Effects of 2 different swallowing exercise regimens during organ‐preservation therapies for head and neck cancers on swallowing function

Virani, Aneesha; Kunduk, Melda; Fink, Daniel; McWhorter, Andrew J.

doi:10.1002/hed.23570

Cited by 58 publications

(49 citation statements)

References 81 publications

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“…As an example, aggressive preventative therapy may ameliorate the soft tissue toxicities in the arena of dysphagia as patients who maintain active swallow efforts throughout the course of radiation and into early recovery have improved swallowing outcomes. [21][22][23] Although the exact mechanism by which proactive swallow therapy enhances long-term outcomes is unknown, it may be postulated that swallowing exercises result in improved lymph flow with decreased acute edema and chronic lymphedema, prevention of constrictive fibrosis, and limiting muscular atrophy.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study of the Lymphedema and Fibrosis Continuum in Patients with Head and Neck Cancer

Ridner

Dietrich

Niermann

et al. 2016

Lymphatic Research and Biology

105

111

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Background: The purpose of this study was to determine the prevalence and nature of internal, external, and combined lymphedema and fibrosis in patients with head and neck cancer (HNC). Materials and Methods: We obtained consent from 100 patients newly diagnosed with having cancer of the head and neck for a 4-year, prospective, longitudinal descriptive study. Recruitment began in August 23, 2010, and the study was completed in April 24, 2014. Eighty-three were evaluated at regular intervals from preradiation therapy to 18 months post-treatment. Percentage developing external, internal, or both types of lymphedema and/or fibrosis and trajectories of the severity of external, internal, or both types of lymphedema and/or fibrosis were determined. Results: Before treatment, lymphedema rates were the following: external: 62.7%, internal: 41.7%, or combined: 29.2%, and/or fibrosis: 42.2%. Ranges of lymphedema late-effect rates were even higher: external: 81.9%-90.1%, internal: 80.4%-89.4%, combined: 70.6%-80.9%, and fibrosis: 66.7%-77.4%. Approximately 75% had a late-effect trajectory characterized by moderate to severe external or internal lymphedema; *47% had moderate to severe fibrosis. Conclusion: Lymphatic and soft tissue complications of HNC occur not only post-treatment but also before treatment. They are ubiquitous throughout the first 18 months post-treatment, with greater than 90% of patients in our study experiencing some form of internal, external, or combined lymphedema, and over half of those patients developing fibrosis. Further research regarding these conditions is indicated.

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Section: Discussionmentioning

confidence: 99%

A Prospective Study of the Lymphedema and Fibrosis Continuum in Patients with Head and Neck Cancer

Ridner

Dietrich

Niermann

et al. 2016

Lymphatic Research and Biology

105

111

View full text Add to dashboard Cite

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“…As it is generally agreed that prolonged disuse is detrimental to swallow function in the HNC population [21], there has been increasing interest in the potential benefit of prophylactic swallowing interventions conducted intensively during and early post-treatment to reduce dysphagia in patients treated with primary CRT [4, 22–30]. Several studies have found some positive results with varying degrees in functional outcomes [4, 22–26, 28, 29].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have found some positive results with varying degrees in functional outcomes [4, 22–26, 28, 29]. Specifically, some of these studies suggested that patients who underwent CRT and adhered to a swallowing exercise program during and/or after treatment returned to an oral diet sooner, had improved weight gain, shorter duration of gastrostomy tube use, and/or exhibited higher quality of life scores [22, 24–27, 29, 30]. Additionally, less floor of mouth muscle deterioration with the implementation of prophylactic swallow exercise protocols has been shown [22].…”

Section: Introductionmentioning

confidence: 99%

Prophylactic Swallow Therapy for Patients with Head and Neck Cancer Undergoing Chemoradiotherapy: A Randomized Trial

et al. 2017

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Evidence supporting prophylactic swallow exercises for patients with head and neck cancer (HNC) has not been universally demonstrated. This RCT examined diet level, feeding tube use, swallow function, and quality of life (QOL) of patients undergoing chemoradiotherapy who performed prophylactic swallowing exercises. Sixty HNC patients were randomized into exercise versus control groups. Swallowing, oromotor, toxicity, and QOL data were recorded (baseline, 3, 6, 12, 24 months). Physiological swallow function was examined at baseline and 3 months. Swallow exercises were completed twice daily. Oral intake at 3 months was 10% better in the exercise group, which was not statistically significant (p = 0.49). Significant (p < 0.05) differences in secondary outcomes including oromotor function, pharyngeal impairment, oral pharyngeal swallow efficiency, and incisal opening were noted at early time points (3–6 months) in the exercise group. Possible positive early improvements in swallow function are associated with swallowing exercises, although these improvements are not significant longer term.

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“…This was in the context of a research protocol and translation to clinical practice is likely to be challenged by resource limitations. A more recent study provided a program whereby exercises were supervised for 45 min, once a week by an SLP [34]. Patient adherence to preventive swallow exercises during and after treatment remains challenging.…”

Section: Considerations In Dysphagia Managementmentioning

confidence: 98%

“…Active promotion of swallowing and swallowing exercise [28,33,34] Optimizing analgesia in the acute phase [31] Pretreatment counselling and rigorous baseline assessment [35,36] Minimize oral mucositis [37] Psychological care [38] Lymphoedema therapy [39,40] Acupuncture for xerostomia and pain [41] [24,25 & ,26] Question Response…”

Section: Considerations In Dysphagia Managementmentioning

confidence: 99%

Human papilloma virus-related oropharyngeal cancer

Goldsmith

Roe

2015

Current Opinion in Otolaryngology & Head and Neck Surgery

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Clinical trials are now underway to ascertain the effectiveness of tailored treatments for HPV-positive OPC with a focus on swallowing outcomes. It is encouraging that studies are now including detailed, multidimensional swallowing evaluation. Until such time as longitudinal data are available, patients should be treated by speech-language pathologists based on existing radiation treatment protocols and in the knowledge that patients may experience significant late swallowing difficulties.

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Effects of 2 different swallowing exercise regimens during organ‐preservation therapies for head and neck cancers on swallowing function

Abstract: Findings indicate significant benefits of the exercise group's exercise regimen in reducing PEG dependence and oral intake difficulties.

Cited by 58 publications

References 81 publications

A Prospective Study of the Lymphedema and Fibrosis Continuum in Patients with Head and Neck Cancer

A Prospective Study of the Lymphedema and Fibrosis Continuum in Patients with Head and Neck Cancer

Prophylactic Swallow Therapy for Patients with Head and Neck Cancer Undergoing Chemoradiotherapy: A Randomized Trial

Human papilloma virus-related oropharyngeal cancer

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