Application of Manual Therapy for Dysphagia in Head and Neck Cancer Patients: A Preliminary National Survey of Treatment Trends and Adverse Events

Abstract

Background Radiation-associated dysphagia is a common and debilitating consequence of treatment for head and neck cancer (HNC). Since commonly employed dysphagia therapy programs for HNC patients still lack authoritative efficacy, some speech-language pathologists (SLPs) have started employing manual therapy (MT) techniques in an attempt to prevent or rehabilitate dysphagia in this patient population. However, exceptionally little is known about the use of MT in this patient population. Objectives The purpose of this study was to describe practice patterns as well as the rate, type, and severity of adverse events associated with SLP provision of MT to HNC patients. Methods An Internet-based questionnaire geared toward SLPs who practice MT was developed and sent to SLPs practicing in the United States, 3 times, through 3 national listservs (American Speech Language Hearing Association [ASHA] Special Interest Division 13, ASHA Special Interest Division 3, and University of Iowa Voiceserv), over the course of 4 weeks. Results Of the 255 respondents, 116 (45.5%) performed MT on HNC patients. Of these 116 SLPs, 27.6% provided proactive MT during radiation, 62.1% provided 1 to 2 sessions per week, and 94.8% prescribed a MT home program. The rate, type, and severity of reported adverse events were similar between HNC and non-HNC patients. Conclusion This preliminary survey demonstrated that SLPs provide MT to HNC patients during and after cancer treatment, and that reported adverse events paralleled those experienced by noncancer patients. However, these results should be taken with caution, and a well-designed prospective study is needed to formally establish the safety and the preliminary efficacy of this novel clinical intervention.

Myofascial Induction Therapy Improves the Sequelae of Medical Treatment in Head and Neck Cancer Survivors: A Single-Blind, Placebo-Controlled, Randomized Cross-Over Study

“…In particular, manual therapy has been associated with improved blood circulation, reduced muscle spasms, increased ROM, the release of connective tissue adhesions, reduced pain and restoring mobility [ 17 , 18 ]. Specifically, in survivors of HNC manual therapy showed no specific adverse outcomes [ 19 ], reporting adverse events similar to those experienced by patients without cancer [ 20 ].…”

Swallowing-related muscle inflammation and fibrosis induced by a single dose of radiation exposure in mice

“…RAD should be prevented to minimize the effects on the quality of life of HNC patients. Few effective treatments are available for HNC patients with RAD, including postural rehabilitation [ 10 , 11 ] Krisciunas et al [ 10 ] demonstrated that SLPs provide Manual Therapy(MT) to HNC patients during and after cancer treatment, and that reported adverse events paralleled those experienced by noncancer patients. National Cancer institute-funded prospective single-arm pilot trial called Manual Therapy for Fibrosis-Related Late Effect Dysphagia (MANTLE) is going on, which is evaluating the feasibility, safety and therapeutic potential of MT in patients with late dysphagia after radiotherapy for HNC [ 11 ]…”

“…Cervical radiation-induced fibrosis (RIF) can lead to strap muscle fibrosis, impairing laryngeal elevation and causing RAD in HNC survivors [ 9 ]. Currently, the only effective treatment for RAD is rehabilitation [ 10 , 11 ]. Moreover, no functional or histological assays are available for the evaluation of RIF of strap muscles.…”

Dysphagia Advances in Head and Neck Cancer

“…Manual therapies, targeting swallow musculature through passive and active stretching and soft muscle mobilisation, may offer a potential treatment to mitigate some of the long-term effects associated with radiation-induced fibrosis. In the USA, there is evidence of clinical application despite only speculative evidence for its effectiveness with patients with HNC [ 75 ]. Preliminary findings suggest manual therapies, often reserved as a reactive intervention for lymphedema, may in fact be tolerable and actually reduce localised pain during radiotherapy in this population [ 76 ].…”