Treatment toxicities and their impact on oral intake following non-surgical management for head and neck cancer: a 3-year longitudinal study

Barnhart, Molly K.; Robinson, Rachelle A.; Simms, Virginia A.; Ward, Elizabeth C.; Cartmill, Bena; Chandler, Sophie J.; Smee, Robert

doi:10.1007/s00520-018-4076-6

Cited by 40 publications

(66 citation statements)

References 34 publications

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“…Patients' perception of dry mouth has been examined in the primary CRT population, often using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck–35 (EORTC QLQ‐H&N35) patient‐rated QOL scale. Studies have typically examined outcomes within the first 6 to 12 months; however, studies have shown complaints of xerostomia up to 3 years following radiotherapy (RT) .…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17][18][19][20][21] In addition, this test has been performed in conjunction with a battery of other vocal tract assessments, as it can easily be completed during a clinic visit. [15][16][17][18][19][20] Patients' perception of dry mouth has been examined in the primary CRT population, 14,15,[20][21][22][23] 24 patient-rated QOL scale. Studies have typically examined outcomes within the first 6 to 12 months 15,20,25 ; however, studies have shown complaints of xerostomia up to 3 years following radiotherapy (RT).…”

Section: Introductionmentioning

confidence: 99%

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Objective and subjective hyposalivation after treatment for head and neck cancer: Long‐term outcomes

Likhterov

Ru²,

Ganz

et al. 2018

The Laryngoscope

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Objectives This study examined saliva weight over time and its association with diet and patient-rated swallowing, dry mouth, sticky saliva, and dysgeusia QoL in HNCA patients treated with surgery (S) plus adjuvant (chemo)radiotherapy (CRT), or primary (C)RT. Methods Prospective cohort study in outpatient HNCA Center setting. Patients were seen pre-treatment, 1,3,6,12,24 and 36+ months post-treatment. All had newly diagnosed oral, oropharynx, nasopharynx, larynx/hypopharynx cancer from 2010–2016 who were to undergo S+(C)RT or primary (C)RT. Stimulated saliva weight was assessed with the Saxon test. Diet, eating, dry mouth and dysguesia QoL were assessed and correlated with saliva weight, treatment modality, and tumor site. Results Saliva weight decreased the most within the first 3 months across treatment groups, except for the S+(C)RT group, which continued to decline. Similar trends were seen by tumor site. PSS Normalcy of Diet and all QoL scores declined following treatment. EORTCHN35 QoL EAT-10, MDADI Composite, Global, and subdomain scores and PSS Diet were significantly correlated with saliva weight. Conclusions Saliva weight worsened post-treatment across groups and tumor site, with improvement by 36+ months. Saliva weight correlated with diet, eating QoL and perception of dysguesia across time points. Despite dose-sparing IMRT, newer technologies are needed to preserve saliva production and maintain higher QoL.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Objective and subjective hyposalivation after treatment for head and neck cancer: Long‐term outcomes

Likhterov

Ru²,

Ganz

et al. 2018

The Laryngoscope

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“…Xerostomia is an unpleasant symptom which may negatively interfere with many aspects of daily life: oral pain, difficult meal selection (in terms of both nutritional value and food consistency), time required to finish a meal, quality of sleep, and speech difficulties. There has been a shift away from clinician‐rated toxicity to patient‐focused reporting of symptoms to improve understanding of the patient experience as it has been alleged that observer‐rated scores have underestimated the severity of symptoms . Furthermore, it has been reported that saliva volume does not always correlate with subjective symptoms of xerostomia .…”

Section: Discussionmentioning

confidence: 99%

“…There has been a shift away from clinician-rated toxicity to patientfocused reporting of symptoms to improve understanding of the patient experience as it has been alleged that observer-rated scores have underestimated the severity of symptoms. 18,19 Furthermore, it has been reported that saliva volume does not always correlate with subjective symptoms of xerostomia. 20 This study still included objective saliva volume as an outcome as purely subjective measurements may not be accepted by some for inclusion in meta-analysis studies.…”

Section: Discussionmentioning

confidence: 99%

Hyperbaric oxygen treatment for the management of radiation‐induced xerostomia

2018

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“…Radiation associated dysphagia can also result from the acute toxicities associated with treatment including but not limited to: mucositis, pain, xerostomia, thick saliva, dysgeusia, nausea, fatigue, altered sensation, and fibrotic tissue changes within the head and neck region (Barnhart et al, 2018;Cartmill, Cornwell, Ward, Davidson, & Porceddu, 2013;Chera et al, 2014;Hj Wu, 2009;Holländer-Mieritz et al, 2019;Logemann et al, 2008;Siddiqui & Movsas, 2017). These related toxicities will be discussed in detail in the below sections as they relate to acute and late toxicity.…”

Section: Dysphagia and Related Toxicitiesmentioning

confidence: 99%

Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

Moroney¹

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The management of head and neck cancer (HNC) using radiotherapy +/-chemotherapy (C)RT is associated with significant morbidity, due to key structures required for speech, swallowing, respiration, and voice falling within the treatment field. Common sequelae of non-surgical treatment include a wide range of toxicities, though dysphagia (swallowing difficulty) is particularly prominent. Dysphagia may be a short-term acute toxicity, or persist long-term, and can have a significant negative impact on quality of life. With recent advancements in technology, new conformal radiotherapy techniques such as helical intensity modulated radiotherapy (H-IMRT) have been introduced into clinical practice. Such techniques offer potential to limit the radiation exposure to non-cancerous normal tissues, and potentially reduce associated treatment toxicities -whilst maintaining cure rates. However as yet, there is limited literature documenting the incidence, severity, and pattern of treatment related toxicities, including dysphagia, associated with H-IMRT +/-chemotherapy, to support if such improvements for the patient are realised. Understanding how patients are impacted by new treatment approaches is crucial information for speech pathology services, that manage the dysphagia and related toxicities of patients. Therefore, the overall objective of this thesis was to evaluate the incidence and severity of dysphagia and related toxicities of patients undergoing H-IMRT +/-chemotherapy to inform speech pathology management practices. A secondary objective was to use this information to develop, and then evaluate a new clinical pathway of care. These objectives were addressed in a series of 4 studies.Study 1 (Chapter 2) prospectively examined the range of dysphagia and related toxicities from baseline to 12 weeks post H-IMRT +/-chemotherapy for a heterogeneous cohort of patients with mixed tumour sites and stages. A high proportion of patients were found to continue to experience grade 2-3 toxicity that peaked in the final week of treatment. Symptoms consistently improved thereafter, with the majority better than baseline by 12 weeks post-treatment.Concurrent chemotherapy at least doubled the odds of experiencing most symptoms. The findings of Chapter 2 confirmed that despite advancements in radiotherapy technique, patients iv The findings, clinical implications, limitations, and future areas of research are discussed in Chapter 6 of this thesis. In conclusion, this thesis provides information detailing the incidence, severity, and temporal pattern of dysphagia and related toxicities experienced by patients with HNC undergoing H-IMRT +/-chemotherapy to optimise supportive care and enhance patient education. These findings can be used to inform the timing and intensity of patient centred speech pathology service delivery models that meet the specific needs of patient subgroups and can form the basis of future guidelines for speech pathology support. v

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Treatment toxicities and their impact on oral intake following non-surgical management for head and neck cancer: a 3-year longitudinal study

Abstract: The dysphagia and associated toxicities HNC patients experience are chronic in nature. Rehabilitation should include mealtime strategies and support with adjusting to the changing presence and impact of toxicities on oral intake.

Cited by 40 publications

References 34 publications

Objective and subjective hyposalivation after treatment for head and neck cancer: Long‐term outcomes

Objective and subjective hyposalivation after treatment for head and neck cancer: Long‐term outcomes

Hyperbaric oxygen treatment for the management of radiation‐induced xerostomia

Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

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