Dysphagia in treated nasopharyngeal cancer

Hughes, Penelope J.; Scott, P. M. J.; Kew, J.; Cheung, D.; Leung, S. F.; Ahuja, Anil T.; Hasselt, C. Andrew van

doi:10.1002/1097-0347(200007)22:4<393::aid-hed13>3.0.co;2-2

Cited by 133 publications

(103 citation statements)

References 12 publications

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“…16,17 While xerostomia is observed to increase oral and pharyngeal transit times, it is not believed to affect laryngeal elevation or pharyngeal contraction. In addition, there is impaired mobility of muscles of the pharynx that can decrease pharyngeal clearance and impair laryngeal closure, resulting in residue pooling.…”

Section: Discussionmentioning

confidence: 99%

“…Much weaker correlations were found between the Patterson scale and the DOSS, once again highlighting the strength of the NOMS classification with swallowing function. 17 There was a correlation between objective findings on NOMS and DOSS scales with EL on the Foldi scale. Once again NOMS yielded a stronger correlation in each situation than DOSS.…”

Section: Discussionmentioning

confidence: 99%

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Internal Lymphedema Correlates with Subjective and Objective Measures of Dysphagia in Head and Neck Cancer Patients

Jackson

Ridner

Deng

et al. 2016

Journal of Palliative Medicine

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Background: Tumor/treatment-related internal lymphedema (IL) and/or external lymphedema (EL) are associated with functional deficits and increased symptom burden in head and neck cancer patients (HNCP). Previously, we noted association between EL/IL and patient-reported dysphagia using the Vanderbilt Head and Neck Symptom Survey (VHNSS) version 1.0. Objective: To determine the relationship between IL/EL and subjective and objective measures of swallowing function. Methods: Eighty-one HNCP completed: (1) VHNSS version 2.0, including 13 swallowing/nutrition-related questions grouped into three clusters: swallow solids (ss), swallow liquids (sl), and nutrition(nt); (2) physical assessment of EL using Foldi scale; (3) endoscopic assessment of IL using Patterson scale (n = 56); and (4) modified barium swallow study rated by dysphagia outcome and severity scale (DOSS) and in conjunction with a swallow evaluation by National Outcomes Measurement System (NOMS). Examinations were performed at varied time points to assess lymphedema spectrum, from baseline (n = 15, 18.1%) to 18 months post-therapy (n = 20, 24.1%). Results: VHNSS swallow/nutrition items scores correlated with NOMS/DOSS ratings ( p < 0.001). Highest correlation was with NOMS: ss (-0.73); sl (-0.61); nt (-0.56). VHNSS swallow/nutrition scores correlated with maximum grade of swelling for any single structure on Patterson scale: ss (0.43; p = 0.001); sl (0.38; p = 0.004); nt (0.41; p = 0.002). IL of aryepiglottic/pharyngoepiglottic folds, epiglottis, and pyriform sinus were most strongly correlated with VHNSS and NOMS ratings. NOMS/DOSS ratings correlated with EL (> = -0.34; p < 0.01). No meaningful correlations exist between VHNSS swallow/nutrition items and EL (< -0.15, p > 0.20). Conclusions: IL correlated with subjective and objective measures of swallow dysfunction. Longitudinal analysis of trajectory and impact of IL/EL on dysphagia is ongoing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Internal Lymphedema Correlates with Subjective and Objective Measures of Dysphagia in Head and Neck Cancer Patients

Jackson

Ridner

Deng

et al. 2016

Journal of Palliative Medicine

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“…11 Delayed neuroendocrine and neuropsychological dysfunctions after RT also have been reported. 12,13 The psychosocial well being of NPC survivors has been less well studied, although a high prevalence of psychological morbidity and poorer healthrelated quality of life compared with normal controls had been demonstrated.…”

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confidence: 99%

A prospective study of the impact of nasopharyngeal cancer and radiotherapy on the psychosocial condition of Chinese patients

Lee

Kwan

Kwong

et al. 2007

Cancer

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BACKGROUND.Radiotherapy (RT) promises optimistic results in the treatment of nasopharyngeal cancer (NPC). The objective of the current study was to map out prospectively the impact of NPC and RT on patients from diagnosis to 1 year posttreatment.METHODS.For this study, 67 Chinese patients (46 men and 21 women) with newly diagnosed stage I or II NPC who received primary RT were recruited. Physical and psychosocial adjustments were measured by using the Rotterdam Symptom Checklist, Beck Anxiety Inventory, Beck Depression Inventory, Perceived Stress Scale, and the 36‐item Short‐Form Health Survey (SF‐36). Semistructured clinical interviews were conducted at bimonthly intervals from pre‐RT to 1 year post‐RT.RESULTS.Physical and psychosocial adjustments were poorest from pre‐RT to the end of RT. Rapid improvements in all areas were noted in the first 2 months post‐RT and reached a plateau at around the 6th month. At 1 year, except for physical symptoms and perceived stress, patient measures recovered to their pre‐RT levels. At 1 year, patients had more physical complaints (P < .001) but less perceived stress (P = .002). The percentage of patients who expressed fear of dying dropped from 28% pre‐RT to 2% at 1 year. However, patients who expressed “fear of the worst happening” increased from 51% pre‐RT to 57% at 1 year.CONCLUSIONS.Different periods in treatment of NPC imposed different psychosocial demands on patients. The current results indicated that the period from diagnosis to 2‐month post‐RT was a high‐risk period both physically and emotionally. After treatment, most patients showed resilience despite persistent side effects of RT and successfully resumed their pretreatment level of functioning by the end of the year. Despite resuming a normal or near‐normal living, patients still noted a subdued fear of recurrence. Cancer 2007. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

“…2,9,[14][15][16][17] Decreased tongue mobility and strength, impairment in bolus preparation and transport, increased oral residue were described as oral phase disorders. 15,18,19 Delayed triggering swallowing reflex, impairment in velopharyngeal closure, decreased tongue base retraxion, pharyngeal contraction, hyolaryngeal elevation, airway closure, upper esophageal sphincter (UOS) opening and increased residue in tongue base, vallecula, pharynx and pyriform sinus were determined as phryngeal disorders after RT. 3,14,15,[20][21][22][23] In a study, decreased tongue base retraxion and hyolaryngeal elevation 1 month after CRT, delayed triggering swallowing reflex, impairment in airway closure 3 months after CRT, decreased UOS opening 6 and 12 months after CRT were found.…”

Section: Discussionmentioning

confidence: 99%

Head and Neck Cancer: Changes in Artrokinematic Parameters of Neck and Swallowing Function after Radiotherapy

Selen¹

2013

UHOD

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The study aimed to show the changes on artrokinematic parameters of the neck and swallowing function after radiotherapy (RT) in head and neck cancer (HNC) patients. The fourty patients with HNC have been evaluated before, 1 and 3 months after RT. The posture, normal joint movement, muscle strength and endurance of the neck were evaluated as artrokinematic parameters. The clinical and radiological swallowing function evaluations were also done. Mean age of patients were 53,22±10,92 years. Head anterior tilt, kyphosis and shoulder protraction were more in the 3rd month after RT in posture analysis (p< 0.001). The neck flexion, lateral flexion and rotation limitations have increased (p< 0.001), neck muscle strength and endurance have gradually decreased (p< 0,001) after RT. At the same time, swallowing phases have been adversely affected after RT with all these side effects (p< 0.001) and the severity of aspiration in all consistencies has increased gradually (p< 0.05). As a result, RT starts to show its negative effects from the early period of cancer treatment. Unlike other studies, we concluded that RT affects head and neck structures negatively and these describes how RT affects swallowing function. So it is highly important to include head and neck structure mobility, strength and endurance assessments and exercises in swallowing rehabilitation.Keywords: Head and neck cancer, Radiotherapy, Swallowing, Neck structures, Dysphagia ÖZET Bafl Boyun Kanseri: Radyoterapi Sonras› Boyun Artrokinematik Parametreleri ve Yutma Fonksiyonundaki De¤iflikliklerÇal›flman›n amac›; bafl boyun kanserli (BBK) hastalarda radyoterapi (RT) sonras› boyun artrokinematik parametreleri ve yutma fonksiyonundaki de¤ifliklikleri göstermektir. BBK'l› 40 hasta RT öncesi, sonras› 1 ve 3. aylarda de¤erlendirildi. Artrokinematik parametreler olarak boyun postür, normal eklem hareketi, kas kuvvet ve endurans› de¤erlendirildi. Klinik ve radyolojik yutma fonksiyon de¤er-lendirmeleri de yap›ld›. Hastalar›n yafl ortalamas› 53,22±10,92 y›ld›. Postür analizinde bafl anterior tilti, kifoz ve omuz protraksiyonu RT sonras› 3. ayda daha fazla idi (p< 0.001). RT sonras› boyun fleksiyon, lateral fleksiyon ve rotasyon limitasyonlar› artt› (p< 0.001), boyun kas kuvvet ve endurans› giderek azald› (p< 0.001). Ayn› zamanda RT sonras› tüm bu yan etkilerle birlikte yutma fazlar› kötü yönde etkilendi (p< 0.001) ve tüm k›vamlarda aspirasyon fliddeti giderek artt› (p< 0.05). Sonuç olarak RT erken dönemden itibaren olumsuz etkilerini göstermeye bafllamaktad›r. Di¤er çal›flmalardan farkl› olarak RT'nin bafl ve boyun yap›lar›n› olumsuz yönde etkiledi¤i ortaya konuldu ve bu da RT'nin yutma fonksiyonunu nas›l etkiledi¤i aç›klamaktad›r. Bu yüzden yutma rehabilitasyonuna bafl boyun yap› hareketlilik, kuvvet ve endurans de¤erlendirme ve egzersizlerini dahil etmek çok önemlidir.

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Dysphagia in treated nasopharyngeal cancer

Cited by 133 publications

References 12 publications

Internal Lymphedema Correlates with Subjective and Objective Measures of Dysphagia in Head and Neck Cancer Patients

Internal Lymphedema Correlates with Subjective and Objective Measures of Dysphagia in Head and Neck Cancer Patients

A prospective study of the impact of nasopharyngeal cancer and radiotherapy on the psychosocial condition of Chinese patients

Head and Neck Cancer: Changes in Artrokinematic Parameters of Neck and Swallowing Function after Radiotherapy

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