Current assessment and treatment strategies of dysphagia in head and neck cancer patients

Abstract

Regarding dysphagia evaluation, there is still a lack of a uniform 'gold-standard' for both assessment and treatment strategies. More high-quality data, adequately controlled, adequately powered and randomized, on prophylactic and therapeutic swallowing exercises are needed, with longer follow-up and better adherence to treatment, for better understanding the effects of chemo and radiotherapy dosage, and of frequency, timing and duration of treatment, to improve swallowing function and optimize quality of life.

Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises

“…Since the 5-year results of this latter trial are published as well [54], and data from prospective studies with longer follow-up after preventive swallowing rehabilitation still are scarce [19], it is again possible and interesting to also compare the more long-term results of both trials. Regarding swallowing function and oral intake, in that earlier study it was found that 7/71 patients (10 %) still required tube feeding at 5 years post-treatment, whereas in the present study all patients were able to consume a normal oral diet at the 6-year assessment point.…”

“…It is not unlikely that the favorable swallowing outcomes in the present study can be attributed to the preventive and continued post-treatment rehabilitation programs, which were applied in this patient cohort. Preventive rehabilitation programs have been associated with better post-treatment swallowing outcomes before [20][21][22][23][24][25][26], especially on the short-term [19], and probably, the exercises applied are associated with better long-term results as well.…”

“…Also maintained oral intake (no feeding tube dependency) has been shown to lead to better swallowing function after CCRT, possibly due to continued use of the swallowing musculature [26][27][28]. Benefits from preventive (swallowing) exercises have been reported in particular on the short term (up to 2 years) [19]. Eisbruch et al [29] were among the first prospectively evaluating swallowing function in HNC survivors, and these authors found objective swallowing dysfunction (high incidence of silent aspiration) 6-12 months after RT.…”

“…So far, focus primarily has been on reduction of the dose on pharyngeal musculature with advanced RT treatment planning techniques such as intensity-modulated radiation therapy (IMRT) [14][15][16][17][18]. More recently, pre-, per-and post-treatment interventions ensuring continued use of swallowing musculature by adherence to targeted swallowing exercises (the 'use it or lose it' concept) are increasingly suggested in the literature to benefit HNC survivors [19]. Preventive rehabilitation programs have been associated with a long list of positive effects: improved QoL [20], better base of tongue retraction and better maintained epiglottic inversion [21], superior muscle maintenance and functional swallowing ability [22], better oral intake and clinician-rated swallowing function at three and 6 months [23], reduced extent and severity of penetration and/or aspiration, less trismus, less weight loss, and less pain (both short term [24] and at oneand two-years post-treatment [25]), and better oral intake and shorter duration of feeding tube dependency [26] posttreatment.…”

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

“…Acute toxic effects of radiotherapy with consequent decrease in oral intake and tube insertion may prompt disuse atrophy on top of accumulating radiation tissue damage [15,21]. The SYNK swallowing exercise program cover exercises specifically recommended for preventive and therapeutic swallowing interventions in HNC patients although currently not used in the Danish standard care [22].…”