Pathophysiology of Radiation-Induced Dysphagia in Head and Neck Cancer

King, Suzanne N.; Dunlap, Neal E.; Tennant, Paul; Pitts, Teresa

doi:10.1007/s00455-016-9710-1

Cited by 193 publications

(194 citation statements)

References 101 publications

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“…Standardizing outcome measures and agreement on the key evaluation time-points will greatly progress efforts to understand if swallowing exercise interventions are indeed beneficial for this group of patients and over what time period. Consideration should also be given to the expected trajectory of swallowing recovery after head and neck cancer treatment including the possible onset of late effects of treatment such as post radiation fibrosis known to impair swallow function [53, 54]. …”

Section: Discussionmentioning

confidence: 99%

Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises

et al. 2017

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BackgroundDysphagia is a significant side-effect following treatment for head and neck cancers, yet poor adherence to swallowing exercises is frequently reported in intervention studies. Behaviour change techniques (BCTs) can be used to improve adherence, but no review to date has described the techniques or indicated which may be more associated with improved swallowing outcomes.MethodsA systematic review was conducted to identify behavioural strategies in swallowing interventions, and to explore any relationships between these strategies and intervention effects. Randomised and quasi-randomised studies of head and neck cancer patients were included. Behavioural interventions to improve swallowing were eligible provided a valid measure of swallowing function was reported. A validated and comprehensive list of 93 discrete BCTs was used to code interventions. Analysis was conducted via a structured synthesis approach.ResultsFifteen studies (8 randomised) were included, and 20 different BCTs were each identified in at least one intervention. The BCTs identified in almost all interventions were: instruction on how to perform the behavior, setting behavioural goals and action planning. The BCTs that occurred more frequently in effective interventions, were: practical social support, behavioural practice, self-monitoring of behaviour and credible source for example a skilled clinician delivering the intervention. The presence of identical BCTs in comparator groups may diminish effects.ConclusionsSwallowing interventions feature multiple components that may potentially impact outcomes. This review maps the behavioural components of reported interventions and provides a method to consistently describe these components going forward. Future work may seek to test the most effective BCTs, to inform optimisation of swallowing interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2990-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises

et al. 2017

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“…Pre-treatment swallowing dysfunction induced by the tumor-driven destruction of normal tissue is possible, particularly with locally advanced stage disease. Baseline dysfunction increases risk of chronic or persistent RAD [91]. Likewise, the prognostic relevance of acute radiation-induced symptoms for the development of late dysphagia underscores the etiologic role of inflammation [11].…”

Section: Dysphagiamentioning

confidence: 99%

Treatment of late sequelae after radiotherapy for head and neck cancer

Strojan

Hutcheson

Eisbruch

et al. 2017

Cancer Treatment Reviews

254

171

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Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.

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“…Radiation‐associated dysphagia (RAD) is typically linked with soft tissue injuries including inflammation, edema, fibrosis, and stricture . Acute tissue injury results from cell depletion and inflammation that contribute to edema, erythema, and mucositis of the oropharyngeal region . Late RT injury is defined classically as 3 months or more after cancer treatment and may represent persistence of early injury (ie, “consequential late effects”) or new damage linked to excessive collagen accumulation, microvascular damage, and overproduction of pro‐fibrotic growth factors β (TGF‐β1) resulting in fibrosis and atrophy .…”

Section: Introductionmentioning

confidence: 99%

Swallowing‐related outcomes associated with late lower cranial neuropathy in long‐term oropharyngeal cancer survivors: cross‐sectional survey analysis

et al. 2019

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Background The purpose of this study was to quantify the association of late lower cranial neuropathy (late LCNP) with swallowing‐related quality of life (QOL) and functional status among long‐term oropharyngeal cancer (OPC) survivors. Methods Eight hundred eighty‐nine OPC survivors (median survival time: 7 years) who received primary treatment at a single institution between January 2000 and December 2013 completed a cross‐sectional survey (56% response rate) that included the MD Anderson Dysphagia Inventory (MDADI) and self‐report of functional status. Late LCNP events ≥3 months after cancer therapy were abstracted from medical records. Multivariate models regressed MDADI scores on late LCNP status adjusting for clinical covariates. Results Overall, 4.0% (n = 36) of respondents developed late LCNP with median time to onset of 5.25 years post‐treatment. LCNP cases reported significantly worse mean composite MDADI (LCNP: 68.0 vs no LCNP: 80.2; P < .001). Late LCNP independently associated with worse mean composite MDADI (β = −6.7, P = .02; 95% confidence interval [CI], −12.0 to −1.3) as well as all MDADI domains after multivariate adjustment. LCNP cases were more likely to have a feeding tube at time of survey (odds ratio [OR] = 20.5; 95% CI, 8.6‐48.9), history of aspiration pneumonia (OR = 23.5; 95% CI, 9.6‐57.6), and tracheostomy (OR = 26.9; 95% CI, 6.0‐121.7). Conclusions In this large survey study, OPC survivors with late LCNP reported significantly poorer swallowing‐related QOL and had significantly higher likelihood of poor functional status. Further efforts are necessary to optimize swallowing outcomes to improve QOL in this subgroup of survivors.

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Pathophysiology of Radiation-Induced Dysphagia in Head and Neck Cancer

Cited by 193 publications

References 101 publications

Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises

Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises

Treatment of late sequelae after radiotherapy for head and neck cancer

Swallowing‐related outcomes associated with late lower cranial neuropathy in long‐term oropharyngeal cancer survivors: cross‐sectional survey analysis

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