Effects of Prophylactic Swallowing Exercises on Dysphagia and Quality of Life in Patients with Head and Neck Cancer Receiving (Chemo) Radiotherapy

Abstract

Background: Squamous carcinoma of the head and neck (HNC) has a high incidence in our context. Although therapeutic radiotherapy protocols try to preserve swallowing function and essential speech organs, dysphagia is a frequent symptom in the acute and long-term phases, due to the toxic effects of therapies needed to confront the illness. Some studies have shown prophylactic oropharyngeal exercises to be quite useful in improving swallowing function after completion of chemo-radiation therapy (CRT) protocols; others have focused on their use to prevent or minimize post-CRT swallowing dysfunction. Patients’ quality of life deteriorates greatly during CRT, with a peak of maximum intensity during the days immediately after finishing CRT treatment. Afterwards, function gradually improves, although scope or timeframe remains undetermined. Available evidence suggests that exercise therapy prior to oncological treatment could potentially improve deglutition and quality of life; however, a randomized study is needed to confirm this observation. Design/Methods: The Redyor singe-blind randomized clinical trial is designed to compare the effect of prophylactic oropharyngeal exercises on quality of life, dysphagia, and sustainability to the length of rehabilitative treatment. At enrollment, participants will be randomly assigned to one of two treatment groups. Both groups follow the protocol described here, although one group begins the training 2 weeks before initiating CRT and the other group just after finishing the therapy. Both groups will complete standard swallow therapy for training submental muscles involved and 3 sets of 5 inspiratory and expiratory repetitions using the Orygen Dual® valve, with a progressive weekly increase in workload. Discussion: This ongoing clinical trial, registered in 2016, is based on the hypothesis that undergoing a pre-radiotherapy rehabilitation (pre-habilitation) program will have greater benefits (less decrease in quality of life, less delay in swallowing parameters, and less severe dysphagia) compared to post-CRT rehabilitation. The primary objective is to assess dysphagia severity and evaluate quality of life due to swallowing dysfunction in HNC patients. Secondary objectives are to assess the correlation between a clinical variable and instrumental parameters in this period

Dysphagia rehabilitation in post-COVID patients: Review of the literature

“…The risk of transmission of COVID-19 involved depends on the way in which they are carried out, dividing them into direct and indirect exercises (Fig. 1) 17,21,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] .…”

Supportive Care in Head and Neck Cancer Patients: The Role of Occupational Therapist. Review

“…Radiation treatment can reach anatomical structures adjacent to the tumor such as cartilage, bones and muscles, teeth and salivary glands that are related to the swallowing function [14] . The presence of edema and later fibrosis in the muscles as an initial process of acute inflammation can result in swallowing disorders [1] . Several factors are associated with the development of dysphagia in HNC patients, such as hyposalivation and changes in saliva composition, sticky mucosa, pain, neurological changes and muscle damage, impaired tongue movements and changes in the reduction of pharyngeal peristalsis [1,14] .…”

“…Head and neck cancer (HNC) remains a major public health concern worldwide. This type of cancer includes malignant lesions that occur in the oral cavity, pharynx, larynx and salivary glands and is mainly associated with primary risk factorsincluding smoking, alcohol consumption, virus infections such as human papilloma virus and Epstein-Barr virus) and genetic predisposition [1] .…”