Acute and chronic changes in swallowing and quality of life following intraarterial chemoradiation for organ preservation in patients with advanced head and neck cancer

Abstract

Background Health‐related quality of life (QOL) provides a measure of the patient's perception of his life after treatment. This study was undertaken to assess changes in QOL and swallowing in patients undergoing concurrent chemoradiotherapy (CR) for head and neck cancer. The assessment tools consisted of the Head and Neck Radiotherapy Questionnaire (HNRQ) and a swallowing questionnaire (SQ). Methods The HNRQ and SQ were administered to a group of CR patients prior to treatment (n = 58), after the last week of treatment (n = 37), and 6 months after treatment (n = 27). Weight change was monitored in treatment subjects. Results The results indicate that QOL and swallowing function decrease acutely during CR (p < .05) but improvement begins shortly after the treatment‐related decline. At 6 months after CR, mean QOL exceeds pretreatment level. The oropharynx patients have the poorest outcome when compared with laryngeal and hypopharyngeal patients. A stronger correlation exists between swallowing and QOL at 6 months post‐CR than during treatment (R = .52 versus R = .30). Conclusions Quality of life and swallowing are compromised in advanced head and neck cancer patients prior to treatment. There was a further decrease in QOL and swallow function during CR. Organ‐preservation programs in head and neck cancer result in improved QOL and swallowing 6 months after treatment. The degree of improvement is site‐specific. © 1998 John Wiley & Sons, Inc. Head Neck 20: 31–37, 1998.

Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review

“…For advanced cases, there has been a shift from surgical treatment towards chemoradiotherapy protocols (especially concomitant chemotherapy and radiotherapy, CRT). These organ preservation protocols, developed to maintain organ anatomy [6][7][8][9][10][11][12], unfortunately do not necessarily preserve the organ's function [5,6,10,13,14]. The toxicities of these combined therapies are often severe and include xerostomia, pain, mucositis, fatigue, as well as late eVects such as limited mouth opening (trismus) [15,16].…”

Recovery from Postsurgical Swallowing Dysfunction in Patients With Oral Cancer

“…The functioning between 1 and 6 months may largely be influenced by xerostomia or fibrosis created by radiotherapy [8][9][10][11] , post-surgical scar formation, and atrophic changes of the free flaps, and in this period, patients were trying to control the new oropharyngeal structure. Because these influences may reduce or become stable after 6 months 9 , the swallowing function more than 6 months post-surgically would be unchanged compared to that at 6 months.…”

“…Evaluation of the post-surgical swallowing function was performed mainly with videofluoroscopic measures [1][2][3][4][5][6] , but some authors use subjective methods such as questionnaires or similar with or without videofluoroscopic measurements [7][8][9][10][11][12] . Pauloski 4 , Wagner 7 To clarify the course of the recovery of post-surgical swallowing dysfunction between 1 and more than 12 months after surgery, and to determine the correlation among videofluoroscopic measures and medical status indicators, post-surgical oropharyngeal swallow efficiency, nutritional condition, type of nutrition, diet levels, and the occurrence of pneumonia were investigated.…”

RADPLAT: An Alternative to Surgery?

“…In a further study carried out by the same group, Murry et al [62] used patient questionnaires to determine that both swallowing ability and QoL were diminished prior to RAD-PLAT treatment for advanced cancer and decreased further during the treatment cycle (p < .05). However, QoL subsequently improved and exceeded the pretreatment level at 6 months after completion of treatment.…”