Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review

Abstract

Organ preservation with radiotherapy and concomitant chemotherapy has become an accepted treatment modality in advanced head and neck cancer. Unfortunately, organ preservation is not synonymous with function preservation. The aim of this review was to systematically assess the eVects of the disease and chemoradiotherapy (CRT) on functions such as swallowing, mouth opening, nutrition, pain and quality of life in patients with head and neck cancer. Another aim was to search for (evidence-based) techniques or strategies known to alleviate or rehabilitate the loss of function(s) associated with CRT. Two databases were searched (time period, January 1997 to August 2007) for the terms head and neck cancer, chemotherapy or cisplatin and radiotherapy, and the functional outcomes swallowing, trismus, nutrition, pain and quality of life or a variation of those words. In total, 15 relevant articles were identiWed that met the inclusion criteria. The majority of the studies that met the criteria focused on the outcomes swallowing, quality of life, and nutrition. Two studies reported on the outcome pain, but no paper reported on the outcome trismus. Only two papers mentioned rehabilitation options, but speciWc information was lacking. Further long-term prospective research is essential, not only to determine the function impairment caused by the tumor and CRT, but also to assess the eVects of known and newly developed rehabilitation measures. Therefore, in September 2006, the Netherlands Cancer Institute started a randomised clinical trial (RCT): Prevention of trismus, swallowing and speech problems in patients treated with chemoradiotherapy for advanced head and neck cancer. This systematic review was carried out to collect the baseline information for the future outcomes of this RCT.

Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose–effect relationships for swallowing and mastication structures

“…Three important swallowing muscles are the inferior, middle, and superior constrictors, innervated by the vagal nerve [7,8]. Disruption of normal swallowing function (dysphagia), may lead to (silent) aspiration, laryngeal penetration, more than normal residue after the swallow and/or reflux [1,[7][8][9][10][11][12]. The structures involved in mastication are the pterygoid, masseter, and temporalis muscles, and the mandibular condyle [13].…”

Swallowing, nutrition and patient-rated functional outcomes at 6 months following two non-surgical treatments for T1–T3 oropharyngeal cancer

“…Late effects of CRT treatment have been reported to include chronic fibrosis resulting in stiffening of the tongue and hyolaryngeal complex [14], reduced glottic closure and oesophageal stenosis [34], that leads to significant oropharyngeal residue and aspiration. Indeed, a systematic review by van der Molen [35] found that chemoradiation regimens were associated with an increased aspiration rate, and this may result from the toxic effect on the neuromuscular junctions causing generalised weakness, fatigue, and sensory changes [36].…”

Development and feasibility of an electronic-Swallowing Intervention Package (e-SiP) to support swallowing function in patients with head and neck cancer (Preprint)

“…The site of the tumour and the side-effects of treatment can impact on eating and drinking, physical appearance, and communication [7,8]. Improved treatments have lowered mortality rates but at the expense of greater morbidity, with many patients experiencing long term or permanent swallowing problems (dysphagia) [9] and younger survivors reporting the most severe problems [10]. Preparing patients for potential swallowing problems is clinically advised, but it is unclear when and how this should be done [11].…”