Deglutition disorders as a consequence of head and neck cancer therapies: a systematic review and meta-analysis

Toledo, Isabela Porto de; Pantoja, Letícia Lopes Quirino; Luchesi, Karen Fontes; Assad, Daniele Xavier; Canto, Graziela De Luca; Guerra, Eliete Neves Silva

doi:10.1007/s00520-019-04920-z

Cited by 19 publications

(24 citation statements)

References 38 publications

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“…The aim of this study was to investigate if easily attainable clinical markers could be considered predictors for severe dysphagia, among patient data, tumor and treatment characteristics. 35% of the cohort in the present study had a PAS ≥5, which corresponds well to other studies reporting prevalence around 35% for aspiration and/or penetration among HNC patients 44,45 . According to the results increasing BMI and patients with tumor of the tonsil and overweight were less likely suffer from severe dysphagia.…”

Section: Discussionsupporting

confidence: 90%

“…35% of the cohort in the present study had a PAS ≥5, which corresponds well to other studies reporting prevalence around 35% for aspiration and/or penetration among HNC patients. 44 , 45 According to the results increasing BMI and patients with tumor of the tonsil and overweight were less likely suffer from severe dysphagia. Weight‐loss following treatment of 7.5% or more and use of feeding tube at time of VFS were predictors of severe dysphagia, with increasing risk with each month's use of a feeding tube.…”

Section: Discussionmentioning

confidence: 97%

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Predictors of severe dysphagia following radiotherapy for head and neck cancer

Petersson

Finizia

Tuomi

2021

Laryngoscope Investig Oto

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Objective To investigate if severe dysphagia following radiotherapy for head and neck cancer (HNC) could be predicted by patient and tumor characteristics, feeding tube use, weight factors, jaw opening function, and saliva secretion. Methods Data was collected from 94 HNC patients 6 to 36 months post radiotherapy. Swallowing function was assessed by videofluroscopy (VFS). Severe dysphagia was defined by Penetration Aspiration Scale (PAS) as PAS≥5 or a total score ≤60 on the M. D. Anderson Dysphagia Inventory (MDADI). Results Thirty‐three patients (35%) had PAS ≥5 and 19 (20%) a MDADI ≤60, that is, presented with severe dysphagia. Univariable logistic regression analysis (UVA) gave that tumor of the tonsil, overweight at time of VFS and each unit increase in Body Mass Index (BMI) predicted less risk of PAS ≥5. Dependency of feeding tube at time of VFS and each month's continued use and weight loss ≥7.5% since treatment to time of VFS predicted increased risk of PAS ≥5. Predictive variables from the UVA of PAS ≥5 (tumor of the tonsil, overweight, and total duration of feeding tube), were analyzed by multivariate logistic regression analysis. All retained power as independent predictors. UVA for MDADI showed that use of feeding tube at time of VFS predicted MDADI ≤60 with the risk increasing each month. Each increasing unit of BMI decreased risk of MDADI ≤60. Conclusion Long time users of feeding tube and higher weight‐loss are at risk of severe dysphagia. This makes collaboration between professionals working with dysphagia an important step in detecting severe dysphagia. Level of Evidence: 3.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 97%

Predictors of severe dysphagia following radiotherapy for head and neck cancer

Petersson

Finizia

Tuomi

2021

Laryngoscope Investig Oto

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“…Two patients suffered from aspiration and three other patients were diagnosed with penetration (PAS). In a previous meta-analysis of deglutition disorders extracted from 17 studies including 229 patients, Porto de Toledo et al reported a high frequency of aspiration in 28.6% of patients immediately posttreatment and during the following three months [ 28 ]. For the course of six months posttreatment, this meta-analysis revealed a penetration of fluids above the vocal folds and an impairment of laryngeal elevation.…”

Section: Discussionmentioning

confidence: 99%

“…From the studies analyzed within the meta-analysis [ 28 ], only the trial of Patterson et al [ 29 ] used FEES as we did. They observed in 8 of 97 patients a silent aspiration at three months posttreatment.…”

Section: Discussionmentioning

confidence: 99%

MRI- and CT-determined changes of dysphagia / aspiration-related structures (DARS) during and after radiotherapy

et al. 2020

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The concept of dysphagia/aspiration-related structures (DARS) was developed against the background of severe late side effects of radiotherapy (RT) for head and neck cancer (HNC). DARS can be delineated on CT scans, but with a better morphological discrimination on magnetic resonance imaging (MRI). Swallowing function was analyzed by use of patient charts and prospective investigations and questionnaires. Method Seventeen HNC patients treated with intensity-modulated radiotherapy (IMRT) ± chemotherapy between 5/2012-8/2015 were included. Planning CT (computed tomography) scans and MRIs (magnetic resonance imaging) prior, during 40 Gray (Gy) radiotherapy and posttreatment were available and co-registered to delineate DARS. The RT dose of each DARS was calculated. Five patients were investigated posttreatment for swallowing function and assessed by means of various questionnaires for quality of life (QoL), swallowing, and voice function. Results By retrospective comparison of DARS volume, a significant change in four of eight DARS was detected over time. Three increased and one diminished. The risk of posttreatment dysphagia rose by every 1Gy above the mean dose (D mean) of RT to DARS. 7.5 was the risk factor for dysphagia in the first 6 months, reducing to 4.7 for months 6-12 posttreatment. For all five patients of the prospective part of swallowing investigations, a function disturbance was detected. These results were in contrast to the self-assessment of patients by questionnaires. There was neither a dose dependency of D mean DARS volume changes over time nor of dysphonia and no correlation between volume changes, dysphagia or dysphonia.

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“…Research reports that up to 90% of patients with HNC have eating and drinking difficulties after treatment [11,12]. A potential range of side effects can inhibit a patient's ability to eat and drink, including pain, xerostomia, mucositis, nausea, lack of appetite, dysphagia, and dysgeusia [11,13].…”

Section: Introductionmentioning

confidence: 99%

A qualitative systematic review of the social eating and drinking experiences of patients following treatment for head and neck cancer

Dornan

Semple

Moorhead

et al. 2021

Support Care Cancer

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Purpose Patients living with and beyond head and neck cancer (HNC) often have long-term, functional challenges as a result of treatment. A key functional challenge relates to eating and drinking; often associated with physical, emotional, and social difficulties. Eating and drinking with family members and friends can become a struggle, increasing the risk of social isolation and loneliness. This systematic review aims to identify and synthesise the literature on the experiences of social eating and drinking for patients following treatment for HNC. Methods Six electronic databases (Pubmed, Web of Science, CINAHL, EMBASE, PsychINFO, and Scopus) were systematically searched using subject headings and free-text word searches in February 2020. Citation chaining and Google Scholar were used to identify grey literature. PRISMA procedures were followed. Results Of 6910 records identified, 24 studies met the inclusion criteria. Synthesis of the research findings results in two major themes: (1) the experience of loss associated with social eating and drinking, and (2) adjusting and support to promote social eating and drinking. Conclusion Losses associated with social eating affect a patient’s psychological and emotional well-being and impact on close relationships. To promote positive participation in social eating, patients were more likely to seek and receive support from someone within their close social network, rather than a healthcare professional. Family and friends are an essential source of support and are integral in facilitating engagement with social eating following treatment for HNC. Future interventions should promote family orientated resources, incorporating self-management strategies.

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Deglutition disorders as a consequence of head and neck cancer therapies: a systematic review and meta-analysis

Cited by 19 publications

References 38 publications

Predictors of severe dysphagia following radiotherapy for head and neck cancer

Predictors of severe dysphagia following radiotherapy for head and neck cancer

MRI- and CT-determined changes of dysphagia / aspiration-related structures (DARS) during and after radiotherapy

A qualitative systematic review of the social eating and drinking experiences of patients following treatment for head and neck cancer

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