“Pharyngocise”: Randomized Controlled Trial of Preventative Exercises to Maintain Muscle Structure and Swallowing Function During Head-and-Neck Chemoradiotherapy

Carnaby-Mann, Giselle; Crary, Michael A.; Schmalfuss, Ilona M.; Amdur, Robert J.

doi:10.1016/j.ijrobp.2011.06.1954

Cited by 273 publications

(280 citation statements)

References 22 publications

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“…This method was pioneered by Ogilvie et al [50] and more recently utilised by Crowther et al [51] to provide a visual display of synthesised evidence, where lack of homogeneity between studies has precluded the traditional use of a forest plot. The average TREND score was 13.8 (range, [10][11][12][13][14][15][16][17][18]. Despite the variable scorings, studies were deemed to have sufficiently comparable quality in their methodology and reported findings, hence none warranted exclusion from the final cohort.…”

Section: Methodological Qualitymentioning

confidence: 99%

“…Historically, treatment approaches have been reactive, with rehabilitation administered after medical intervention (either surgical or non-surgical). However, emerging evidence [15][16][17][18][19] has instigated a shift towards the use of preventative dysphagia rehabilitation, based on the premise that proactively exercising swallowing structures known to be negatively impacted by radiation may limit the extent of (C)RT-induced dysfunction [20].…”

Section: Introductionmentioning

confidence: 99%

“…In particular, the findings of three RCTs [16,17,19] have demonstrated that patients who underwent prophylactic swallowing rehabilitation protocols pre-and/or during (C)RT had superior outcomes across a range of swallowing indexes following treatment, including: improved functional swallowing outcomes; significantly less deterioration in head and neck muscle composition; less decline in mouth opening, taste and smell; better preservation of salivary PHYSIOLOGICAL SWALLOWING DEFICITS FOLLOWING (C)RT FOR HNC 4 flow; and fewer patients requiring or dependent on gastrostomy tube feeding. However, despite each reporting some degree of positive findings for prophylactic swallowing exercises in the (C)RT-HNC population, examination of the study protocols reveals wide variability in the exercises employed, with each study reporting use of different groups of therapy tasks.…”

Section: Introductionmentioning

confidence: 99%

“…However, despite each reporting some degree of positive findings for prophylactic swallowing exercises in the (C)RT-HNC population, examination of the study protocols reveals wide variability in the exercises employed, with each study reporting use of different groups of therapy tasks. In each, a range of between two and five therapy tasks have been implemented, which have included batteries of stretch and strengthening techniques including: tongue-base strengthening, range of motion and retraction exercises, Masako, effortful swallow, supersupraglottic swallow and Mendelsohn manoeuvres, falsetto, jaw range of motion and jaw resistance training using the Therabite Jaw Rehabilitation System (Atos Medical AB, Hörby, Sweden) [16,17,19]. Great diversity in prophylactic exercise protocols has also been revealed in the clinical domain.…”

Section: Introductionmentioning

confidence: 99%

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Physiological Changes to the Swallowing Mechanism Following (Chemo)radiotherapy for Head and Neck Cancer: A Systematic Review

et al. 2013

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Emerging research suggests that preventative swallowing rehabilitation, undertaken pre-or during (chemo)radiotherapy ([C]RT), can significantly improve early swallowing outcomes for head and neck cancer (HNC) patients. However, these treatment protocols are highly variable. Determining specific physiological swallowing parameters which are most likely to be impacted post-(C)RT would assist in refining clear targets for preventative rehabilitation.Therefore, this systematic review (1) examined the frequency and prevalence of physiological swallowing deficits observed post-(C)RT for HNC, and (2) determined the patterns of prevalence of these key physiological deficits over time post-treatment. Online databases were searched for relevant papers published between January 1998 and March 2013. In total, 153 papers were identified and appraised for methodological quality and suitability based on exclusionary criteria. Ultimately, nineteen publications met the study's inclusion criteria.Collation of reported prevalence of physiological swallowing deficits revealed reduced laryngeal excursion, base of tongue (BOT) dysfunction, reduced pharyngeal contraction and impaired epiglottic movement as most frequently reported. BOT dysfunction and impaired epiglottic movement showed a collective prevalence of over 75% in the majority of patient cohorts, whilst reduced laryngeal elevation and pharyngeal contraction had a prevalence of over 50%. Sub-analysis suggested a trend that the prevalence of key deficits is dynamic although persistent over time. These findings can be used by clinicians to inform preventative intervention, and support the use of specific, evidence-based therapy tasks explicitly selected to target the highly prevalent deficits post-(C)RT for HNC.

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Section: Methodological Qualitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Physiological Changes to the Swallowing Mechanism Following (Chemo)radiotherapy for Head and Neck Cancer: A Systematic Review

et al. 2013

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“…swallowing function and reduce the need for enteral feeding [4][5][6] . Earlier dysphagia intervention is also shown to have an overall positive effect on quality of life (qol) for these patients 7 .…”

mentioning

confidence: 99%

Feasibility of Assessing Patient Health Benefits and Incurred Costs Resulting from Early Dysphagia Intervention during and Immediately after Chemoradiotherapy for Head-and-Neck Cancer

et al. 2017

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Eat and Exercise During Radiotherapy or Chemoradiotherapy for Pharyngeal Cancers

Hutcheson

Bhayani

Beadle

et al. 2013

JAMA Otolaryngol Head Neck Surg

208

215

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Objective Proactive swallowing therapy promotes ongoing use of the swallowing mechanism during radiotherapy through 2 goals: eat and exercise. The purpose of this study was to evaluate the independent effects of maintaining oral intake throughout treatment and preventive swallowing exercise. Design Retrospective observational study. Setting The University of Texas MD Anderson Cancer Center, Houston. Patients The study included 497 patients treated with definitive radiotherapy (RT) or chemoradiation (CRT) for pharyngeal cancer (458 oropharynx, 39 hypopharynx) between 2002 and 2008. Main Outcome Measures Swallowing-related endpoints were: final diet after RT/CRT and length of gastrostomy-dependence. Primary independent variables included per oral (PO) status at the end of RT/CRT (nothing per oral [NPO], partial PO, 100% PO) and swallowing exercise adherence. Multiple linear regression and ordered logistic regression models were analyzed. Results At the conclusion of RT/CRT, 131 (26%) were NPO, 74% were PO (167 [34%] partial, 199 [40%] full). Fifty-eight percent (286/497) reported adherence to swallowing exercises. Maintenance of PO intake during RT/CRT and swallowing exercise adherence were independently associated (p<0.05) with better long-term diet after RT/CRT and shorter length of gastrostomy dependence in models adjusted for tumor and treatment burden. Conclusions Data indicate independent, positive associations between maintenance of PO intake throughout RT/CRT and swallowing exercise adherence with long-term swallowing outcomes. Patients who either eat or exercise fare better than those who do neither. Patients who both eat and exercise have the highest return to a regular diet and shortest gastrostomy dependence.

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“Pharyngocise”: Randomized Controlled Trial of Preventative Exercises to Maintain Muscle Structure and Swallowing Function During Head-and-Neck Chemoradiotherapy

Cited by 273 publications

References 22 publications

Physiological Changes to the Swallowing Mechanism Following (Chemo)radiotherapy for Head and Neck Cancer: A Systematic Review

Physiological Changes to the Swallowing Mechanism Following (Chemo)radiotherapy for Head and Neck Cancer: A Systematic Review

Feasibility of Assessing Patient Health Benefits and Incurred Costs Resulting from Early Dysphagia Intervention during and Immediately after Chemoradiotherapy for Head-and-Neck Cancer

Eat and Exercise During Radiotherapy or Chemoradiotherapy for Pharyngeal Cancers

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