Asymptomatic swallowing disorders may be present in individuals with laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy

Álvarez-Marcos, César; Benito, Andrea Vicente; Fernández, Agueda Gayol; Pedregal‐Mallo, Daniel; Rodríguez, Paloma Sirgo; Rabanal, Liliana Santamarina; Llorente, José Luís; López, Fernando; Rodrigo, Juan P.

doi:10.1007/s00405-021-06861-y

Cited by 3 publications

(7 citation statements)

References 35 publications

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“…The passage of time from the end of the CRT treatment to the completion of the QoL questionnaires (mean: 31.52, range: 24-36 months) favours adaptation to sequelae and the trend to positively judge having an intact voice. Other studies have shown that an adaptation mechanism can occur over time, as seen in swallowing disorders in the same LHC patients treated with CRT, where a self-administered test such as EAT-10 was normal, while other more specific and objective parameters were altered 22 . Several authors have pointed out that in patients with HNC treated with CRT swallowing disorders affect QoL in a more negative way than voice disorders 2 , 4 , 22 , 23 , concluding that it is very possible that the impact of CRT on voice has not been sufficiently clarified and is generally minimised.…”

Section: Discussionmentioning

confidence: 89%

“…Other studies have shown that an adaptation mechanism can occur over time, as seen in swallowing disorders in the same LHC patients treated with CRT, where a self-administered test such as EAT-10 was normal, while other more specific and objective parameters were altered 22 . Several authors have pointed out that in patients with HNC treated with CRT swallowing disorders affect QoL in a more negative way than voice disorders 2 , 4 , 22 , 23 , concluding that it is very possible that the impact of CRT on voice has not been sufficiently clarified and is generally minimised. In this regard, it has been proposed to reduce these sequelae, both vocal and swallowing, through early rehabilitation exercises and extend their use once treatment with CRT has been completed 6 .…”

Section: Discussionmentioning

confidence: 89%

“…They would therefore be a guide to indicate different supportive and rehabilitation therapies, as suggested by other authors 2 , 6 , 26 . Our group is conducting a study similar to the present one in the same group of patients but with diagnostic instruments and QoL questionnaires for swallowing disorders 22 . Therefore, it would be necessary to design balanced QoL questionnaires for each therapeutic modality used, both surgical (total laryngectomy, supraglottic) and CRT, since the latter preserves the anatomical structures related to voice and swallowing, while the functional impact is not the same.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, it is difficult to determine to what extent voice alterations intervene in QoL when they have so little weight in its global assessment. It would be beneficial if in the global calculation of QoL of patients undergoing CRT the number of items that assess vocal disorders and swallowing disorders were more balanced 2 , 22 , 23 , as for example with the HADS (Scale of hospital anxiety and depression) that assesses anxiety/depression with 14 items (7 for each disorder) 24 .…”

Section: Discussionmentioning

confidence: 99%

“…There is much information in the literature on voice and swallowing in patients with HNC treated with CRT, but it is often at variance 2 , 4 , 22 . This is due to the difficulty of obtaining uniform series in terms of tumour location, CRT modality and evaluation time with respect to treatment (during, early end, late end).…”

Section: Discussionmentioning

confidence: 99%

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Voice outcomes in patients with advanced laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy

Álvarez-Marcos

Vicente-Benito

Gayol-Fernández

et al. 2022

Acta Otorhinolaryngol Ital

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SUMMARY Objective Patients with locally advanced laryngeal and hypopharyngeal cancer (LHC) are often treated with chemo-radiotherapy to avoid total laryngectomy, although voice problems may occur even if not markedly manifest. We sought to evaluate the impact of chemoradiation on voice and quality of life. Methods We studied 21 patients with locally advanced LHC with tumour control at least two years after chemo-radiotherapy. None manifested clinical symptoms related to the treatment and maintained an activity considered as within normal limits. All patients had a voice handicap index (VHI) of less than 15. Voice function was evaluated by perceptual vocal analysis (CAPE-V) and aerodynamic and acoustic study. Quality of life was assessed with the EORTC-H&N35 (voice items 46, 53 and 54). Results Voice changes were frequent, with alterations in all CAPE-V attributes, and predominantly type II and III spectrograms in acoustic analysis (78%). The EORTC-H&N35 scale showed a reduction in scores in 10-40% of items related to voice. Conclusions Subclinical voice disorders are common after chemo-radiotherapy. Although patients consider vocal impairment to be very minor and to not interfere with their daily life, it may contribute to a reduced quality of life.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Voice outcomes in patients with advanced laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy

Álvarez-Marcos

Vicente-Benito

Gayol-Fernández

et al. 2022

Acta Otorhinolaryngol Ital

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Oncological and functional outcomes of transoral laser surgery for hypopharyngeal carcinoma

Casanueva

López

García-Cabo

et al. 2022

Eur Arch Otorhinolaryngol

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Background Surgical resection or radiotherapy (RT) are standard approaches for early-staged hypopharyngeal squamous cell carcinoma (HPSCC). Transoral laser microsurgery (TOLMS) seems to provide good oncological and functional results with few local complications. The aim of our study was to analyze the outcomes of TOLMS, with or without neck dissection or RT, in the treatment of HPSCC in a tertiary referral center. Methods A retrospective study was conducted in patients with early T-category (T1–T2) HPSCC treated by TOLMS. Results A total of 34 patients were included in the study. The series includes 17 (50%) T1 and 17 (50%) T2 classified tumors. The 5-year overall survival and disease-specific survival rates were 51% and 66%, respectively, with a 5-year local control rate of 92%. All patients reassumed oral diet and none of them had a tracheostomy at the end of the follow-up. Conclusions TOLMS offers an effective treatment option in terms of oncologic control and function preservation in locally circumscribed HPSCC.

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Effects of Tongue Strength Training on Quality of Life in Head and Neck Cancer Patients: Results From a Pilot Interventional Clinical Trial

Culbert,

Fullerton,

Edwards

et al. 2024

Ann Otol Rhinol Laryngol

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Background: Head and neck cancer (HNC) patients often have dysphagia following surgical and/or chemoradiation treatment, which can lead to reduced quality of life. Some patients suffer from decreased tongue strength and mobility that may cause discomfort and difficulty with swallowing. Our group has developed a patented genioglossus muscle strength trainer (GMST) to increase tongue protrusive force that has been used in patients with sleep apnea. We hypothesized that the GMST device would increase tongue strength in the HNC population. Methods: We conducted an IRB approved, non-randomized, interventional clinical trial of HNC patients with dysphagia to determine the effect of GMST on tongue strength. Our secondary objective was to assess dysphagia quality of life, as determined by questionnaires. Genioglossus muscle strength measurements (measured in Newtons, N) and dysphagia quality of life scores (SWAL-QoL questionnaire) were obtained from enrolled patients at baseline and following 4 weeks of intervention. Treatment was at-home GMST exercise regimen 3 times daily, 5 days per week. Compliance was assessed via review of training logs. Two-sided paired t-tests at significance level α = .05 were performed to assess difference in mean GG muscle strength pre- and post-treatment. Results: Out of 10 patients initially enrolled, 7 patients completed the trial. Eighty-six percent were male and the average age was 60. About 5 patients had surgery plus adjuvant radiation and 2 patients had primary radiation. All patients had baseline dysphagia as determined by patient complaint and/or objective measurement (prior modified barium swallow). No adverse events were reported. We observed a statistically significant increase in genioglossus muscle strength (mean change: 4.0 N, 95% CI 1.1-6.9, P = .015) after 4 weeks of treatment. Patients reported reduced swallowing burden and feeling of stigma around eating based on SWAL-QoL results. Conclusions: Our data suggest that protrusive tongue-training exercises utilizing a novel tongue trainer device is well-tolerated and increases genioglossus muscle strength in treated HNC patients complaining of dysphagia. Patient-reported outcomes based on the SWAL-QoL survey indicate improvements in quality-of-life post-treatment, although our results are limited by small sample size. Larger studies are needed to see if this device could have clinically meaningful results for this difficult-to-treat patient population.

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Asymptomatic swallowing disorders may be present in individuals with laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy

Cited by 3 publications

References 35 publications

Voice outcomes in patients with advanced laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy

Voice outcomes in patients with advanced laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy

Oncological and functional outcomes of transoral laser surgery for hypopharyngeal carcinoma

Effects of Tongue Strength Training on Quality of Life in Head and Neck Cancer Patients: Results From a Pilot Interventional Clinical Trial

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