Dysphagia and Oral Morbidities in Chemoradiation-Treated Head and Neck Cancer Patients

Abstract

This study prospectively evaluated relationships between oral morbidities and swallowing ability in head/neck cancer patients following chemoradiation therapy (CRT) and at 3 months following CRT. Thirty patients with confirmed head/neck cancer undergoing chemoradiation were assessed with a battery of swallowing measures and measures of oral morbidities related to chemoradiation (xerostomia, mucositis, pain, taste/smell, oral moisture). All measures were completed at baseline (within the first week of CRT), at 6 weeks (end of treatment), and at 3 months following chemoradiation. Descriptive and univariate statistics were used to depict change over time in swallowing and each oral morbidity. Correlation analyses evaluated relationships between swallowing function and oral morbidities at each time point. Most measures demonstrated significant negative change at 6 weeks with incomplete recovery at 3 months. At 6 weeks, mucositis ratings, xerostomia, and retronasal smell intensity demonstrated significant inverse relationships with swallowing function. In addition, oral moisture levels demonstrated significant positive relationships with swallowing function. At 3 months, mucositis ratings maintained a significant, inverse relationship with swallow function. Taste and both orthonasal and retronasal smell intensity ratings demonstrated inverse relationships with measures of swallow function. Swallow functions and oral morbidities deteriorate significantly following CRT with incomplete recovery at 3 months post treatment. Furthermore, different patterns of relationships between swallow function measures and oral morbidities were obtained at the 6-week versus the 3-month assessment point suggesting that different mechanisms may contribute to the development versus the maintenance of dysphagia over the trajectory of treatment in these patients.

Acute Stage Longitudinal Change of Quality of Life from Pre- to 3 Months after Surgical Treatment in Head and Neck Cancer Patients

“…Dysphagia is among the most prevalent and debilitating symptoms resulting from HNC treatment. It has been reported that different mechanisms may contribute to the development and maintenance of dysphagia during HNC treatment (Ihara et al, 2018). The pattern in correlation between QOL and functional assessment items differed according to the time point after treatment.…”

“…Common oral morbidities resulting from HNC treatment include oral pain, oral dryness, and altered taste and smell perception. One of the most prevalent and debilitating side effects of HNC treatment is dysphagia (i.e., swallowing difficulty) (Ihara et al, 2018) that may develop as both acute and chronic complication of HNC treatment (Hutcheson et al,2012;Van den Berg et al, 2014). Dysphagia has been reported in over 76% of HNC patients treated with concurrent chemotherapy (CRT).…”

“…However, only few studies have conducted a multidirectional analysis that include QOL before and after HNC treatment. Further, majority of previous studies focused on HNC patients who received chemoradiation therapy (Van den Berg et al, 2014;Rütten et al, 2011;Ihara et al, 2018;Hutcheson et al, 2012;Kalyanam et al, 2018). Some previous study reported that QOL of HNC patients were returned baseline (before treatment) after a year post treatment (Gritz et al, 1999;Martine et al, 2019;Marzouki et al, 2018).…”

Analysis of pharyngeal edema post‐chemoradiation for head and neck cancer: Impact on swallow function

“…7,8 It should be noted, however, that both of these prior studies were conducted on patients >3 months post-CRT; a time when the acute effects of radiation such as mucositis and radiation dermatitis, which cause pain, excessive mucous production, and xerostomia, would have likely subsided. 5 It is plausible that at the early time point (one month post-CRT treatment completion) captured in this study, the etiology of dysphagia is multi-faceted, 26 with factors other than edema alone contributing to increased EAT-10 and DIGEST scores post-treatment. Inspection of the data plotted in Figures 2 and 3 visually confirms the regression results.…”

Subjective functional outcomes in oropharyngeal cancer treated with induction chemotherapy using the MD Anderson Symptom Inventory (MDASI)

“…While other reviews have suggested good IC responses can allow for reduction in subsequent RT dosing, risk-based RT dose de-escalation was not used in this cohort of patients. Thus the feeding tube requirements were still significant in this population of patients but were not significantly worse compared to historical data for OPC patients in general, 22 although patient reported dysphagia may under-estimate physiologic assessment of dysphagia. 23 Our experience has defined patients with T3-4 tumors, those undergoing concurrent chemotherapy with radiation, current active smoking while on therapy, and baseline swallowing dysfunction or weight loss are more likely to have feeding tube placement; however, adherence to an aggressive swallowing program may reduce long-term dependency.…”