Dysphagia Treatment for Patients With Head and Neck Cancer Undergoing Radiation Therapy: A Meta-analysis Review

Greco, Elissa; Simić, Tijana; Ringash, Jolie; Tomlinson, George; Inamoto, Yoko; Martino, Rosemary

doi:10.1016/j.ijrobp.2018.01.097

“…Patients with persistent post-treatment dysphagia may benefit from swallowing rehabilitation. 18 Validated screening tools, such as Patient Generated-Subjective Global Assessment, can be used throughout follow-up to detect patients at risk for malnutrition, with early referral to a specialist dietitian. 19 Data from ongoing prospective, randomized trials are needed to minimize treatment-related morbidity in OPSCC.…”

Section: Discussionmentioning

confidence: 99%

De‐escalation of post‐treatment surveillance in oropharyngeal cancer

Ilmarinen

¹

,

Keski-Säntti

²

,

Markkanen‐Leppänen

³

et al. 2018

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Background The majority of new oropharyngeal squamous cell carcinoma (OPSCC) cases are associated with human papillomavirus and favorable prognosis. Post‐treatment follow‐up should be targeted to patients at greatest risk for disease recurrence. Methods To assess the benefits of routine clinical surveillance in OPSCC, we reviewed all follow‐up visits conducted in 2014 at Helsinki University Hospital Department of Otorhinolaryngology. Results Of 366 visits, 26 (7%) were from patients presenting with a new symptom, and disease recurrence was detected in four. The presence of a new symptom was significantly associated with disease recurrence (P < 0.001). Of 366 visits, 340 (93%) were from patients presenting without new symptoms, and not a single recurrence was found during these visits. Conclusions Based on our findings, and previous studies assessing the prognosis and pattern of recurrent OPSCC, we concluded that the number of routine post‐treatment visits can be reduced. Follow‐up should rather focus on symptom‐directed examinations.

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“…The focus of our study has been on feasibility outcomes that will optimise the planning and conduct of a future trial, and therefore does not report on intervention efficacy at this stage. It is encouraging to note that since our initial work on this topic, a more recent meta-analysis of swallowing exercise interventions in the head and neck population has demonstrated that exercises both before and after chemoradiation treatment show improvements in jaw opening and swallow function, with early interventions also having a positive effect on airway protection during swallowing (32). Although the review authors found no evidence for improved quality of life outcomes for either early or late interventions, their meta-analysis and recommendations render further support for more well-designed trials on this subject.…”

Section: Discussionmentioning

confidence: 98%

“…Many previous studies of swallowing exercise interventions in the head and neck population have been reported as definitive trials drawing conclusions about efficacy despite frequent inadequate sample sizes (32). The focus of our study has been on feasibility outcomes that will optimise the planning and conduct of a future trial, and therefore does not report on intervention efficacy at this stage.…”

Section: Discussionmentioning

confidence: 99%

SIP SMART: A parallel group randomised feasibility trial of a tailored pre-treatment swallowing Intervention package compared with usual care for patients with head and neck cancer

Govender

¹

,

Smith

²

,

Barratt

³

et al. 2020

Preprint

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Background: Dysphagia or difficulty in swallowing affects quality of life for most patients with head and neck cancer. SIP SMART – [Swallowing Intervention Package: Self-Monitoring, Assessment, Rehabilitation Training] aims to improve post-treatment swallowing outcomes through a targeted and tailored pre-treatment intervention. This feasibility study assessed 1) recruitment and retention, 2) patient acceptability of randomisation and participation, 3) patient adherence, and 4) sought to identify a suitable primary outcome for a definitive trial, including sample size estimation. Methods: This two-arm parallel group non-blinded randomised feasibility trial took place within a head and neck centre at a teaching hospital in London, UK. Patients newly diagnosed with stage III/IV head and neck cancer were recruited and underwent 6-month follow-up. Patients were randomised to SIP-SMART or usual care via an online web-based system. SIP SMART comprised two 45-minute consultations including a baseline clinical and instrumental swallowing assessment, relevant educational information, targeted swallowing exercises, and specific behaviour change strategies to increase exercise adherence. Usual care comprised a single session including a baseline clinical assessment and generic information about the likely impact of treatment on swallowing. Results: A total of 106 patients were identified at pre-screening, 70 were assessed for eligibility. Twenty-six patients did not meet eligibility criteria [0.37, 95% CI 0.27 to 0.49]. Five of 44 [0.11, 95% CI 0.05 to 0.24] eligible patients were not approached by researchers during clinic. Seven [0.18, 95% CI 0.08 to 0.33] of the 39 approached declined participation. Target recruitment (32 consented patients) was achieved within the timeframe. At 6-months 29/32 [0.91, 95% CI 0.76 to 0.97] patients remained in the trial. Acceptability of randomisation and participation in the intervention was favourable, and adherence to the exercises exceeded the pre-defined 35% minimum criterion. The MD Anderson Dysphagia Inventory swallow related quality of life measure was selected as the most suitable primary outcome for sample size estimation. No adverse effects arose from the intervention, or study participation. Conclusions: A definitive trial of the SIP SMART intervention compared to usual care is feasible and can be undertaken with patients with head and neck cancer treated within the NHS.Trial Registration: ISRCTN40215425, registered retrospectively http://www.isrctn.com/ISRCTN40215425

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“…The focus of our study has been on feasibility outcomes that will optimise the planning and conduct of a future trial, and therefore does not report on intervention efficacy at this stage. It is encouraging to note that since our initial work on this topic, a more recent meta-analysis of swallowing exercise interventions in the head and neck population has demonstrated that exercises both before and after chemoradiation treatment show improvements in jaw opening and swallow function, with early interventions also having a positive effect on airway protection during swallowing (29). Although the review authors found no evidence for improved quality of life outcomes for either early or late interventions, their meta-analysis and recommendations render further support for more well-designed trials on this subject.…”

Section: Discussionmentioning

confidence: 98%

“…Many previous studies of swallowing exercise interventions in the head and neck population have been reported as definitive trials drawing conclusions about efficacy despite frequent inadequate sample sizes (29). The focus of our study has been on feasibility outcomes that will optimise the planning and conduct of a future trial, and therefore does not report on intervention efficacy at this stage.…”

Section: Discussionmentioning

confidence: 99%

SIP SMART: A parallel group randomised feasibility trial of a tailored pre-treatment Swallowing Intervention Package compared with usual care for patients with head and neck cancer

Govender

¹

,

Smith

²

,

Barratt

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: Dysphagia or difficulty in swallowing affects quality of life for most patients with head and neck cancer. SIP SMART – [Swallowing Intervention Package: Self-Monitoring, Assessment, Rehabilitation Training] aims to improve post-treatment swallowing outcomes through a targeted and tailored pre-treatment intervention. This feasibility study assessed 1) recruitment and retention, 2) patient acceptability of randomisation and participation, 3) patient adherence, and 4) sought to identify a suitable primary outcome for a definitive trial, including sample size estimation. Methods: This two-arm parallel group non-blinded randomised feasibility trial took place within a head and neck centre at a teaching hospital in London, UK. Patients newly diagnosed with stage III/IV head and neck cancer were recruited and underwent 6-month follow-up. Patients were randomised to SIP-SMART or usual care via an online web-based system. SIP SMART comprised two 45-minute consultations including a baseline clinical and instrumental swallowing assessment, relevant educational information, targeted swallowing exercises, and specific behaviour change strategies to increase exercise adherence. Usual care comprised a single session including a baseline clinical assessment and generic information about the likely impact of treatment on swallowing. Results: A total of 106 patients were identified at pre-screening, 70 were assessed for eligibility. Twenty-six patients did not meet eligibility criteria [0.37, 95% CI 0.27 to 0.49]. Five of 44 [0.11, 95% CI 0.05 to 0.24] eligible patients were not approached by researchers during clinic. Seven [0.18, 95% CI 0.08 to 0.33] of the 39 approached declined participation. Target recruitment (32 consented patients) was achieved within the timeframe. At 6-months 29/32 [0.91, 95% CI 0.76 to 0.97] patients remained in the trial. Acceptability of randomisation and participation in the intervention was favourable, and adherence to the exercises exceeded the pre-defined 35% minimum criterion. The MD Anderson Dysphagia Inventory swallow related quality of life measure was selected as the most suitable primary outcome for sample size estimation. No adverse effects arose from the intervention, or study participation. Conclusions: A definitive trial of the SIP SMART intervention compared to usual care is feasible and can be undertaken with patients with head and neck cancer treated within the NHS. Trial Registration: ISRCTN40215425

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Dysphagia Treatment for Patients With Head and Neck Cancer Undergoing Radiation Therapy: A Meta-analysis Review

Cited by 93 publications

References 51 publications

De‐escalation of post‐treatment surveillance in oropharyngeal cancer

De‐escalation of post‐treatment surveillance in oropharyngeal cancer

SIP SMART: A parallel group randomised feasibility trial of a tailored pre-treatment swallowing Intervention package compared with usual care for patients with head and neck cancer

SIP SMART: A parallel group randomised feasibility trial of a tailored pre-treatment Swallowing Intervention Package compared with usual care for patients with head and neck cancer

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