A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

Abstract

Altered fractionation radiotherapy for head and neck cancer has been associated with improved locoregional control, overall survival, and heightened toxicity compared with conventional treatment. Swallowing, nutrition and patient-perceived function for altered fractionation radiotherapy with concomitant boost (AFRT-CB) for T1-T3 oropharyngeal SCC has not been previously reported. Fourteen consecutive patients treated with AFRT-CB for oropharyngeal SCC were recruited from November 2006 to August 2009 in a tertiary hospital in Brisbane, Australia. Swallowing, nutrition and patient-perceived functional impact assessments were conducted pre-treatment, at 4-6 weeks post-treatment and at 6 months posttreatment. Deterioration from pre-treatment to 4-6 weeks post-treatment in swallowing, nutrition and functional impact was evident, likely due to the heightened toxicity associated with AFRT-CB. There was significant improvement at 6 months post-treatment in functional swallowing, nutritional status, patient-perceived swallowing and overall function, consistent with recovery from acute toxicity. However, weight and patient-perception of their physical function and side effects remained significantly worse than pre-treatment scores. The ongoing deficits related to weight and patient-perceived outcomes at 6 months revealed this treatment has a long-term impact on function possibly related to the chronic effects of AFRT-CB.

Long-term Functional Outcomes and Patient Perspective Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

“…However, by 12 months post-treatment this had improved with only 7% having ongoing significant dysphagia (11). In a more recent study of the impact of AFRT with a concomitant boost (AFRT-CB) in a homogeneous group of patients with oropharyngeal cancers, the current research team found significant deterioration in functional swallowing, nutrition, and patient-rated functional impact from pretreatment to 6 weeks post-treatment, with some recovery (but still below pretreatment levels) by 6 months post-treatment (10). This pattern of improvement toward 6 months post-treatment also concurs with previous research examining quality of life (QoL) following a hyperfractionated and accelerated radiotherapy protocol (dose/fraction size <1.5-1.6Gy), which found improved outcomes at 6 and 12 months post-treatment compared to baseline (18).…”

“…Acute toxicity, such as mucositis and pain, has been associated with deteriorating functional outcomes known to impact on swallowing and mastication (9), resulting in a large proportion of patients requiring modified diets and nutritional supplementation (10,11).…”

“…Whether or not this same pattern is evident following AFRT requires further investigation, as few studies to date have employed longitudinal study designs which extend to 2 years or more posttreatment. The preliminary data that is currently available would suggest that significant improvements in dysphagia and functional swallowing status can be anticipated in the long term (10,11). Eighteen percent of a heterogenous HNC population who received AFRT required alternative feeding due to dysphagia 1-2 months post-treatment (11).…”

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

“…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). Whilst such research has furthered our understanding of the impact of dysphagia following HNC management, the majority of studies to date have applied quantitative methods to measure the extent of functional change (Barringer, Hutcheson, Sturgis, Kies, & Lewin, 2009;Cartmill, Cornwell, Ward, Davidson, & Porceddu, 2011a;Cartmill et al, 2012;Jensen et al, 2007) or change in QoL (Lovell et al, 2005;Maurer et al, 2011;Nguyen et al, 2005). The value of taking a quantitative approach has been to confirm that a problem exists (Llewellyn et al, 2008;Lovell et al, 2005;Murry, Madasu, Martin, & Robbins, 1998;Nguyen et al, 2005).…”

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

“…At 6 months post-treatment, all participants underwent a range of assessments relating to swallowing, nutrition and the functional impact of treatment which have been described in detail elsewhere [23].…”