Exercise-based dysphagia rehabilitation for adults with oesophageal cancer: a systematic review

Abstract

Background Dysphagia is prevalent in oesophageal cancer with significant clinical and psychosocial complications. The purpose of this study was i) to examine the impact of exercise-based dysphagia rehabilitation on clinical and quality of life outcomes in this population and ii) to identify key rehabilitation components that may inform future research in this area. Methods Randomised control trials (RCT), non-RCTs, cohort studies and case series were included. 10 databases (CINAHL Complete, MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest Dissertations and Theses, OpenGrey, PROSPERO, RIAN and SpeechBITE), 3 clinical trial registries, and relevant conference abstracts were searched in November 2020. Two independent authors assessed articles for eligibility before completing data extraction, quality assessment using ROBINS-I and Downs and Black Checklist, followed by descriptive data analysis. The primary outcomes included oral intake, respiratory status and quality of life. All comparable outcomes were combined and discussed throughout the manuscript as primary and secondary outcomes. Results Three single centre non-randomised control studies involving 311 participants were included. A meta-analysis could not be completed due to study heterogeneity. SLT-led post-operative dysphagia intervention led to significantly earlier start to oral intake and reduced length of post-operative hospital stay. No studies found a reduction in aspiration pneumonia rates, and no studies included patient reported or quality of life outcomes. Of the reported secondary outcomes, swallow prehabilitation resulted in significantly improved swallow efficiency following oesophageal surgery compared to the control group, and rehabilitation following surgery resulted in significantly reduced vallecular and pyriform sinus residue. The three studies were found to have ‘serious’ to ‘critical’ risk of bias. Conclusions This systematic review highlights a low-volume of low-quality evidence to support exercise-based dysphagia rehabilitation in adults undergoing surgery for oesophageal cancer. As dysphagia is a common symptom impacting quality of life throughout survivorship, findings will guide future research to determine if swallowing rehabilitation should be included in enhanced recovery after surgery (ERAS) programmes. This review is limited by the inclusion of non-randomised control trials and the reliance on Japanese interpretation which may have resulted in bias. The reviewed studies were all of weak design with limited data reported.

Long-term Patient-Reported Outcomes in a Population-Based Cohort Following Radiotherapy vs Surgery for Oropharyngeal Cancer

“…It is unclear whether the presence of a feeding tube may serve as a proxy for significant head and neck functional disability, such as due to late cranial neuropathy as suggested by the powerful association between active feeding tube use and neck disability, or whether the presence and use of the feeding tube itself increases the symptom burden. Regardless of directionality, current enteral feeding was associated with dramatically worse PROs, and proactive efforts to rehabilitate swallowing function may improve a variety of domains of health-related QOL . Continued innovations are needed in radiotherapy delivery, transoral surgery, and speech-language pathology to improve this essential clinical outcome.…”

Nature, severity, and impact of chronic oropharyngeal dysphagia following curative resection for esophageal cancer: a cross-sectional study

“…We recently conducted a systematic review which highlighted a paucity of evidence on dysphagia rehabilitation exercises both prior to and following EC surgery. 38 Future studies could evaluate the efficacy of exercises specifically targeting the most frequently impaired pathophysiological impairments and symptoms of dysphagia detected in this current study including oral and pharyngeal residue, reduced laryngeal elevation, reduced hyoid movement, and delayed swallow initiation. Oral and pharyngeal residue may potentially be caused by reduced lingual and pharyngeal strength 39 secondary to sarcopenia, a known cause of dysphagia acutely post-esophagectomy, 40 and therefore exercises targeting sarcopenic dysphagia may be beneficial to treat chronic symptoms.…”

Effects of suprahyoid muscle strengthening exercise using kinesiology taping on muscle activation and thickness in community-dwelling elderly: A randomized controlled trial

“…Exercises to strengthen the suprahyoid muscles are clinically important for dysphagia prevention and rehabilitation. [ 21 , 22 ] Therefore, this study investigated the effect of the recently reported resistive swallowing exercise method using KT on the activation and thickness change of the suprahyoid muscles in older individuals living in the community.…”