Dysphagia Advances in Head and Neck Cancer

Abstract

Purpose of Review This review summarises the current literature regarding head and neck cancer–associated dysphagia. Up-to-date evidence for dysphagia outcome measurement for this population is provided, in addition to recent innovations that aim to prevent, reduce or remediate the common and debilitating side effects of treatment. Recent Findings Both patient-reported outcomes and clinical measures are necessary to capture the multi-dimensional nature of swallowing. A minimally important difference in scores has been calculated for some of these measures, to aid interpretation and powering of clinical trials. The number of dysphagia-related trials has increased, predominantly investigating optimal treatment for oropharyngeal HPV-positive disease, and speech and language pathology interventions using an impairment-based approach. Summary Although substantial progress has been made, further work is necessary to establish a consensus over outcome measures. Modifying treatments may improve outcomes. Several trials are underway to establish the effectiveness of speech and language pathology dysphagia interventions.

Relationship Between Subjective Questionnaires and Videofluoroscopy of Dysphagia Evaluation: A Systematic Review and Meta-Analysis

“…The relationship between subjective questionnaires designed to assess swallowing disorder severity and the videofluoroscopy-based PAS score was the focus of this study, with the primary goal being to understand the severity of dysphagia symptoms and the PAS score, which represent the physiological manifestation of airway invasion (Patterson & Lawton, 2023; Printza et al, 2021).…”

Post-Radiotherapy Dysphagia in Head and Neck Cancer: Current Management by Speech-Language Pathologists

“…There is a clear need for well-designed trials with adequate sample sizes and inclusion of validated baseline and endpoint outcome measures to inform clinical decisions regarding swallow rehabilitation. Integration of device-driven, functional skill-based activity and strengthening exercises with individualised swallow programmes may yield the best results within a holistic model of care [ 6 , 36 ]. Critical to the delivery of targeted swallow rehabilitation is an improved understanding of the impact of radiotherapy on the CNS and the association between radiation-induced dysphagia and sarcopenia.…”

“…Assessment of dysphagia in the HNC population typically consists of clinical and instrumental assessments in combination with patient-reported outcome measures (PROMs). Specific measures are outlined comprehensively in scientific literature [ 2 , 6 , 7 ]. Dynamic instrumental assessment of swallowing is considered gold standard.…”

“…Research has demonstrated that this approach results in improved QOL and swallow function as demonstrated on VFSS [ 44 ]. However, adherence to high-intensity programmes is limited with the time commitment likely to be a contributing factor to reduced engagement [ 6 , 41 ].…”

Swallowing after total laryngectomy surgery: where are we after 150 years?

“…Head and neck specific patient reported outcome measures (PROMs) are used to determine the presence and nature of swallow dysfunction following total laryngectomy, and include the MDADI, Swal-QoL, Sydney Swallow Questionnaire, and EAT-10 [10,11 ▪▪ ]. The prevalence of dysphagia is reported as being between 35% and 89% [10] and is characterized by difficulties eating solid foods, prolonged mealtimes, sticking of the bolus and/or a need to ‘wash down’ a bolus, needing to swallow multiple times, regurgitation and discomfort/stress associated with swallowing [9,12].…”