A Randomized Preventive Rehabilitation Trial in Advanced Head and Neck Cancer Patients Treated with Chemoradiotherapy: Feasibility, Compliance, and Short-term Effects

Abstract

The aim of this study was to assess the effect of (preventive) rehabilitation on swallowing and mouth opening after concomitant chemoradiotherapy (CCRT). Forty-nine patients with advanced oral cavity, oropharynx, hypopharynx and larynx, or nasopharynx cancer treated with CCRT were randomized into a standard (S) or an experimental (E) preventive rehabilitation arm. Structured multidimensional assessment (i.e., videofluoroscopy, mouth-opening measurement, structured questionnaires) was performed before and 10 weeks after CCRT. In both S and E arms, feasibility was good (all patients could execute the exercises within a week) and compliance was satisfactory (mean days practiced per week was 4). Nevertheless, mouth opening, oral intake, and weight decreased significantly. Compared to similar CCRT studies at our institute, however, fewer patients were still tube-dependent after CCRT. Furthermore, some functional outcomes seemed less affected than those of studies in the literature that did not incorporate rehabilitation exercises. Patients in the E arm practiced significantly fewer days in total and per week, but they obtained results comparable to the S arm patients. Preventive rehabilitation (regardless of the approach, i.e., experimental or standard) in head and neck cancer patients, despite advanced stage and burdensome treatment, is feasible, and compared with historical controls, it seems helpful in reducing the extent and/or severity of various functional short-term effects of CCRT.

Trismus and reduced quality of life in patients with oral squamous cell carcinoma, who received post-operative radiotherapy alone or combined with chemotherapy

“…Reduced systemic health, financial difficulties and family problems could be some of the main reasons for this inadequate compliance to the study. Other authors reported inadequate compliance of a large number of patients because of death before the completion of study, refusal for a re-examination, withdrawal from the study, poor systemic health, administrative and technical difficulties [29]. Increased compliance might be achieved with the contribution of the appropriately educated dentist and the support and maintenance of oral health in head and neck cancer patients, as it was shown in the literature [33].…”

Physiological Changes to the Swallowing Mechanism Following (Chemo)radiotherapy for Head and Neck Cancer: A Systematic Review

“…Historically, treatment approaches have been reactive, with rehabilitation administered after medical intervention (either surgical or non-surgical). However, emerging evidence [15][16][17][18][19] has instigated a shift towards the use of preventative dysphagia rehabilitation, based on the premise that proactively exercising swallowing structures known to be negatively impacted by radiation may limit the extent of (C)RT-induced dysfunction [20].…”

“…In particular, the findings of three RCTs [16,17,19] have demonstrated that patients who underwent prophylactic swallowing rehabilitation protocols pre-and/or during (C)RT had superior outcomes across a range of swallowing indexes following treatment, including: improved functional swallowing outcomes; significantly less deterioration in head and neck muscle composition; less decline in mouth opening, taste and smell; better preservation of salivary PHYSIOLOGICAL SWALLOWING DEFICITS FOLLOWING (C)RT FOR HNC 4 flow; and fewer patients requiring or dependent on gastrostomy tube feeding. However, despite each reporting some degree of positive findings for prophylactic swallowing exercises in the (C)RT-HNC population, examination of the study protocols reveals wide variability in the exercises employed, with each study reporting use of different groups of therapy tasks.…”

“…However, despite each reporting some degree of positive findings for prophylactic swallowing exercises in the (C)RT-HNC population, examination of the study protocols reveals wide variability in the exercises employed, with each study reporting use of different groups of therapy tasks. In each, a range of between two and five therapy tasks have been implemented, which have included batteries of stretch and strengthening techniques including: tongue-base strengthening, range of motion and retraction exercises, Masako, effortful swallow, supersupraglottic swallow and Mendelsohn manoeuvres, falsetto, jaw range of motion and jaw resistance training using the Therabite Jaw Rehabilitation System (Atos Medical AB, Hörby, Sweden) [16,17,19]. Great diversity in prophylactic exercise protocols has also been revealed in the clinical domain.…”

Swallowing therapy and progressive resistance training in head and neck cancer patients undergoing radiotherapy treatment: randomized control trial protocol and preliminary data

“…Research based on pilot studies and small scale trials suggests that the potential benefit from interventions to promote general physical activity and exercise before, during and after treatment may be of value for this patient group [11][12][13], and that HNC patients may also benefit from exercises before and during treatment to promote strength, mobility, and endurance of base of tongue, pharyngeal constrictors, and suprahyoid strap muscles [14][15][16][17].…”