH
| | - Joanne Yee
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Nicole Rogus-Pulia
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Surgery-Otolaryngology, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
| |
Collapse
|
9
|
Adherence to swallowing recommendations during (chemo)radiotherapy in head and neck cancer survivors: a scoping review. Curr Opin Otolaryngol Head Neck Surg 2023; 31:171-179. [PMID: 36912234 DOI: 10.1097/moo.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW There is a paucity of knowledge regarding patient adherence to dysphagia recommendations. It is recognized that unique barriers and facilitators contribute to poor treatment adherence in head and neck cancer (HNC) survivors. This review aims to identify the key themes and knowledge gaps regarding adherence to swallowing recommendations in HNC survivors during (chemo)radiotherapy (C)RT. RECENT FINDINGS Seven studies were identified. Six facilitators to adherence were extracted, namely pain relief, behavioural intervention, attendance at multidisciplinary clinic, individualised swallowing therapy, absence of prophylactic percutaneous endoscopic gastronomy (PEG) and positive social control from a spouse. Barriers to adherence included pain, depression and presence of prophylactic PEG. Adherence to swallowing recommendations positively impacted swallowing outcomes in one study. SUMMARY Little is known about adherence to swallowing recommendations during (C)RT in HNC survivors. Capturing adherence is challenging. Several knowledge gaps were identified. Further research is needed to better understand the barriers and facilitators from the survivors' perspective. This will inform development of best practice regarding how swallowing recommendations are provided to promote adherence and improve outcomes.
Collapse
|
10
|
Patterson JM, Lawton M. Dysphagia Advances in Head and Neck Cancer. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023; 11:1-8. [PMID: 36816911 PMCID: PMC9930077 DOI: 10.1007/s40136-023-00445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 02/19/2023]
Abstract
Purpose of Review This review summarises the current literature regarding head and neck cancer-associated dysphagia. Up-to-date evidence for dysphagia outcome measurement for this population is provided, in addition to recent innovations that aim to prevent, reduce or remediate the common and debilitating side effects of treatment. Recent Findings Both patient-reported outcomes and clinical measures are necessary to capture the multi-dimensional nature of swallowing. A minimally important difference in scores has been calculated for some of these measures, to aid interpretation and powering of clinical trials. The number of dysphagia-related trials has increased, predominantly investigating optimal treatment for oropharyngeal HPV-positive disease, and speech and language pathology interventions using an impairment-based approach. Summary Although substantial progress has been made, further work is necessary to establish a consensus over outcome measures. Modifying treatments may improve outcomes. Several trials are underway to establish the effectiveness of speech and language pathology dysphagia interventions.
Collapse
Affiliation(s)
- J. M. Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre, University of Liverpool, 1.17 Thompson Yates Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB USA
| | - M. Lawton
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre, University of Liverpool, 1.17 Thompson Yates Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB USA
| |
Collapse
|
11
|
Kamarunas E, Mulheren R, Wong SM, Griffin L, Ludlow CL. The Feasibility of Home-Based Treatment Using Vibratory Stimulation in Chronic Severe Dysphagia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2539-2556. [PMID: 36346969 DOI: 10.1044/2022_ajslp-22-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Previously, externally placed vibratory laryngeal stimulation increased rates of swallowing in persons with and without dysphagia. This study examined the feasibility of using a vibratory device on the skin over the thyroid cartilage for home-based swallowing rehabilitation in long-standing dysphagia. METHOD Only participants with long-standing dysphagia (> 6 months) following cerebrovascular accident or head/neck cancer who had not previously benefited from dysphagia therapy participated. The device had two modes used daily for 90 days. In automatic mode, participants wore the device when awake, which vibrated for 4-8 s every 5 min to trigger a volitional swallow. In manual mode, participants practiced by activating vibration while swallowing rapidly. Study-related adverse events, such as pneumonia, and device-recorded adherence were tracked. Swallowing function on a modified barium swallow study was assessed at baseline and after 3 months of device use. Outcome measures included the Dysphagia Outcome and Severity Scale (DOSS), Penetration-Aspiration Scale (PAS), and swallowing timing measures. Participants' perceptions of the vibratory device and training were obtained. RESULTS The intent to treat analysis showed seven of 11 participants completed the study, all with severe chronic dysphagia. Of those seven participants completing the study, two developed respiratory complications (possibly due to pneumonia) that cleared after antibiotic intervention. For prescribed practice trials, adherence was 80% or greater in four of seven participants (57%) whereas prescribed automatic stimulations were met in only two of seven participants (29%). Three participants (43%) had a modest benefit on DOSS. The time to vestibule closure after the bolus passed the ramus was reduced in five participants (71%) on the modified barium swallow study. CONCLUSION Overall, the results have indicated that intensive home-based practice with stimulation may provide limited functional benefits in severe chronic dysphagia. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21498591.
Collapse
Affiliation(s)
- Erin Kamarunas
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA
| | - Rachel Mulheren
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Seng Mun Wong
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Speech and Language Therapy Program, Health and Social Sciences, Singapore Institute of Technology
- Speech Therapy Department, Singapore General Hospital
| | - Lindsay Griffin
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Department of Communication Sciences and Disorders, School of Communication, Emerson College, Boston, MA
| | - Christy L Ludlow
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA
| |
Collapse
|
12
|
Sharma A, Sharma A, Patni S, Gupta A, Ledwani N, Saini S, Patni N, Bapna A, Somani N, Sharma M, Verma S, Sharma GK, Nunia V. A single centre study from western India to evaluate the frequency of developing second and subsequent multiple primary malignancies among cancer survivors. SURGICAL AND EXPERIMENTAL PATHOLOGY 2022. [DOI: 10.1186/s42047-022-00122-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Aim
This study was designed to evaluate the frequency of developing second and subsequent primary cancers among cancer survivors.
Methods
We have retrospectively analyzed 121 multiple primary cancer patients treated at Bhagwan Mahavir Cancer Hospital and Research Centre, Jaipur, Rajasthan, India from the last 20 years. The survival analysis was performed by Kaplan-Meier methodology.
Results
The prevalence of multiple primary malignant tumors (MPMTs) was 1.51% (121/8000), with a male to female ratio of 1:1.42. In males most of the reported MPMTs were synchronous and most common first primary cancer cases were head & neck and lung whereas, in females most of the reported MPMTs were metachronous and most common first primary cancer cases were breast and gynaecological malignancies. Family history was reported in 15 cases. Maximum 33.05% patients received combined treatment of chemotherapy, radiotherapy and 91.73% (111/121) of patients with MPMTs were effectively followed up, 35 (28.92%) patients died and 5-year survival rate of the remaining 86 patients was 68.46%.
Conclusions
In the present observational study the most frequent sites of MPMTs in men were head & neck and lung whereas, in women breast and gynaecological sites were common. Therefore, careful monitoring and follow up are required for these patients.
Collapse
|
13
|
Baudelet M, Duprez F, Van den Steen L, Nuyts S, Nevens D, Goeleven A, Vandenbruaene C, Massonet H, Vergauwen A, Bollen H, Deschuymer S, Wouters K, Peeters M, Van Laer C, Mariën S, Van den Brekel M, van der Molen L, Vauterin T, van Dinther J, Verstraete H, Hutsebaut I, Meersschout S, Vanderveken O, De Bodt M, Van Nuffelen G. Increasing Adherence to Prophylactic Swallowing Exercises During Head and Neck Radiotherapy: The Multicenter, Randomized Controlled PRESTO-Trial. Dysphagia 2022; 38:886-895. [PMID: 36121560 PMCID: PMC9484351 DOI: 10.1007/s00455-022-10513-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/15/2022] [Indexed: 12/02/2022]
Abstract
Background Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients’ adherence. Methods A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group; n = 49), app-supported (app group; n = 49) or therapist-supported (therapist group; n = 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction. Results Adherence and evolution of adherence over time was significantly different between the three groups (p < .001). Adherence rates decreased in all three groups during the 4 training weeks (p < .001). During all 4 weeks, the therapist group achieved the highest adherence rates, whilst the app group showed the lowest adherence rates. Conclusions PSE adherence decreased during the first 4 radiotherapy weeks regardless of group, but with a significant difference between groups. The therapist group achieved the highest adherence rates with a rather limited decline, therefore, increasing the face-to-face contact with a speech-language therapist can overcome the well-known problem of low adherence to PSE in this population. Trial Registration 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.
Collapse
Affiliation(s)
- Margot Baudelet
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium. .,Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Fréderic Duprez
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Antwerp University Hospital, Antwerp, Belgium
| | - Sandra Nuyts
- University Hospital Leuven, Louvain, Belgium.,KU Leuven, Louvain, Belgium
| | - Daan Nevens
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium.,Iridium Network, Antwerp, Belgium
| | - Ann Goeleven
- University Hospital Leuven, Louvain, Belgium.,KU Leuven, Louvain, Belgium
| | | | - Hanne Massonet
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,KU Leuven, Louvain, Belgium
| | | | - Heleen Bollen
- University Hospital Leuven, Louvain, Belgium.,KU Leuven, Louvain, Belgium
| | - Sarah Deschuymer
- Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,KU Leuven, Louvain, Belgium
| | - Kristien Wouters
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Marc Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Carl Van Laer
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Steven Mariën
- Antwerp University Hospital, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Michiel Van den Brekel
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Joost van Dinther
- Department of ENT-HNS, European Institute for ORL-HNS, Sint-Augustinus Hospital, GZA, Antwerp, Belgium
| | - Hilde Verstraete
- Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium.,Iridium Network, Antwerp, Belgium
| | | | | | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Antwerp University Hospital, Antwerp, Belgium.,Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Antwerp University Hospital, Antwerp, Belgium
| | | |
Collapse
|
14
|
Starmer HM, Klein D, Montgomery A, Goldsmith T, McCarroll L, Richmon J, Christopher Holsinger F, Beadle B, Jain P. Head and Neck Virtual Coach: A Randomized Control Trial of Mobile Health as an Adjunct to Swallowing Therapy During Head and Neck Radiation. Dysphagia 2022; 38:847-855. [PMID: 35960394 DOI: 10.1007/s00455-022-10506-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
Dysphagia is a common consequence of head and neck radiation and may be mitigated by performance of swallowing exercises during radiation treatment. Given historically poor adherence to such exercise protocols, we created a mobile health application, HNC Virtual Coach as an adjunct to standard clinical care. This randomized control trial investigated the impact of HNC Virtual Coach on adherence as well as swallowing outcomes by comparing those using the mobile app to those receiving only standard clinical care and paper logs. Both treatment groups were provided with the same exercise protocol as well as the same baseline educational information. Outcome measures included adherence rates, physiologic measures obtained during a Modified Barium Swallow Study (PAS, MBS-ImP, DIGEST), patient-reported outcomes (MDADI), diet levels (FOIS, PSS-HN), and quality of information received (INFO-25). Patients using the HNC Virtual Coach tended to have better adherence to treatment recommendations during radiation therapy. Increased adherence was associated with better patient-reported quality of life, but not physiologic function 2-3 months following completion of radiation. Results suggest that a mobile health application may provide benefit for some patients undergoing head and neck radiation.
Collapse
Affiliation(s)
- Heather M Starmer
- Stanford University, 900 Blake Wilbur Drive Suite 3025, Palo Alto, CA, 94305, USA.
| | | | | | | | | | | | | | - Beth Beadle
- Stanford University, 900 Blake Wilbur Drive Suite 3025, Palo Alto, CA, 94305, USA
| | | |
Collapse
|
15
|
Carnaby GD, Chhabria K. Preliminary development and validation of a measure of fear of swallowing and swallowing-related movement injury in head and neck cancer: Swallowing Kinesiophobia Scale. Head Neck 2020; 43:967-976. [PMID: 33269550 DOI: 10.1002/hed.26573] [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: 04/13/2020] [Revised: 10/24/2020] [Accepted: 11/20/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fear is an under-recognized issue in intervention adherence in head and neck cancer (HNC). We developed and validated a patient reported outcome for swallowing fear in HNC patients. METHODS Items were adapted from the Tampa Scale for Kinesiophobia to swallowing function. A beta version was completed by 51 HNC patients undergoing chemo +/- radiotherapy at baseline and post-treatment. Psychometric and factor structure analyses were applied. RESULTS Swallowing Kinesiophobia Scale (SWKS) demonstrated strong face and content validity, internal consistency, and test-retest reliability. Factor analysis revealed three-factors: somatic factor, swallow avoidance, and fear of harm. Factors correlated positively with depression score, worry scale, and anxiety and pain scales. Score differences between patient subgroups (dysphagic vs nondysphagic) confirmed discriminative validity. CONCLUSION The SWKS is a psychometrically valid tool to identify patients with fear of swallowing and swallowing-related movement. It can help identify patients early in treatment who may need additional support.
Collapse
Affiliation(s)
- Giselle D Carnaby
- School of Communication Sciences & Disorders, University of Central Florida, Orlando, Florida, USA
| | - Karishma Chhabria
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, Texas, USA
| |
Collapse
|
16
|
Effects of Tongue-Strengthening Self-Exercises in Healthy Older Adults: A Non-Randomized Controlled Trial. Dysphagia 2020; 36:925-935. [PMID: 33215265 PMCID: PMC8464581 DOI: 10.1007/s00455-020-10216-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
Tongue-strengthening exercises (TSE) using a device have been proposed as an intervention for improving tongue strength and endurance. However, devices for TSE have been expensive and difficult to manipulate and are not commonly used in home or clinical settings. This study therefore aimed to investigate whether tongue-strengthening self-exercises (TSsE) using a tongue-strengthening self-exercise tool at home can improve tongue strength in healthy older adults. This study included 27 participants (exercise group, η = 16, 7 men, 9 women, median age 84.5 years; control group, n = 11, 2 men, 9 women, median age 79.0 years). Exercises in the exercise group consisted of pushing the anterior tongue against the hard palate 30 times, 3 times a day, 5 days a week, for 8 weeks using a tongue-strengthening self-exercise tool. This tool is available in five levels of hardness. The most suitable hardness of the tool for each participant was calculated based on 60% of maximum tongue pressure (MTP) during the first 2 weeks of the training period and 80% of MTP for the remainder of the training period, as assessed using a tongue pressure-measuring device. The exercise group showed a significant improvement of 4.1 kPa in MTP (an 11.53% increase) and 4.53 s in endurance of tongue pressure (ETP) (a 99.86% increase). Furthermore, adherence in the exercise group was 99.2%. In conclusion, performing TSsE for 8 weeks was effective for increasing MTP and ETP in healthy older adults. This indicates that TSsE may be useful in older individuals at home to prevent age-related tongue muscle weakness.
Collapse
|
17
|
Swallowing exercises for head and neck cancer patients: A systematic review and meta-analysis of randomized control trials. Int J Nurs Stud 2020; 114:103827. [PMID: 33352439 DOI: 10.1016/j.ijnurstu.2020.103827] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 07/02/2020] [Accepted: 11/04/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Extensive surgery and chemo/radiation therapy (C/RT) to manage head and neck cancer (HNC) patients affects their ability to swallow food and liquids, risk of aspiration and greatly influences their quality of life (QOL). OBJECTIVES Ascertain the effectiveness of swallowing exercises on improving swallowing function, performance status, mouth opening, risk of aspiration/penetration and QOL in HNC patients. DESIGN Systematic review and meta-analysis of randomized controlled trials DATA SOURCES: PubMed, Ovid-Medline, Embase, Cochrane Library, CINAHL and Web of Science and included all available RCTs. REVIEW METHODS We followed the PRISMA guidelines and standard methods for conducting a systematic review and meta-analysis. Comprehensive Meta-analysis 3.0 using the random effects model was used for data analysis. RESULTS In total, 19 RCTs with 1100 participants were identified and included in the current review. Swallowing exercises had significant small effect on swallowing function 0.33 (95%CI = 0.00-0.65) and moderate effect on mouth opening 0.60 (95%CI = 0.21-0.99) immediately after intervention and small effect at 6-month follow-up 0.46 (95%CI = 0.11-0.81). However, non-significant effects were observed on risk of aspiration/penetration, performance status and all domains of QOL. CONCLUSION Swallowing exercises demonstrated effectiveness in improving swallowing function and mouth opening in HNC patients undergoing multimodal treatment. This is the first comprehensive systematic review and meta-analysis of RCTs to assess the effect of swallowing exercises in HNC patients undergoing multimodal treatment. Nurses can play an important role in assisting the delivery of oropharyngeal swallowing exercises including jaw exercises, tongue exercises and swallowing maneuvers with assistance and guidance from speech pathologists to help improve HNC complications and QOL for HNC survivors.
Collapse
|
18
|
Govender R, Smith CH, Barratt H, Gardner B, Taylor SA. SIP SMART: a parallel group randomised feasibility trial of a tailored pre-treatment swallowing intervention package compared with usual care for patients with head and neck cancer. BMC Cancer 2020; 20:360. [PMID: 32349693 PMCID: PMC7191731 DOI: 10.1186/s12885-020-06877-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Dysphagia or difficulty in swallowing affects quality of life for most patients with head and neck cancer. SIP SMART - [Swallowing Intervention Package: Self-Monitoring, Assessment, Rehabilitation Training] aims to improve post-treatment swallowing outcomes through a targeted and tailored pre-treatment intervention. This feasibility study assessed 1) recruitment and retention, 2) patient acceptability of randomisation and participation, 3) patient adherence, and 4) sought to identify a suitable primary outcome for a definitive trial, including sample size estimation. METHODS This two-arm parallel group non-blinded randomised feasibility trial took place within a head and neck centre at a teaching hospital in London, UK. Patients newly diagnosed with stage III/IV head and neck cancer were recruited and underwent 6-month follow-up. Patients were randomised to SIP-SMART or usual care via an online web-based system. SIP SMART comprised two 45-min consultations including a baseline clinical and instrumental swallowing assessment, relevant educational information, targeted swallowing exercises, and specific behaviour change strategies to increase exercise adherence. Usual care comprised a single session including a baseline clinical assessment and generic information about the likely impact of treatment on swallowing. RESULTS A total of 106 patients were identified at pre-screening, 70 were assessed for eligibility. Twenty-six patients did not meet eligibility criteria [0.37, 95% CI 0.27 to 0.49]. Five of 44 [0.11, 95% CI 0.05 to 0.24] eligible patients were not approached by researchers during clinic. Seven [0.18, 95% CI 0.08 to 0.33] of the 39 approached declined participation. Target recruitment (32 consented patients) was achieved within the timeframe. At 6-months 29/32 [0.91, 95% CI 0.76 to 0.97] patients remained in the trial. Acceptability of randomisation and participation in the intervention was favourable, and adherence to the exercises exceeded the pre-defined 35% minimum criterion. The MD Anderson Dysphagia Inventory swallow related quality of life measure was selected as the most suitable primary outcome for sample size estimation. No adverse effects arose from the intervention, or study participation. CONCLUSIONS A definitive trial of the SIP SMART intervention compared to usual care is feasible and can be undertaken with patients with head and neck cancer treated within the NHS. TRIAL REGISTRATION ISRCTN40215425, registered retrospectively.
Collapse
Affiliation(s)
- Roganie Govender
- Research Department of Behavioural Science & Health, University College London and Head & Neck Cancer Centre, University College London Hospital, 250 Euston Road, Ground floor Central, London, NW1 2PQ UK
| | - Christina H. Smith
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Helen Barratt
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Benjamin Gardner
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Kings College London, London, UK
| | - Stuart A. Taylor
- Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
19
|
Baudelet M, Van den Steen L, Duprez F, De Bodt M, Deschuymer S, Goeleven A, Hutsebaut I, Mariën S, Meersschout S, Nevens D, Nuyts S, Peeters M, Specenier P, Van den Brekel M, van der Molen L, Vandenbruaene C, Vanderveken O, Van Dinther J, Van Laer C, Vauterin T, Verstraete H, Van Nuffelen G. Study protocol for a randomized controlled trial: prophylactic swallowing exercises in head-and-neck cancer patients treated with (chemo)radiotherapy (PRESTO trial). Trials 2020; 21:237. [PMID: 32122397 PMCID: PMC7053144 DOI: 10.1186/s13063-020-4171-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/13/2020] [Indexed: 01/10/2023] Open
Abstract
Background Dysphagia is a common and serious complication after (chemo)radiotherapy (CRT) for head-and-neck cancer (HNC) patients. Prophylactic swallowing exercises (PSE) can have a significantly positive effect on post-treatment swallowing function. However, low adherence rates are a key issue in undermining this positive effect. This current randomized trial will investigate the effect of adherence-improving measures on patients’ swallowing function, adherence and quality of life (QOL). Methods This ongoing trial will explore the difference in adherence and swallowing-related outcome variables during and after PSE in HNC patients performing the same therapy schedule, receiving different delivery methods. One hundred and fifty patients treated in various hospitals will be divided into three groups. Group 1 performs PSE at home, group 2 practices at home with continuous counseling through an app and group 3 receives face-to-face therapy by a speech and language pathologist. The exercises consist of tongue-strengthening exercises and chin-tuck against resistance with effortful swallow. The Iowa Oral Performance Instrument and the Swallowing Exercise Aid are used for practicing. Patients are evaluated before, during and after treatment by means of strength measurements, swallowing and QOL questionnaires. Discussion Since low adherence rates undermine the positive impact of PSE on post-treatment swallowing function, there is need to develop an efficient PSE protocol maximizing adherence rates. Trial registration ISRCTN, ID: ISRCTN98243550. Registered retrospectively on 21 December 2018.
Collapse
Affiliation(s)
- Margot Baudelet
- Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
| | - Sarah Deschuymer
- Department of Radiation Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Ann Goeleven
- Department of ENT, University Hospitals Leuven, Swallowing Clinic, Leuven, Belgium.,Department of Head and Neck Surgery, University Hospitals Leuven, Swallowing Clinic, Leuven, Belgium
| | - Isabel Hutsebaut
- Department of Radiation Oncology, AZ Sint-Jan General Hospital, Bruges, Belgium
| | - Steven Mariën
- Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Sabine Meersschout
- Department of Radiation Oncology, AZ Sint-Jan General Hospital, Bruges, Belgium
| | - Daan Nevens
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Radiation Oncology, Iridium Kanker Netwerk, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Sandra Nuyts
- Department of Radiation Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Marc Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Pol Specenier
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Michiel Van den Brekel
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Faculty of Humanities, University of Amsterdam, Spui 21, 1012 WX, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Caroline Vandenbruaene
- Department of Speech-Language Pathology and Audiology, Sint-Jan General Hospital, Bruges, Belgium
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Joost Van Dinther
- Department of Otorhinolaryngology, Sint-Augustinus Hospital, Antwerp, Belgium
| | - Carl Van Laer
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Tom Vauterin
- Department of Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan General Hospital, Bruges, Belgium
| | - Hilde Verstraete
- Department of Radiation Oncology, Iridium Kanker Netwerk, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
| | | |
Collapse
|
20
|
Jansen F, Eerenstein SEJ, Cnossen IC, Lissenberg-Witte BI, de Bree R, Doornaert P, Halmos GB, Hardillo JAU, van Hinte G, Honings J, van Uden-Kraan CF, Leemans CR, Verdonck-de Leeuw IM. Effectiveness of a guided self-help exercise program tailored to patients treated with total laryngectomy: Results of a multi-center randomized controlled trial. Oral Oncol 2020; 103:104586. [PMID: 32045734 DOI: 10.1016/j.oraloncology.2020.104586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a guided self-help exercise program on swallowing, speech, and shoulder problems in patients treated with total laryngectomy (TL). MATERIALS AND METHODS This randomized controlled trial included patients treated with TL in the last 5 years. Patients were randomized into the intervention group (self-help exercise program with flexibility, range-of-motion and lymphedema exercises and self-care education program) or control group (self-care education program). Both groups completed measurements before and 3 and 6-months after randomization. The primary outcome was swallowing problems (SWAL-QOL). Secondary outcomes were speech problems (SHI), shoulder problems (SDQ), self-management (patient activation: PAM) and health-related quality of life (HRQOL: EORTC QLQ-C30/H&N35). Adherence was defined as moderate-high in case a patient exercised >1 per day. Linear mixed model analyses were conducted to investigate the effectiveness of the intervention and to investigate whether neck dissection, treatment indication (primary/salvage TL), time since treatment, severity of problems, and preferred format (online/booklet) moderated the effectiveness. RESULTS Moderate-high adherence to the exercise program was 59%. The intervention group (n = 46) reported less swallowing and communication problems over time compared to the control group (n = 46) (p-value = 0.013 and 0.004). No difference was found on speech, shoulder problems, patient activation and HRQOL. Time since treatment moderated the effectiveness on speech problems (p-value = 0.025): patients within 6 months after surgery benefitted most from the intervention. Being treated with a neck dissection, treatment indication, severity of problems and format did not moderate the effectiveness. CONCLUSION The guided self-help exercise program improves swallowing and communication. TRIAL REGISTRATION NTR5255.
Collapse
Affiliation(s)
- Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit, Amsterdam Public Health, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
| | - Simone E J Eerenstein
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Ingrid C Cnossen
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Cancer Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Patricia Doornaert
- Department of Radiation Oncology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - György B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - José A U Hardillo
- Department of Otorhinolaryngology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Gerben van Hinte
- Department of Rehabilitation, Radboud University Medical Center Nijmegen, Netherlands, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Cornelia F van Uden-Kraan
- Department of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit, Amsterdam Public Health, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit, Amsterdam Public Health, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| |
Collapse
|
21
|
Survival analysis of head and neck cancer: Results from a hospital based cancer registry in southern Karnataka. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
|
22
|
Photobiomodulation Therapy in the Treatment of Chronic Dysphagia Post Hormonal Therapy in a Breast Cancer Patient. Dent J (Basel) 2019; 7:dj7020053. [PMID: 31086017 PMCID: PMC6630633 DOI: 10.3390/dj7020053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 12/20/2022] Open
Abstract
Among the few supportive care measures available for the management of dysphagia, Photobiomodulation (PBM) therapy, defined as the therapeutic use of light, has shown significant promise. In this case report, effective management of chronic dysphagia post hormonal therapy in a breast cancer patient was made. Experts in the supportive care in cancer and PBM proposed and requested further investigations of the protocol used in this case report in the management of dysphagia. In this case report, the protocol of PBM was proposed by experts in supportive care in cancer. Functional outcome swallowing scale for staging oropharyngeal dysphagia was used to assess the effectiveness of the treatment in pre-operative, per and post-operative stage. This case reports that PBM is effective in the management of dysphagia, a side effect of hormonal therapy in a cancer patient.
Collapse
|
23
|
Cowie J, Boa S, King E, Wells M, Cairns D. Electronic Swallowing Intervention Package to Support Swallowing Function in Patients With Head and Neck Cancer: Development and Feasibility Study. JMIR Form Res 2018; 2:e15. [PMID: 30320300 PMCID: PMC6181202 DOI: 10.2196/formative.9703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Many patients undergoing treatment for head and neck cancer (HNC) experience significant swallowing difficulties, and there is some evidence that swallowing exercises may improve outcomes, including quality of life. This feasibility study developed an evidence-based, practical Swallowing Intervention Package (SiP) for patients undergoing chemoradiotherapy (CRT) for HNC. As part of the study, an electronic version of SiP (e-SiP) was concurrently developed to support patients to self-manage during treatment. This paper reports on the e-SiP component of this work. Objective The objective of our study was to develop and conduct a preliminary evaluation of an electronic support system (e-SiP) for patients undergoing CRT for HNC. Methods The study was conducted using a recognized mHealth development and evaluation framework and involved health professionals and patients who were undergoing CRT for HNC. The scoping stage of e-SiP development investigated the potential usefulness of the app, exploring how e-SiP would look and feel and what content would be appropriate to provide. Patient and carer focus groups and a health professionals’ consensus day were used as means of data gathering around potential e-SiP content. A repeat focus group looked at an outline version of e-SiP and informed the next stage of its development with regard to refining the requirements for the tool. This was followed by further development and a testing stage of e-SiP that involved the coding of a prototype, which was then evaluated using a series of steering group meetings, semistructured interviews with both patients and health care professionals, and analysis of e-SiP log data. Results Feedback from focus groups and health professional interviews was very positive, and it was felt e-SiP use would support and encourage patients in conducting their swallowing exercises. However, of the 10 patients who were offered e-SiP, only 2 opted to use it. For these patients, the aspects of the e-SiP app were considered useful, in particular, the ease of keeping a diary of exercises performed. Interviews with users and nonusers suggested significant barriers to its use. Most significantly, the lack of flexibility of the platform on which e-SiP could be accessed appeared a dominant factor in deterring e-SiP use. Conclusions The results suggest that further research needs to be conducted around the implementation of e-SiP. This involves evaluating how e-SiP can be better integrated into usual care and through patient training and staff engagement, can be perceived as a beneficial tool to help support patients in conducting swallowing exercises.
Collapse
Affiliation(s)
- Julie Cowie
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Sally Boa
- Strathcarron Hospice, Denny, United Kingdom
| | - Emma King
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Mary Wells
- Nursing, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - David Cairns
- Department of Computing Science and Maths, University of Stirling, Stirling, United Kingdom
| |
Collapse
|
24
|
Carmignani I, Locatello LG, Desideri I, Bonomo P, Olmetto E, Livi L, Le Saec O, Coscarelli S, Mannelli G. Analysis of dysphagia in advanced-stage head-and-neck cancer patients: impact on quality of life and development of a preventive swallowing treatment. Eur Arch Otorhinolaryngol 2018; 275:2159-2167. [PMID: 29978259 DOI: 10.1007/s00405-018-5054-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/02/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Swallowing and voice dysfunctions are common side effects following head-and-neck squamous-cell carcinoma (HNSCC) treatment. Our aim was to analyze the relationships between quality of life, swallowing, and phonatory problems in patients with an advanced-stage HNSCC and to prospectively evaluate the effects of a prophylactic swallowing program. METHODS First, we retrospectively studied 60 advanced HNSCC patients treated with exclusive or adjuvant radiotherapy/chemoradiotherapy (RT/CRT). Subjects were classified according to general and clinical-therapeutic features. Outcome measures included EORTC QLQ-C30, EORTC QLQ-H&N35, Dysphagia Handicap Index (DHI), M.D.Anderson Dysphagia Inventory (MDADI), and Voice Handicap Index (VHI). Then, we conducted a prospective evaluation of a prophylactic swallowing counselling in 12 consecutive advanced-stage HNSCC patients by a two-arm case-control analysis. These patients were treated with exclusive or adjuvant RT/CRT. RESULTS 71% of the retrospective population studied reported swallowing dysfunction as a major side effect. No differences were detected in the severity of dysphagia or dysphonia according to type of treatment or staging of the primary tumour, while hypopharyngeal and laryngeal cancer patients showed significantly better swallowing ability and better QoL compared to oral cavity and oropharyngeal localisation (p < 0.05). In addition, a relevant correlation between swallowing and voice problems emerged (p < 0.05). In the prospective part, while no statistical correlation was evident before the start of RT/CRT in the experimental group compared to the control one, the former showed better performances at MDADI (p = 0.006) and DHI (p = 0.002) test 3 months after its end. CONCLUSION Dysphagia is both an acute-and-long-term side effect which greatly affects QoL of HNSCC patients undergoing multimodality treatment. Our data show that a prophylactic swallowing program could actually produce a beneficial effect on patients' outcomes. LEVEL OF EVIDENCE 1b and 2b.
Collapse
Affiliation(s)
- Ilaria Carmignani
- Otorhinolaryngology-Head and Neck Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Via Largo Palagi 1, 50134, Florence, Italy
| | - Luca Giovanni Locatello
- Otorhinolaryngology-Head and Neck Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Via Largo Palagi 1, 50134, Florence, Italy
| | - Isacco Desideri
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Emanuela Olmetto
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Odile Le Saec
- Phoniatrics Unit, University Hospital Careggi, Florence, Italy
| | | | - Giuditta Mannelli
- Otorhinolaryngology-Head and Neck Surgery Unit, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Via Largo Palagi 1, 50134, Florence, Italy.
| |
Collapse
|
25
|
Effects of a swallowing exercise education program on dysphagia-specific health-related quality of life in oral cavity cancer patients post-treatment: a randomized controlled trial. Support Care Cancer 2018; 26:2919-2928. [DOI: 10.1007/s00520-018-4148-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
|