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

Abstract

Purpose: Altered fractionation radiotherapy with concomitant boost (AFRT-CB) may be considered an alternative treatment for patients not appropriate for chemoradiation (CRT). As functional outcomes following AFRT-CB have been minimally reported, this exploratory paper describes the outcomes of patients managed with AFRT-CB or CRT at 6 months post treatment.Methods: Using a cross-sectional analysis design, functional outcomes of 14 AFRT-CB and 17 CRT patients with T1-T3 oropharyngeal cancers were explored at 6 months post-treatment. Clinical and instrumental swallow assessments, weight and nutritional status, and the functional impact of treatment were examined.Results: Inferior outcomes were observed for the CRT patients on the RBHOMS (p = 0.03) which was reflected in diet and fluid restrictions with 18% of the CRT group requiring modified fluids and diets.Although a trend (p = 0.07) was noted for increased lingual deficits and aspiration risk for fluids in the CRT group, no other significant differences were observed. Both groups experienced an average of 10kg weight loss and reported reduced general and swallowing related function. Conclusions:This preliminary data suggests functional outcomes following AFRT-CB and CRT were largely comparable at 6 months post treatment. Treatment intensification in any form may contribute to impaired function which requires multidimensional intervention. Larger cohort investigations with systematic methodology are needed to further examine these initial findings.Keywords: swallowing, nutrition, oropharyngeal cancer, chemoradiation, altered fractionation radiotherapy This paper aims to inform research by providing further evidence for functional outcomes following non-surgical treatment for head and neck cancer.

Gastrostomy tube placement in patients with oropharyngeal carcinoma treated with radiotherapy or chemoradiotherapy: Factors affecting placement and dependence

“…Despite the small percentage of patients (7.2%) in our study who received 3D conformal treatment, we also found the use of 3D conformal RT techniques to be significantly associated with increased rates of g‐tube placement and prolonged tube dependence compared with the use of IMRT. Although radiotherapy intensification has been shown to improve locoregional control in patients with oropharyngeal cancer, the cost has been increased severity and duration of treatment‐related toxicity leading to increased g‐tube dependence . More conformal planning with IMRT that restricts the dose to pharyngeal musculature uninvolved with the tumor has been shown to reduce significant dysphagia and prolonged g‐tube dependence .…”

Survivors’ experiences of dysphagia‐related services following head and neck cancer: Implications for clinical practice

“…It can lead to serious medical complications such as malnutrition, dehydration, and aspiration pneumonia, as well as decreased functioning, reduced participation in life activities, negative psychosocial consequences, and reduced quality of life (Cartmill et al . , McQuestion et al . , Nguyen et al .…”

“…Dysphagia, or difficulty swallowing, is a common acute and ongoing chronic effect of definitive, nonsurgical treatment for HNC. It can lead to serious medical complications such as malnutrition, dehydration, and aspiration pneumonia, as well as decreased functioning, reduced participation in life activities, negative psychosocial consequences, and reduced quality of life (Cartmill et al 2012, McQuestion et al 2011, Nguyen et al 2005, Nourissat et al 2012, Ottosson et al 2013. Speech and language therapists (SLTs) have an integral role in the diagnosis and management of dysphagia, and are core members of the multidisciplinary HNC team who provide services for people with dysphagia pre, during and post-treatment (Krisciunas et al 2012, Roe et al 2012.…”

The lived experience of dysphagia following non-surgical treatment for head and neck cancer

“…The medical complications of dysphagia following head and neck cancer (HNC), including aspiration, malnutrition, and dehydration are now well recognised (Agarwal et al, 2011;Buchmann, Conlee, Hunt, Agarwal, & White, 2013;Cartmill, Cornwell, Ward, Davidson, & Porceddu, 2011bHutcheson & Lewin, 2012;Nguyen et al, 2008). As a consequence, in more recent literature there has been increased consideration of the functional outcomes and changes to quality of life (QoL) associated with dysphagia in the HNC population (Llewellyn, Weinman, McGurk, & Humphris, 2008;Lovell, Wong, Loh, Ngo, & Wilson, 2005;Nguyen et al, 2005).…”