Swallowing Exercise During Head and Neck Cancer Treatment: Results of a Randomized Trial

Abstract

The diagnosis and treatment of head and neck cancer (HNC) can have substantial impact on swallowing function, nutritional balance, physical function and quality of life (QoL). Early initiated swallowing exercises are hypothesized to improve swallowing function in HNC patients. The aim was to investigate the effects of swallowing exercises and progressive resistance training (PRT) during radiotherapy on swallowing function, physical function and QoL in patients with pharynx-, larynx-, oral cavity cancer or unknown primary compared to usual care. In a multi-centre RCT participants were assigned to (a) twice-weekly PRT and daily swallowing exercises throughout treatment or (b) usual care. Outcomes were measured at end of treatment and 2, 6 and 12 months after. Primary outcome was penetration aspiration score (PAS). Data were analysed on an “intention-to-treat” basis by GEE logistic regression model, linear mixed effects model and cox regression. Of 371 invited HNC patients, 240 (65%) enrolled. Five participants were excluded. At 12 months follow-up, 59 (25%) participants were lost. Analyses showed significant effect on mouth opening, QoL, depression and anxiety at 12 months when comparing intervention to non-active controls. The trial found no effect on swallowing safety in HNC undergoing radiotherapy, but several positive effects were found on secondary outcomes when comparing to non-active controls. The intervention period may have been too short, and the real difference between groups is too small. Nevertheless, the need to identify long-lasting intervention to slow down or avoid functional deteriorations is ever more crucial as the surviving HNC population is growing.

Health Literacy and Adherence to Clinical Recommendations in Head and Neck Cancer

“…Several studies have shown that pre-emptive counseling, early identification of impairments, and early targeted therapy can reduce physical and socioemotional related morbidity secondary to HNC treatment ( Dawson et al, 2019 ; Guru et al, 2012 ; Lydiatt, 2020 ; Sterba et al, 2019 ). Additionally, recent reports have identified meaningful benefits of PT and SLPT with regard to quality of life (QOL) ( Baudelet et al, 2020 ; Burgos-Mansilla et al, 2021 ; Chiu et al, 2021 ; Hajdú et al, 2022 ). Despite the abundance of data demonstrating the benefit of PT and SLPT, several new reports have identified low adherence rates as a key detractor from the expected positive effects ( Baudelet et al, 2020 ; Chee et al, 2021 ; Chiu et al, 2021 ).…”

Quality of Life as a Mediator between Cancer Stage and Long-Term Mortality in Nasopharyngeal Cancer Patients Treated with Intensity-Modulated Radiotherapy

“…The second strategy entails enhancing QoL through specific interventions. Recommended interventions include the provision of swallowing function training and oral health care training to reduce the severity of dysphagia [38,39], the substitution of saliva for mouthwash to reduce xerostomia [40], implementation of regular home nursing interventions to improve global health [41], implementation of nutrition support and head-and-neck rehabilitation exercise to ameliorate fatigue [42], implementation of psychological interventions (particularly cognitive behavioral therapy) to mitigate depression or anxiety [43], and implementation of transdisciplinary geriatric and palliative care interventions to enhance the QoL of older adults with cancer [44].…”

Dysphagia Advances in Head and Neck Cancer

“…However, dosimeter information is rarely used to direct dysphagia management [ 59 ] and may be important to guide future clinical protocols. New studies have emerged which focus on personalising interventions based on motivation, mental reserve, treatment toxicity and tumour site [ 13 , 60 ]. Individually tailored therapy programmes combine functional skills training with progressive resistance training based on clinical examination of swallowing function [ 61 ].…”