Adhering to Eat and Exercise Status During Radiotherapy for Oropharyngeal Cancer for Prevention and Mitigation of Radiotherapy-Associated Dysphagia

Abstract

ImportancePreviously published work reported independent benefit of maintenance of oral intake (eat) and swallowing exercise adherence (exercise) during radiotherapy (RT) on diet and functional outcomes. The current study seeks to validate the authors’ previously published findings in a large contemporary cohort of patients with oropharynx cancer (OPC) and address limitations of the prior retrospective study using prospective, validated outcome measures.ObjectiveTo examine the longitudinal association of oral intake and swallowing exercise using validated, clinician-graded and patient-reported outcomes.Design, Setting, and ParticipantsSecondary analysis of a prospective OPC registry including patients who underwent primary RT/chemoradiotherapy (CRT) or primary transoral robotic surgery plus RT/CRT for OPC at a single-institution comprehensive cancer center.ExposuresAdherence to speech pathology swallowing intervention during RT coded as (1) eat: oral intake at end of RT (nothing by mouth [NPO]; partial oral intake [PO], with feeding tube [FT] supplement; full PO); and (2) exercise: swallowing exercise adherence (nonadherent vs partial/full adherence).Main Outcomes and MeasuresFeeding tube and diet (Performance Status Scale for Head and Neck Cancer) patient-reported swallowing-related quality of life (MD Anderson Dysphagia Inventory; MDADI) and clinician-graded dysphagia severity grade (videofluoroscopic Dynamic Imaging Grade of Swallowing Toxicity; DIGEST) were collected at baseline, 3 to 6 months, and 18 to 24 months post-RT.ResultsA total of 595 patients (mean [SD] age, 65 [10] years; 532 [89%] male) who underwent primary RT (111 of 595 [19%]), CRT (434 of 595 [73%]), or primary transoral robotic surgery plus RT/CRT (50 of 595 [8%]) were included in this cohort study. At the end of RT, 55 (9%) patients were NPO, 115 (19%) were partial PO, 425 (71%) were full PO, and 340 (57%) reported exercise adherence. After multivariate adjustment, subacute return to solid diet and FT were independently associated with oral intake (odds ratio [OR], 2.0; 95% CI, 1.0-4.1; OR, 0.1; 95% CI, 0.0-0.2, respectively) and exercise (OR, 2.9; 95% CI, 1.9-4.5; OR, 0.3; 95% CI, 0.1-0.5, respectively). Subacute MDADI (β = 6.5; 95% CI, 1.8-11.2), FT duration (days; β = −123.4; 95% CI, −148.5 to −98.4), and less severe dysphagia per DIGEST (OR, 0.6; 95% CI, 0.3-1.0) were independently associated with oral intake, while exercise was independently associated with less severe laryngeal penetration/aspiration per DIGEST-safety (OR, 0.7; 95% CI, 0.4-1.0). DIGEST grade associations with oral intake were not preserved long-term; however, exercise was associated with a higher likelihood of solid diet intake and better swallow safety per DIGEST.Conclusions and RelevanceThe findings of this cohort study extend the authors’ previously published findings that oral intake and swallowing exercise during RT are associated with favorable functional outcomes, now demonstrated with broader domains of function using validated measures. Patterns of benefit differed in this study. Specifically, better subacute recovery of swallow-related quality of life and less severe dysphagia were found among patients who maintained oral intake independent of exercise adherence, and shorter FT utilization and better long-term diet and swallowing safety were found among those who exercised independent of oral intake.

Supportive care among head and neck cancer patients: An initial validation of the Dutch version of the Performance Status Scale for Head and Neck Cancer (D‐PSS‐HN)

“…The D‐PSS‐HN can also easily be used in research setting, for example to assess the evolution of patients’ functioning before, immediately after and months to years after a specific treatment. The English scale is already frequently used for this purpose (Barbon et al., 2022; Brady et al., 2022; Jovanovic et al., 2021). However, our study is not without limitations.…”

Tongue electrical impedance myography correlates with functional, neurophysiologic, and clinical outcome measures in long‐term oropharyngeal cancer survivors with and without hypoglossal neuropathy: An exploratory study

“…Patient 0016's severe QOL detriment highlights the urgent need for earlier neuropathy detection, which might guide and motivate the prescription of tongue strength and swallowing exercises to prevent further atrophy through disuse or contralateral tongue compensation. [37][38][39] It is possible that pre-symptomatic, quantitative biomarkers of tongue health might motivate clinicians and their patients to engage in proactive rehabilitation efforts against late effects. Simple, noninvasive testing would be mandatory to achieve this clinical goal.…”

The role of the speech and language therapist in the rehabilitation of speech, swallowing, voice and trismus in people diagnosed with head and neck cancer

“…12 People can be provided with swallowing exercises and compensatory strategies to maintain range of jaw motion and to optimise swallowing function. 13 With trismus being a potential consequence of treatment, providing information and exercises to encourage early, pre-treatment adoption of strengthening muscles of mastication and range of motion are recommended. 14 SLT input is acknowledged to be key in the prevention of long-term trismus and working in partnership with surgical, dental and physiotherapy colleagues is a critical part of making the most appropriate treatment recommendations 6 (Table 1).…”