Swallowing dysfunction in cancer patients

Abstract

PurposeDysphagia (swallowing dysfunction) is a debilitating, depressing, and potentially life-threatening complication in cancer patients that is likely underreported. The present paper is aimed to review relevant dysphagia literature between 1990 and 2010 with a focus on assessment tools, prevalence, complications, and impact on quality of life in patients with a variety of different cancers, particularly in those treated with curative chemoradiation for head and neck cancer.MethodsThe literature search was limited to the English language and included both MEDLINE/PubMed and EMBASE. The search focused on papers reporting dysphagia as a side effect of cancer and cancer therapy. We identified relevant literature through the primary literature search and by articles identified in references.ResultsA wide range of assessment tools for dysphagia was identified. Dysphagia is related to a number of factors such as direct impact of the tumor, cancer resection, chemotherapy, and radiotherapy and to newer therapies such as epidermal growth factor receptor inhibitors. Concomitant oral complications such as xerostomia may exacerbate subjective dysphagia. Most literature focuses on head and neck cancer, but dysphagia is also common in other types of cancer.ConclusionsSwallowing impairment is a clinically relevant acute and long-term complication in patients with a wide variety of cancers. More prospective studies on the course of dysphagia and impact on quality of life from baseline to long-term follow-up after various treatment modalities, including targeted therapies, are needed.

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

“…Relevant terminology was operationally defined a priori as follows: (1) head and neck cancer included any malignancies of the head, neck, and/or cervical esophagus, excluding melanomas, lymphomas, and cancers affecting only the superficial face, orbit, ear, or thyroid; (2) prophylactic PEG tube included any PEG tube placed prior to or during radiotherapy with no evidence of premorbid swallowing impairment, weight loss, malnutrition, and/or dehydration; (3) therapeutic/reactive PEG tube included any PEG placed before, during or after radiotherapy with the purpose of addressing an existing malnutrition-, dehydration-, or dysphagia-related concern; (4) radiotherapy included any curative dose of radiation administered either internally (brachytherapy) or externally (external beam) to treat the HNC; (5) primary surgery included any surgical procedure (other than biopsy) used to remove any or all of the primary tumor (therefore, neck dissection was not considered primary surgery, as it is predominantly used to treat nodal metastasis); (6) dysphagia included any impairment of the oropharyngeal phase of swallowing, demonstrated by abnormalities in swallow physiology; and (7) dysphagia-related function and/or quality of life included any change in swallow-related function, oral intake, PEG tube use/dependence (which is sometimes used as a surrogate marker of swallow function [78,79]), and/or quality of life that was specifically linked or attributed to the impaired swallow.…”

“…Some studies used long-term PEG dependence and/or duration of PEG use as a surrogate marker for dysphagia [78,79]. As with dysphagia frequency and dysphagia severity, findings for PEG dependence and/or duration were inconclusive.…”

Qualidade De Vida Em Deglutição E Câncer De Cabeça E Pescoço: Revisão De Literatura

“…Alguns indicadores de problemas de deglutição incluem histórico de dificuldade para deglutir, presença de engasgos/tosse, sensação de bolo na garganta, substituição de consistências alimentares, nutrição deficiente e qualidade vocal anormal depois de deglutir, como por exemplo, a percepção da voz "molhada" 2,14 . Os distúrbios da deglutição representam um grande impacto na QV pela relação da alimentação com os aspectos nutricionais, sociais e com a manutenção da vida 15 .…”

“…Entre os fatores que influenciam na frequência e gravidade da disfagia antes do tratamento e suas sequelas estão o estágio do tumor e a sua localização, desde que estes afetem a motilidade das estruturas envolvidas 2,17,18 . A função da deglutição foi avaliada em 352 pacientes com CCP pré-tratamento.…”

Current assessment and treatment strategies of dysphagia in head and neck cancer patients

“…Raber-Durlacher et al [29] emphasized in their review that dysphagia evaluation should start pretreatment, as many patients may present with swallowing difficulties already pretreatment. Also Tippett and Webster [8] stress that patients should be queried about their pretreatment swallowing status.…”