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Lakshmipathy D, Allibone M, Rajasekaran K. Dysphagia in Head and Neck Cancer. Otolaryngol Clin North Am 2024; 57:635-647. [PMID: 38485539 DOI: 10.1016/j.otc.2024.02.013] [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: 07/01/2024]
Abstract
Dysphagia is a common symptom in patients with head and neck cancer that can significantly impact health outcomes and quality of life. The origin of dysphagia in these patients is often multifactorial, making diagnosis and management especially complex. The evaluating otolaryngologist should be well versed with the patient's neoplasm, comorbidities, and treatment history alongside dysphagia-specific imaging modalities. Management is often dynamic, requiring frequent monitoring, interprofessional collaboration, and a variety of supportive and invasive measures to achieve optimal outcomes.
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Affiliation(s)
- Deepak Lakshmipathy
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA
| | - Melissa Allibone
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA; Department of Speech-Language Pathology, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, 800 Walnut Street, 18th Floor, Philadelphia, PA 19107, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, USA.
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Pavlidou E, Kyrgidis A, Vachtsevanos K, Constantinidis J, Triaridis S, Printza A. Efficacy of High-Intensity Training in Patients with Moderate to Severe Dysphagia after Glossectomy. J Clin Med 2023; 12:5613. [PMID: 37685680 PMCID: PMC10488737 DOI: 10.3390/jcm12175613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Dysphagia is the main impairment arising from glossectomy for tongue cancer treatment. The study aimed to determine if an eight-week training protocol paired with accuracy tasks and swallowing exercises is effective and can improve tongue strength and swallowing in patients after tongue resection. Maximum isometric pressures, tongue endurance, swallowing pressures, mealtime duration, and oropharyngeal swallow function were studied in patients with moderate to severe dysphagia after glossectomy. Twenty-five (25) patients and thirty-one (31) healthy participants were enrolled in the study. The therapy group (TG) consisted of seventeen (17) patients who followed an 8-week treatment protocol and had multiple measurements. The follow-up control group (FUG) consisted of eight non-treated patients who had a baseline and an 8-week follow-up examination. Healthy participants served as the reference group (RF). Maximum isometric pressures, endurance, and swallowing pressures increased significantly in the TG versus the FUG. Significant improvement was documented in the TG regarding the EAT-10 questionnaire, the Penetration-Aspiration Scale scores at thickened and solid boluses, and post-swallow residues at thickened and solid boluses. The treatment protocol with tongue strength exercises combined with accuracy tasks and swallowing exercises improves the post-operative swallowing function in patients after glossectomy. Patients in the TG had more significant and quicker improvement in pressures and endurance compared to FUG.
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Affiliation(s)
- Elena Pavlidou
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| | - Athanasios Kyrgidis
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (K.V.)
| | - Konstantinos Vachtsevanos
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (A.K.); (K.V.)
| | - Jannis Constantinidis
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| | - Stefanos Triaridis
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
| | - Athanasia Printza
- 1st Department of Otorhinolaryngology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (J.C.); (S.T.)
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Kwon S, Kim G, Cha S, Han K, Paik NJ, Kim WS. Incidence of dysphagia requiring medical attention in various types of cancers: A nationwide population-based cohort study. Support Care Cancer 2023; 31:309. [PMID: 37115351 DOI: 10.1007/s00520-023-07778-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/25/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE Most previous reports on dysphagia in cancer have focused on specific cancer types, particularly head and neck cancer. Therefore, we aimed to investigate the incidence of dysphagia in patients with various cancers using a nationwide database in South Korea. METHODS This was a retrospective cohort study using the National Health Insurance Service database. Claim codes were used for the selection criteria and operational definitions. The total population data from 2010 to 2015 were extracted. The crude incidence of dysphagia was calculated per 1,000 person-years. The multivariate adjusted Cox proportional hazards regression was used to determine the effects of different cancers on the incidence of dysphagia. RESULTS People with cancer had a lower income and suffered from a higher risk of comorbidities compared to people without cancer. The risk of dysphagia increased in all types of cancers, particularly in the oral cavity and pharynx (hazard ratio [HR]: 20.65, 95% confidence interval [CI]: 17.73-24.06), esophagus (HR: 18.25, 95% CI: 15.66-21.26), larynx (HR: 12.87, 95% CI: 10.33-16.02), and central nervous system (HR: 12.42, 95% CI: 10.33-14.94). CONCLUSIONS The risk of dysphagia was significantly higher in the cancer group than in the non-cancer group. As the survival of cancer patients is improving with the development of new treatments, more attention should be paid to dysphagia in the management of cancer. Prompt and appropriate multidisciplinary interventions for dysphagia are necessary to improve the recovery and quality of life in cancer patients.
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Affiliation(s)
- SuYeon Kwon
- Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, School of Medicine, Seoul, Republic of Korea
| | - Gowun Kim
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Examination of Suprahyoid Muscle Resection and Other Factors Affecting Swallowing Function in Patients With Advanced Oral Cancer After Surgical Resection and Reconstruction. J Craniofac Surg 2022; 33:e840-e844. [PMID: 36409859 PMCID: PMC9612680 DOI: 10.1097/scs.0000000000008770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/04/2022] [Indexed: 11/05/2022] Open
Abstract
Dysphagia is one of the most common adverse effects associated with oral cancer therapy and could greatly impair postoperative quality of life. The objective of this study was to analyze postoperative swallowing outcomes and factors influencing postoperative swallowing function in patients with advanced oral cancer who underwent primary reconstruction after surgical resection to identify patients at risk of experiencing severe dysphagia after immediate reconstruction of surgical defects, and to determine an ideal approach to provide appropriate perioperative interventions. The swallowing status was evaluated at 4 week postoperatively using the Functional Oral Intake Scale. We also analyzed the effects of patient, tumor, surgical, and other factors on postoperative swallowing function. The study included 67 patients. At 4 weeks postoperatively, 11 patients showed reduced swallowing function, whereas 56 patients showed good swallowing function. The number of resected suprahyoid muscles (odds ratio, 1.55; 95% confidence interval, 1.03-2.32; P=0.035) was an independent factor influencing postoperative swallowing function. Thus, among patients who underwent radical resection of oral cancer with primary reconstruction, those with extensive resection of the suprahyoid muscles were at higher risk of developing postoperative dysphagia. These findings are expected to facilitate increased vigilance for dysphagia, better counseling, and appropriate rehabilitation interventions.
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Kung LY, Li TI, Chung CH, Lee SP, Chen GS, Chien WC, Tzeng NS. Risk of depression in patients with oral cancer: a nationwide cohort study in Taiwan. Sci Rep 2021; 11:23524. [PMID: 34876632 PMCID: PMC8651796 DOI: 10.1038/s41598-021-02996-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/22/2021] [Indexed: 01/01/2023] Open
Abstract
This study investigates an association between oral cancers and the risk of developing depression. We conducted a total of 3031 patients with newly diagnosed oral cancers and 9093 age-, sex-, and index year-matched controls (1:3) from 2000 to 2013 were selected from the National Health Insurance Research Database (NHIRD) of Taiwan. After adjusting for confounding factors, multivariate Cox proportional hazards analysis was used to compare the risk of depression over a 13-year follow-up. Of the patients with oral cancer, 69 (2.28%, or 288.57 per 105 person-years) developed depression compared to 150 (1.65%, 135.64 per 105 person-years) in the control group. The Cox proportional hazards regression analysis showed that the adjustment hazard ratio (HR) for subsequent depression in patients with oral cancer diagnosed was 2.224 (95% Confidence Interval [CI] 1.641–3.013, p < 0.001). It is noteworthy that in the sensitivity analysis is the adjusted HR in the group with depression diagnosis was 3.392 and in the oral cancer subgroup of “Tongue” was 2.539. This study shows oral cancer was associated with a significantly increased risk for developing subsequent depression and early identification and treatment of depression in oral cancer patients is crucial.
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Affiliation(s)
- Ling-Yu Kung
- Department of Family Dentistry and Oral Diagnosis, Tri-Service General Hospital, Taipei, Taiwan, ROC.,School of Dentistry, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tsung-I Li
- Department of Family Dentistry and Oral Diagnosis, Tri-Service General Hospital, Taipei, Taiwan, ROC.,School of Dentistry, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 7115R, No. 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, 11490, Taiwan, ROC.,Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan, ROC
| | - Shiao-Pieng Lee
- School of Dentistry, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Gunng-Shinng Chen
- School of Dentistry, National Defense Medical Center, Taipei, Taiwan, ROC. .,Department of Orthodontics and Pediatrics Dentistry, School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, Taiwan, ROC.
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC. .,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 7115R, No. 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, 11490, Taiwan, ROC. .,Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan, ROC. .,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC.
| | - Nian-Sheng Tzeng
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, Taiwan, ROC. .,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC.
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Abstract
Dysphagia, defined as impairment of the swallowing process, is a common symptom and can be a significant source of morbidity and mortality in the general population. This article summarizes the causes of the condition, its prevalence, and the consequences and costs of untreated dysphagia. The aim of this article is to provide a framework for the general internist in assessing, diagnosing, and managing dysphagia in an adult patient. Basic diagnostic screening procedures and techniques for management are emphasized. A basic treatment pathway based on cause is provided for reference.
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Affiliation(s)
- E Berryhill McCarty
- Department of Otolaryngology, University of Pittsburgh, 203 Lothrop Street #500, Pittsburgh, PA 15213, USA
| | - Tiffany N Chao
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, 3737 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
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Hussain H, Ahmad K, Yahaya Z, Wan Puteh SE, Mohd Ibrahim H. Level of Awareness, Knowledge, and Involvement of Malaysian Medical and Dental Practitioners in Dysphagia Management of Head and Neck Cancer Patients. Dysphagia 2021; 37:856-862. [PMID: 34304329 DOI: 10.1007/s00455-021-10343-y] [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: 02/09/2021] [Accepted: 07/13/2021] [Indexed: 12/01/2022]
Abstract
Head and neck cancer patients are at high risk of developing dysphagia from undergoing cancer treatment. It is essential for medical and dental practitioners to recognize speech-language pathologists' role and dysphagia symptoms to provide a timely referral to speech-language pathologists. This study aims to determine the level of awareness, knowledge, and involvement of medical and dental practitioners in dysphagia management. A total of 391 medical and dental practitioners from 22 government hospitals across Malaysia participated in this cross-sectional study. Participants completed the questionnaire specifically on the level of involvement, knowledge, awareness regarding the role of SLP and dysphagia symptoms. The results revealed a statistically significant relationship between the level of awareness of the role of SLP, χ2 (4, 391) = 9.87, p = 0.043 and the level of involvement of medical and dental practitioners, χ2 (8, 391) = 27.68, p = 0.001 and percentage of referring head and neck cancer patients. The odds of referring head and neck cancer patients for pre-treatment assessment increased three times for each one unit of the participation of medical and dental practitioners [OR] 3.65 (1.56, 8.51) p = 0.003 among those who are already highly involved in dysphagia management. These findings compel healthcare practitioners in head and neck cancer to revisit their collaborative practices. Head and neck cancer patients should receive swallowing management from speech-language pathologists to improve their swallowing function and avoid further complications such as dehydration, malnutrition, and death.
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Affiliation(s)
- Husmeela Hussain
- Hospital Rehabilitasi Cheras, Jalan Yaacob Latiff, 53000, Kuala Lumpur, Malaysia
| | - Kartini Ahmad
- Centre for Rehabilitation & Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Zakinah Yahaya
- Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Sharifa Ezat Wan Puteh
- Fakulti Perubatan, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, 56000, Kuala Lumpur, Malaysia
| | - Hasherah Mohd Ibrahim
- Centre for Rehabilitation & Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
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Asymptomatic swallowing disorders may be present in individuals with laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy. Eur Arch Otorhinolaryngol 2021; 279:995-1001. [PMID: 33963434 DOI: 10.1007/s00405-021-06861-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Patients with advanced laryngeal and hypopharyngeal cancer are often treated with chemo-radiotherapy to avoid total laryngectomy. Subclinical swallowing disorders could be present in these patients even though patients do not complain of any symptoms. We sought to evaluate the impact of chemoradiation on swallowing and quality of life. METHODS We studied 21 patients undergoing chemo-radiotherapy for advanced laryngeal and hypopharyngeal cancer. All patients were tumor-free and none reported symptoms related to dysphagia during follow-up or showed altered routine screening tests (EAT-10) to detect it. Swallowing functions were assessed using volume-viscosity swallow test (V-VST) and fiberoptic endoscopic evaluation of swallowing (FEES). Quality of life was assessed with the EORT-H&N35, and SWAL-QOL scales. RESULTS Frequent alterations in swallowing efficacy (100%) and safety (85.5%) were detected with V-VST and FEES. Quality-of-life scales showed a reduction in their scores between 12 and 17%, mainly in the areas of symptoms. CONCLUSION Swallowing disorders are common after chemo-radiotherapy, even in patients who do not clinically manifest these disorders, contributing to a decrease in patients' quality of life. FEES and V-VST are useful procedures to detect asymptomatic swallowing disorders.
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Schreiber AM, Dawson C, Skoretz SA. Late Dysphagia Following Radiotherapy After Nasopharyngeal Carcinoma: A Case Series. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:319-326. [PMID: 31805250 DOI: 10.1044/2019_ajslp-19-0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Standard treatment for nasopharyngeal carcinoma (NPC) is radiation therapy (RT); however, long-term effects of RT frequently include significant swallowing impairments (dysphagia; Gaziano, 2002; Hui, Chan, & Le, 2018). Our objective was to describe swallowing physiology in consecutive outpatients with a history of NPC following RT using standardized methods. Understanding dysphagia characteristics in this patient population could ultimately inform rehabilitation strategies and improve patient outcomes. Method We conducted a retrospective, observational, descriptive study of consecutive outpatients undergoing videofluoroscopic swallowing (VFS) exams at our clinic, from 2009 to 2014. We included those with a diagnosis of NPC treated with RT. Those with other cancer diagnoses; previous tracheostomy; acute neurological injury; and progressive, degenerative neurological conditions were excluded. Two registered MBSImP clinicians, blinded to each other, reviewed and scored the VFS exams according to previously published methods (Martin-Harris et al., 2008). Following unblinding, a single reviewer collected demographic data from the electronic medical record. We reported overall impairment and MBSImP component scores descriptively. Results Of 158 outpatients undergoing VFS, 6 (N) met our inclusion criteria. The median time from completion of RT to outpatient VFS was 21.0 years. Patients reported a variety of dysphagia symptoms. All patients had high oral and pharyngeal residue scores (scores ≥ 2) and high impairment scores on components contributing to bolus transport and airway closure. Conclusions All patients presented with impairments in oral-pharyngeal bolus transport and airway protection. Our results identify specific swallowing impairments for this patient group highlighting possible latent RT effects on swallowing. This population would benefit from dysphagia rehabilitation and maintenance programs informed by multimodal diagnostic approaches.
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Affiliation(s)
- Ann-Marie Schreiber
- Department of Speech-Language Pathology, Richmond Hospital, British Columbia, Canada
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Camilla Dawson
- Department of Speech and Language Therapy, Queen Elizabeth Hospital Birmingham, United Kingdom
| | - Stacey A Skoretz
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
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Sacco AG, Coffey CS, Sanghvi P, Rubio GP, Califano J, Athas J, Tamayo GJ, Linnemeyer K, Barnachea LC, Orosco RK, Brumund KT, Cohen EE, Gold K, Mell LK, Sharabi A, Daniels GA, Abbott Y, Collins R, Clynch K, Noboa M, Blumenfeld L. Development of Care Pathways to Standardize and Optimally Integrate Multidisciplinary Care for Head and Neck Cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/10463356.2018.1527118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | | | | | | | | | - Jayna Athas
- UC San Diego Moores Cancer Center, La Jolla, Calif
| | | | | | | | | | | | | | - Kathryn Gold
- UC San Diego Moores Cancer Center, La Jolla, Calif
| | | | | | | | - Yuko Abbott
- UC San Diego Moores Cancer Center, La Jolla, Calif
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Prosiegel M, Weber S. Mit Schluckstörungen assoziierte Erkrankungen. DYSPHAGIE 2018:69-133. [DOI: 10.1007/978-3-662-56132-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Psychometric Properties of the Chinese Version of the M.D. Anderson Dysphagia Inventory for Head and Neck Cancer Patients. Cancer Nurs 2017; 40:E9-E16. [PMID: 27244664 DOI: 10.1097/ncc.0000000000000397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dysphagia is a common side effect of anticancer treatments in patients with head and neck cancer (HNC) and can worsen patients' quality of life. A well-established measure is essential to evaluate dysphagia in HNC patients. OBJECTIVES The aim of this study is to determine the psychometric properties of the Chinese version of the M.D. Anderson Dysphagia Inventory (MDADI-C) for HNC patients. METHODS A total of 220 subjects were included in the study. Reliability was examined by internal consistency (Cronbach's α) and test-retest reliability (intraclass correlation coefficient). Validity was evaluated with Spearman correlations (r). RESULTS The Cronbach's α and intraclass correlation coefficient of the MDADI-C were .923 and 0.942, respectively. The criterion validity of the MDADI-C was 0.777. The Spearman correlation coefficients of the MDADI-C with the European Organization for Research Into the Treatment of Cancer Quality of Life Questionnaire for Head and Neck Cancer (r = -0.851), Hospital Anxiety and Depression Scale (r = -0.424), radiotherapy dose (r = -0.553), and treatment regimens (r = -0.407) demonstrated good construct validity (all P < .01). CONCLUSIONS The MDADI-C demonstrated good psychometric properties and would be a valuable tool for clinicians to screen dysphagia rapidly and evaluate its impact on the quality of life of HNC patients. IMPLICATIONS FOR PRACTICE The MDADI-C could be used to document and monitor the dysphagia level of HNC patients for clinicians, nurses, and researchers. This validated questionnaire will help nurses and doctors to improve dysphagia management in HNC patients and will allow researchers to compare the study results across different countries.
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Swallowing Disorders after Oral Cavity and Pharyngolaryngeal Surgery and Role of Imaging. Gastroenterol Res Pract 2017; 2017:7592034. [PMID: 28496456 PMCID: PMC5381198 DOI: 10.1155/2017/7592034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/16/2017] [Indexed: 11/18/2022] Open
Abstract
Head and neck squamous cell carcinoma is the sixth most common cancer diagnosed worldwide and the eighth most common cause of cancer death. Malignant tumors of the oral cavity, oropharynx, and larynx can be treated by surgical resection or radiotheraphy with or without chemotheraphy and have a profound impact on quality of life functions, including swallowing. When surgery is the chosen treatment modality, the patient may experience swallowing impairment in the oral and pharyngeal phases of deglutition. A videofluoroscopic study of swallow enables the morphodynamics of the pharyngeal-esophageal tract to be accurately examined in patients with prior surgery. These features allow an accurate tracking of the various phases of swallowing in real time, identifying the presence of functional disorders and of complications during the short- and long-term postoperative recovery. The role of imaging is fundamental for the therapist to plan rehabilitation. In this paper, the authors aim to describe the videofluoroscopic study of swallow protocol and related swallowing impairment findings in consideration of different types of surgery.
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Abstract
: The overall incidence of head and neck cancer-which includes laryngeal, hypopharyngeal, nasal cavity, paranasal sinus, nasopharyngeal, oral, oropharyngeal, and salivary gland cancers-has declined in the United States over the past 30 years with the concomitant reduction in tobacco use. Over that same period, however, the worldwide incidence of oropharyngeal cancer has escalated significantly, most notably among men and women under age 60 who live in developed countries. This epidemic rise in oropharyngeal cancer is largely attributed to certain genotypes of the human papillomavirus (HPV). In the United States, HPV prevalence in oropharyngeal tumors increased dramatically, from roughly 16% between 1984 and 1989 to nearly 73% between 2000 and 2004, and the annual incidence of HPV-positive oropharyngeal cancer is expected to surpass that of HPV-related cervical cancer by 2020.This article provides an overview of head and neck cancer-its incidence, risk factors, treatment, and posttreatment sequelae-with a focus on HPV-related oropharyngeal cancer. Unlike other forms of head and neck cancer, HPV-related oropharyngeal cancer tends to affect younger patients with few or none of the traditional risk factors and has a distinctive presentation, histology, and natural course. In order to provide appropriate patient education and to help these patients monitor and manage late and long-term treatment effects, it is important for nurses to be aware of this disease and its treatment, and of the unique survivorship issues that arise for affected patients.
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Bressan V, Stevanin S, Bianchi M, Aleo G, Bagnasco A, Sasso L. The effects of swallowing disorders, dysgeusia, oral mucositis and xerostomia on nutritional status, oral intake and weight loss in head and neck cancer patients: A systematic review. Cancer Treat Rev 2016; 45:105-19. [DOI: 10.1016/j.ctrv.2016.03.006] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 02/07/2023]
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Zhang L, Huang Z, Wu H, Chen W, Huang Z. Effect of swallowing training on dysphagia and depression in postoperative tongue cancer patients. Eur J Oncol Nurs 2014; 18:626-9. [DOI: 10.1016/j.ejon.2014.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/31/2014] [Accepted: 06/03/2014] [Indexed: 12/27/2022]
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Surkin MI, Schwartz SA, Markiewicz DA. Late-onset complications after chemoradiation for head and neck carcinomas. EAR, NOSE & THROAT JOURNAL 2014; 92:E18. [PMID: 23975497 DOI: 10.1177/014556131309200822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acute complications from chemoradiation for head and neck cancers are relatively common. These can be minor or severe and can have a significant impact on the patient's quality of life. The incidence of late-onset (>5 years after cancer cure) complications is unknown, but the effect on quality of life is just as severe as with acute problems. What makes matters worse is that many of these patients lived years without dysphagia or other issues and were able to resume a normal lifestyle before developing complications. We present 4 cases involving patients with late-onset complications and discuss the need to remain vigilant in follow-up and caring for patients with head and neck cancer.
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Affiliation(s)
- Marc I Surkin
- Department of Otolaryngology, Drexel University College of Medicine, 301 West Chester Pike, Havertown, PA 19083, USA.
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Dysphagia in Head and Neck Cancer Patients: Pretreatment Evaluation, Predictive Factors, and Assessment during Radio-Chemotherapy, Recommendations. Clin Exp Otorhinolaryngol 2013; 6:117-26. [PMID: 24069513 PMCID: PMC3781223 DOI: 10.3342/ceo.2013.6.3.117] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 03/06/2013] [Accepted: 05/15/2013] [Indexed: 12/02/2022] Open
Abstract
Progress in head and neck cancer (HNC) therapies has improved tumor response, loco-regional control, and survival. However, treatment intensification also increases early and late toxicities. Dysphagia is an underestimated symptom in HNC patients. Impairment of swallowing process could cause malnutrition, dehydration, aspiration, and pneumonia. A comprehensive literature review finalized in May 2012 included searches of electronic databases (Medline, Embase, and CAB abstracts) and scientific societies meetings materials (American Society of Clinical Oncology, Associazione Italiana Radioterapia Oncologica, Associazione Italiana di Oncologia Cervico-Cefalica, American Head and Neck Society, and European Society for Medical Oncology). Hand-searches of HNC journals and reference lists were carried out. Approximately one-third of dysphagia patients developed pneumonia requiring treatment. Aspiration pneumonia associated mortality ranged from 20% to 65%. Unidentified dysphagia caused significant morbidity, increased mortality, and decreased the quality of life. In this review we underline definition, causes, predictive factors of dysphagia and report on pretreatment and on-treatment evaluation, suggesting some key points to avoid underestimation. A multi-parameter assessment of swallowing problems may allow an earlier diagnosis. An appropriate evaluation might lead to a better treatment of both symptoms and cancer.
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Prealbumin is a more sensitive marker than albumin to assess the nutritional status in patients undergoing radiotherapy for head and neck cancer. Contemp Oncol (Pozn) 2013; 17:276-80. [PMID: 24596514 PMCID: PMC3934060 DOI: 10.5114/wo.2013.35281] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/22/2012] [Accepted: 11/27/2012] [Indexed: 01/23/2023] Open
Abstract
Aim of the study The aim of this prospective study was to determine the prevalence of malnutrition and to evaluate a more sensitive marker to assess the nutritional status in patients undergoing RT for head and neck cancer. Material and methods The prospective study included 51 (mean age of 57.6 ±11.2 years) patients undergoing RT for head and neck cancer. Malnutrition was defined as weight loss > 5% of baseline. Results Forty-six (90.2%) of 51 patients were male. Malnutrition developed in 33 (64.7%) patients during RT. Mean prealbumin level was significantly lower in patients with malnutrition than in those without malnutrition (17 ±5 g/dl vs. 22 ±5 g/dl, respectively, p = 0.004). On the other hand, there was no significant difference between the two groups in terms of other nutrition parameters including total protein, albumin, total cholesterol, triglyceride, and glucose (p > 0.05). The percentage of weight loss negatively correlated with prealbumin (r = –0.430, p = 0.002), but not with other nutrition parameters including total protein, albumin, triglyceride, total cholesterol, HDL cholesterol, LDL cholesterol, and glucose (p > 0.05). Conclusions The prevalence of malnutrition was high in patients with head and neck cancer. Prealbumin was a more sensitive marker than albumin to assess the nutritional status in these patients.
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Rosen JE, Gardiner P, Lee SL. Complementary and Integrative Treatments. Otolaryngol Clin North Am 2013; 46:423-35. [DOI: 10.1016/j.otc.2013.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND The number of cancer survivors in the general population is increasing. Oral and dental status affects patients' quality of life and oral function, which, in turn, may affect nutritional intake and general health. The authors review the importance of oral health and the role of the oral health care provider in supporting dietary intake and providing nutritional guidance. METHODS The authors provide a brief review of oral complications of therapy and nutritional guidelines for patients with head and neck cancer. RESULTS Oral adverse effects of head and neck cancer treatment include salivary gland dysfunction, taste change, orofacial pain and mucosal sensitivity, oral infection, tissue defects and necrosis, trismus and fibrosis, progressive dental and periodontal disease, and problems with prosthesis function. CONCLUSIONS Managing oral adverse effects of treatment may have an impact on dietary and nutritional intake, as well as on quality of life. Dietary modifications may be needed because of the patient's oral function and may include modification of food texture and flavor, as well as the use of dietary supplements. CLINICAL IMPLICATIONS As part of the patient's health care team, dental care professionals should be aware of the oral adverse effects of cancer therapy, as well as their role in recognizing and treating the resulting oral conditions. In addition, they should provide guidance to patients to support their oral dietary and nutritional intake.
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Guedes RLV, Angelis ECD, Chen AY, Kowalski LP, Vartanian JG. Validation and Application of the M.D. Anderson Dysphagia Inventory in Patients Treated for Head and Neck Cancer in Brazil. Dysphagia 2012; 28:24-32. [DOI: 10.1007/s00455-012-9409-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
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Swallowing, speech and quality of life in patients undergoing resection of soft palate. Eur Arch Otorhinolaryngol 2012; 270:305-12. [DOI: 10.1007/s00405-012-2006-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
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Messing BP, Ryniak K, Shellenberger J, Hieber B, Ulmer K, Gold D, Harrer K, Kim M, Valasek L, Silinonte J. Multidisciplinary Care of the Head and Neck Cancer Patient. ACTA ACUST UNITED AC 2012. [DOI: 10.1044/vvd22.1.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
When a patient is diagnosed with head and neck cancer, there is a tremendous physical, social, and emotional burden placed on the patient and his or her family. The complex nature of the diagnostic and treatment-planning process, along with the intensity of this life-altering event, requires an integrated, multidisciplinary team approach. Clinicians representing the disciplines of surgery, medical oncology, radiation oncology, speech-language pathology, nursing, nutrition, social work, and other health professionals must work together to meet the entire spectrum of the patient's needs before, during, and after treatment. The purpose of this article is to share the integrated approach that enables the oncology team of professionals at our center to address the needs of our patients. We will present a clinical pathway that focuses on medical, functional, psychosocial, and nutritional requirements that ensure optimal outcomes.
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Affiliation(s)
- Barbara P. Messing
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Keri Ryniak
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Jaclyn Shellenberger
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Bethany Hieber
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Karen Ulmer
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Dorothy Gold
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Karen Harrer
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Melissa Kim
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Lisa Valasek
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
| | - Jessica Silinonte
- The Milton J. Dance, Jr. Head and Neck Center, Johns Hopkins Voice Center at the Greater Baltimore Medical Center Baltimore, Maryland
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Jung SJ, Kim DY, Joo SY. Rick factors associated with aspiration in patients with head and neck cancer. Ann Rehabil Med 2011; 35:781-90. [PMID: 22506206 PMCID: PMC3309370 DOI: 10.5535/arm.2011.35.6.781] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 10/05/2011] [Indexed: 11/06/2022] Open
Abstract
Objective To determine the major risk factors and abnormal videofluoroscopic swallowing study (VFSS) findings associated with aspiration in patients with head and neck cancer (HNC). Method Risk factors associated with aspiration were investigated retrospectively in 241 patients with HNC using medical records and pre-recorded VFSS. Age, gender, lesion location and stage, treatment factors, and swallowing stage abnormalities were included. Results Aspiration occurred in 50.2% of patients. A univariate analysis revealed that advanced age, increased duration from disease onset to VFSS, higher tumor stage, increased lymph node stage, increased American Joint Committee on Cancer (AJCC) stage, operation history, chemotherapy history, and radiotherapy history were significantly associated with aspiration (p<0.05). Among them, advanced age, increase AJCC stage, operation history, and chemotherapy history were significantly associated with aspiration in the multivariate analysis (p<0.05). Delayed swallowing reflex and reduced elevation of the larynx were significantly associated with aspiration in the multivariate analysis (p<0.05). Conclusion The major risk factors associated with aspiration in patients with HNC were advanced age, higher AJCC stage, operation history, and chemotherapy history. A VFSS to evaluate aspiration is needed in patients with NHC who have these risk factors. Delayed swallowing reflex and reduced elevation of the larynx were major abnormal findings associated with aspiration. Dysphagia rehabilitation should focus on these results.
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Affiliation(s)
- Soo Jin Jung
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea
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Tong MCF, Lee KYS, Yuen MTY, Lo PSY. Perceptions and experiences of post-irradiation swallowing difficulties in nasopharyngeal cancer survivors. Eur J Cancer Care (Engl) 2011; 20:170-8. [PMID: 20412286 DOI: 10.1111/j.1365-2354.2010.01183.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aimed to explore the perceptions and experiences of swallowing difficulties in irradiated survivors of nasopharyngeal carcinoma (NPC). Qualitative semi-structured interviews were conducted with 60 post-irradiation NPC patients after they had answered a set of self-report questions. The interviews were transcribed verbatim for analysis. Results of the self-report data showed that in response to a global question 'Do you have any swallowing difficulties?' eight-five per cent of the respondents reported a certain degree of difficulty. The qualitative interview findings, however, suggested that this figure might have been underestimated. Patient interpretations of swallowing difficulties had excluded part of the symptoms. Some respondents who claimed to have no difficulty swallowing, in fact, were suffering from oral retention of food bolus, regurgitation of food or liquids through the nose, and/or even choking. The risk of aspiration was generally neglected. Informants' concerns focused more on the threat of cancer recurrence, thus paid less attention to the radiation-induced swallowing complication. Respondents did not possess sufficient knowledge to judge their swallowing abilities at a general level. This study suggests ways to enhance patient-provider communication and health education to improve patient knowledge.
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Affiliation(s)
- M C F Tong
- Department of Otorhinolaryngology, Head & Neck Surgery, The Chinese University of Hong Kong, Hong Kong, China
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Zhen Y, Wang JG, Tao D, Wang HJ, Chen WL. Efficacy survey of swallowing function and quality of life in response to therapeutic intervention following rehabilitation treatment in dysphagic tongue cancer patients. Eur J Oncol Nurs 2011; 16:54-8. [PMID: 21444245 DOI: 10.1016/j.ejon.2011.03.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 02/25/2011] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE This quasi-experimental parallel cluster study was carried out to investigate the utility of interdisciplinary swallowing therapy exercises in improving swallowing function and quality of life (QOL) in dysphagic cancer patients following tongue resection and subsequent rehabilitation treatment. METHODS All subjects in the experimental group underwent a structured swallowing training program. The subjects in the experimental group (n = 23) received 30 min of swallowing training each day, 6 days per week for 2 weeks. The control group (n = 23) received no training. Analysis of variance was used, and the M.D. Anderson Dysphagia Inventory (MDADI) discriminated between groups of subjects. RESULTS Patients who underwent structured swallowing training (n = 23) showed improvement in the overall MDADI score (P < 0.01) compared with the control population. Furthermore, a separate analysis of individual domains of the MDADI (global, emotional, functional, and physical) demonstrated improved QOL. Although the mean score for tongue rehabilitation indicated that ≥50% subjects in the functional subscale were improved compared with the control population, the difference was not statistically significant (P > 0.05). CONCLUSIONS This study used objectively timed swallowing tests, an interdisciplinary swallowing therapy protocol, and a swallowing questionnaire to evaluate the effects of swallowing training. We found that implementation of swallowing education and exercises improved dysphagia and QOL in cancer patients following tongue resection and rehabilitation. Furthermore, this study indicated that swallowing safety and dysphagia training for nursing professionals is effective.
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Affiliation(s)
- Yan Zhen
- Department of Oral and Maxillofacial Surgery, Sun Yet-sen Memorial Hospital (Second Affiliated Hospital) of Sun Yat-sen University, Guangzhou, China
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van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Rasch CRN, Hilgers FJM. A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia 2010; 26:155-70. [PMID: 20623305 PMCID: PMC3098976 DOI: 10.1007/s00455-010-9288-y] [Citation(s) in RCA: 159] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 06/22/2010] [Indexed: 11/25/2022]
Abstract
The aim of this study was to assess the effect of (preventive) rehabilitation on swallowing and mouth opening after concomitant chemoradiotherapy (CCRT). Forty-nine patients with advanced oral cavity, oropharynx, hypopharynx and larynx, or nasopharynx cancer treated with CCRT were randomized into a standard (S) or an experimental (E) preventive rehabilitation arm. Structured multidimensional assessment (i.e., videofluoroscopy, mouth-opening measurement, structured questionnaires) was performed before and 10 weeks after CCRT. In both S and E arms, feasibility was good (all patients could execute the exercises within a week) and compliance was satisfactory (mean days practiced per week was 4). Nevertheless, mouth opening, oral intake, and weight decreased significantly. Compared to similar CCRT studies at our institute, however, fewer patients were still tube-dependent after CCRT. Furthermore, some functional outcomes seemed less affected than those of studies in the literature that did not incorporate rehabilitation exercises. Patients in the E arm practiced significantly fewer days in total and per week, but they obtained results comparable to the S arm patients. Preventive rehabilitation (regardless of the approach, i.e., experimental or standard) in head and neck cancer patients, despite advanced stage and burdensome treatment, is feasible, and compared with historical controls, it seems helpful in reducing the extent and/or severity of various functional short-term effects of CCRT.
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Affiliation(s)
- Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Maya A. van Rossum
- Department of Otorhinolaryngology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Lori M. Burkhead
- Department of Otolaryngology, Voice and Swallowing Centre, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912 USA
| | - Ludi E. Smeele
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Coen R. N. Rasch
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Frans J. M. Hilgers
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Institute of Phonetic Sciences, University of Amsterdam, Spuistraat 210, 1012 VT Amsterdam, The Netherlands
- Department of Otorhinolaryngology, Academic Medical Centre/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Abstract
Previous thought was that total laryngectomy and difficulty with swallowing were incongruous. Patients were counseled that the loss of their larynx would leave them without a vocal source, but that swallowing would not be affected. Successful rehabilitation was defined as being cancer-free and regaining functional communication. Patients were not queried and frequently did not complain of dysphagia as long as they were able to maintain an oral diet. Knowledge has changed, and this article will focus on dysphagia in the patient with laryngectomy and will discuss anatomical sites to physiologic problems.
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Affiliation(s)
| | - Donna S. Lundy
- Department of Otolaryngology, University of MiamiMiami, FL
| | - Paula A. Sullivan
- Neurology Service, Division of Speech Pathology, Malcom Randall Veterans Medical CenterGainesville, FL
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Piemonte ED, Lazos JP, Brunotto M. Relationship between chronic trauma of the oral mucosa, oral potentially malignant disorders and oral cancer. J Oral Pathol Med 2010; 39:513-7. [PMID: 20456614 DOI: 10.1111/j.1600-0714.2010.00901.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral cancer represents 2%-5% of all cancers, being one of the 10 most frequent ones. Apart from oral cancer risk factors already described in literature, such as tobacco and alcohol consumption, others emerging risk factors have been proposed, such as chronic irritation from dental factors. The aim of this work was to assess the influence of chronic trauma of the oral mucosa (CTOM) in patients with oral potentially malignant disorders (OPMD) and cancer. METHODS A retrospective study of 406 patients (both sexes; aged between 18 and 80 years; with OPMD and cancer) who attended the Department of Clinical Stomatology A of the National University of Cordoba was performed by non-probabilistic sampling. The association of variables and outcome variable diagnosis, with levels control, OPMD, oral cancer, was evaluated by multinomial regression model. RESULTS Population under study was represented by 72% of control patients, 16% patients with OPMD and 11% of patients with oral cancer. It was observed a significant association between diagnosis and CTOM (P = 0.000), after adjustment of confounding factors (smoking and drinking habits, sex, cancer inheritance and denture use). CONCLUSIONS Our results suggest that CTOM is, together with other factors, an important risk factor in patients with oral cancer diagnosis, but not for patients with OPMD.
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Affiliation(s)
- Eduardo David Piemonte
- Departamento de Patología Bucal, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
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Manikantan K, Khode S, Sayed SI, Roe J, Nutting CM, Rhys-Evans P, Harrington KJ, Kazi R. Dysphagia in head and neck cancer. Cancer Treat Rev 2009; 35:724-32. [DOI: 10.1016/j.ctrv.2009.08.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Revised: 07/14/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
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Hayward MC, Shea AM. Nutritional needs of patients with malignancies of the head and neck. Semin Oncol Nurs 2009; 25:203-11. [PMID: 19635399 DOI: 10.1016/j.soncn.2009.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To provide strategies to manage nutrition in patients with head and neck cancer. DATA SOURCES Empirical articles, reviews, books, and anecdotal evidence. CONCLUSION Major nutrition issues include sore mouth/throat, difficulty swallowing, taste changes, dry mouth/thick saliva, constipation, nausea/vomiting, and decreased appetite. IMPLICATIONS FOR NURSING PRACTICE Nurses are one of the main providers for patients with head and neck cancer and may be the first to recognize a nutritional issue. The oncology dietitian and nurse work closely together to manage the nutritional care of the patient.
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Affiliation(s)
- Michele C Hayward
- Hayes Lab, Lineberger Comprehensive Cancer Center,University of North Carolina-Chapel Hill, 450 West Drive, Chapel Hill, NC 27599-7295, USA.
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Dysphagia in Head and Neck Cancer Patients Treated with Chemoradiotherapy. Dysphagia 2009; 25:139-52. [DOI: 10.1007/s00455-009-9247-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 07/31/2009] [Indexed: 11/25/2022]
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van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Hilgers FJM. Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review. Eur Arch Otorhinolaryngol 2008; 266:889-900. [DOI: 10.1007/s00405-008-0817-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 08/11/2008] [Indexed: 01/23/2023]
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Costa Bandeira AK, Azevedo EHM, Vartanian JG, Nishimoto IN, Kowalski LP, Carrara-de Angelis E. Quality of Life Related to Swallowing After Tongue Cancer Treatment. Dysphagia 2007; 23:183-92. [DOI: 10.1007/s00455-007-9124-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 08/23/2007] [Indexed: 11/29/2022]
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Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: Impact on quality of life. Clin Nutr 2007; 26:710-7. [PMID: 17954003 DOI: 10.1016/j.clnu.2007.08.006] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 08/23/2007] [Accepted: 08/30/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND & AIMS To determine the prevalence of dysphagia in head and neck cancer patients treated with surgery and radiotherapy or chemoradiotherapy. To study the impact of dysphagia on food habits, nutritional status, and quality of life. METHODS Retrospective cross-sectional study of 87 head and neck cancer patients treated with surgery and radiotherapy or chemoradiotherapy from January 2000 through May 2005. Time since surgery was 28.5+/-17.8 months. A clinical test was used to detect dysphagia. A nutritional assessment was performed in all patients. A questionnaire was used to evaluate quality of life. RESULTS Oropharyngeal dysphagia was present in 50.6% of patients, mostly to solid foods (72.4%). Patients with total glossectomy and chemoradiotherapy had the highest rate of dysphagia. Nutritional support was necessary in 57.1% of patients. Malnutrition was present in 20.3% of patients, mainly marasmus (81%). Fifty-one percent of patients reported a decrease in their quality of life due to dysphagia. CONCLUSIONS We found a high prevalence of dysphagia in head and neck cancer patients treated with surgery and coadjuvant treatment. This problem negatively affects their quality of life. It is important that nutritional surveillance be provided to detect it and to prevent malnutrition.
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Armstrong JA, McCaffrey R. The Effects of Mucositis on Quality of Life in Patients with head and Neck Cancer. Clin J Oncol Nurs 2006; 10:53-6. [PMID: 16482728 DOI: 10.1188/06.cjon.53-56] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A search of the literature from 1993-2005 revealed four articles on quality-of-life issues for patients with head and neck cancer who develop mucositis. This article reviews four views on quality-of-life issues for patients who receive cancer treatments and develop mucositis. Small samples were utilized in each of the reviewed articles; however, because of the studies' qualitative designs, researchers concluded that quality-of-life issues exist among patients with head and neck cancer who are undergoing radiation and chemotherapy. Nurses play a significant role in assisting patients to tolerate their treatments. Further research is necessary to develop effective nursing interventions to improve quality of life for patients who develop mucositis while undergoing chemotherapy and radiation therapy.
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Affiliation(s)
- Judith A Armstrong
- Christine E. Lynn College of Nursing at Florida Atlantic University, Boca Raton, USA
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Kulbersh BD, Rosenthal EL, McGrew BM, Duncan RD, McColloch NL, Carroll WR, Magnuson JS. Pretreatment, Preoperative Swallowing Exercises May Improve Dysphagia Quality of Life. Laryngoscope 2006; 116:883-6. [PMID: 16735913 DOI: 10.1097/01.mlg.0000217278.96901.fc] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Dysphagia is commonly associated with head and neck cancer treatment. Traditional dysphagia management strategies focus on post-treatment therapy. This study evaluated the utility of pretreatment swallowing exercises in improving post-treatment swallowing quality of life (QOL). STUDY DESIGN Prospective cohort study and cross-sectional QOL analysis. METHODS This study includes 37 patients who underwent primary radiation or combined chemoradiation treatment for newly diagnosed hypopharyngeal, laryngeal, or oropharyngeal primary tumors at the University of Alabama at Birmingham. Of the 37, 25 patients underwent swallowing exercises beginning 2 weeks prior to the start of radiation. The M.D. Anderson Dysphagia Inventory (MDADI) was administered an average of 14 months after treatment to assess the success of the protocol. Analysis of QOL scores related to gender, primary site, stage, and race were obtained. RESULTS Patients who performed pretreatment swallowing exercises (n = 25) showed improvement in the overall MDADI score (P = .0002) compared to the control population (n = 12) who underwent post-treatment therapy. Furthermore, a separate analysis of individual domains of the MDADI (global, emotional, functional, and physical) demonstrated improved quality of life. CONCLUSIONS Implementation of pretreatment swallowing education and exercise may improve dysphagia-specific QOL in head and neck cancer patients undergoing radiation and/or chemoradiation therapy.
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Ledeboer QCP, Velden LA, Boer MF, Feenstra L, Pruyn JFA. Physical and psychosocial correlates of head and neck cancer: an update of the literature and challenges for the future (1996-2003). Clin Otolaryngol 2005; 30:303-19. [PMID: 16209671 DOI: 10.1111/j.1365-2273.2005.01035.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
An update of the literature on physical and psychosocial aspects of head and neck cancer, with special emphasis on effects of treatment, patient-related factors and psychosocial intervention on quality of life (QoL). QoL deteriorates during and directly after treatment and returns only slowly to pre-treatment values. Organ preservation, gender and coping-strategies are factors related to QoL after treatment. As prognosis and survival were found to be comparable under different treatment regimes, we noticed a gradual shift in therapy towards organ preservation. Systematic care, using specific instruments is important for improving the QoL. We feel that more attention should be given to improving support, in order to optimize the QoL of patients during the palliative stage.
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Affiliation(s)
- Q C P Ledeboer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, Rotterdam.
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Evans-Stoner N, Ruiz C, Antonopoulos O. Cancer: Head and Neck. Clin Nutr 2005. [DOI: 10.1016/b978-0-7216-0379-7.50048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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