Pretreatment swallowing assessment in head and neck cancer patients

Starmer, Heather H.; Gourin, Christine G.; Lua, Lannah L.; Burkhead, Lori M.

doi:10.1002/lary.21800

Cited by 53 publications

(18 citation statements)

References 14 publications

(11 reference statements)

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“…14 Speech and swallowing dysfunction is common in patients with advanced laryngeal and hypopharyngeal tumors. 9,15 Even among patients who remain clinically disease-free after primary chemoradiation for these malignancies, the morbidity of treatment can be significant. A meta-analysis of 230 patients who received primary chemoradiation treatment for head and neck cancers showed that a primary site in the larynx or hypopharynx was more strongly correlated with the presence of severe late toxicity in multivariate analysis than any other variable examined.…”

Section: Discussionmentioning

confidence: 99%

Persistent tracheostomy after primary chemoradiation for advanced laryngeal or hypopharyngeal cancer

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Persistent tracheostomy after primary chemoradiation for advanced laryngeal or hypopharyngeal cancer

et al. 2013

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“…Patients <65 years were distinguished from those aged ≥65 years 18. The duration from onset to examination was defined from the day when the HNC diagnosis was given until the day when VFSS was performed.…”

Section: Methodsmentioning

confidence: 99%

Rick Factors Associated with Aspiration in Patients with Head and Neck Cancer

2011

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ObjectiveTo determine the major risk factors and abnormal videofluoroscopic swallowing study (VFSS) findings associated with aspiration in patients with head and neck cancer (HNC).MethodRisk factors associated with aspiration were investigated retrospectively in 241 patients with HNC using medical records and pre-recorded VFSS. Age, gender, lesion location and stage, treatment factors, and swallowing stage abnormalities were included.ResultsAspiration occurred in 50.2% of patients. A univariate analysis revealed that advanced age, increased duration from disease onset to VFSS, higher tumor stage, increased lymph node stage, increased American Joint Committee on Cancer (AJCC) stage, operation history, chemotherapy history, and radiotherapy history were significantly associated with aspiration (p<0.05). Among them, advanced age, increase AJCC stage, operation history, and chemotherapy history were significantly associated with aspiration in the multivariate analysis (p<0.05). Delayed swallowing reflex and reduced elevation of the larynx were significantly associated with aspiration in the multivariate analysis (p<0.05).ConclusionThe major risk factors associated with aspiration in patients with HNC were advanced age, higher AJCC stage, operation history, and chemotherapy history. A VFSS to evaluate aspiration is needed in patients with NHC who have these risk factors. Delayed swallowing reflex and reduced elevation of the larynx were major abnormal findings associated with aspiration. Dysphagia rehabilitation should focus on these results.

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“…In present study majority (34.89 %) of patients with aspiration had laryngeal cancer followed by tongue cancer (22.14 %). In contrast, Stenson et al [12] reported that the incidence rate of aspiration reaches 30, 67, and 80 % in patients with oral, laryngeal, and pharyngeal head and neck cancers respectively, whereas Starmer et al [13] reported that head and neck cancer involving the larynx or the hypopharynx is a principal risk factor for aspiration. Eischbruch et al [1] reported that though swallowing-related structures were normal, radio therapy and chemotherapy affects movement of the oral cavity and laryngopharyngeal musculature and, thus, causes aspiration.…”

Section: Discussionmentioning

confidence: 95%

Aspiration in Head and Neck Cancer Patients: A Single Centre Experience of Clinical Profile, Bacterial Isolates and Antibiotic Sensitivity Pattern

Lakshmaiah

Sirsath

Subramanyam

et al. 2013

Indian J Otolaryngol Head Neck Surg

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Most patients with head and neck cancer have dysphagia and are at increased risk of having aspiration and subsequent pneumonia. It can cause prolonged hospitalization, treatment delay and/or interruption and mortality in cancer patients. The treatment of these infections often relies on empirical antibiotics based on local microbiology and antibiotic sensitivity patterns. The aim of present study is to analyse respiratory tract pathogens isolated by sputum culture in head and neck cancer patients undergoing treatment at a tertiary cancer centre in South India who presented with features of aspiration. The study is carried out to establish empirical antibiotic policy for head and neck cancer patients who present with features of aspiration. This was a retrospective study. The study included sputum samples sent for culture and sensitivity from January 2011 to December 2012. Analysis of microbiologic species isolated in sputum specimen and the antibiotic sensitivity pattern of the bacterial isolates was performed. A detailed study of case files of all patients was done to find out which is the most common site prone for producing aspiration. There were 47 (31.54 %) gram positive isolates and 102 (68.45 %) gram negative isolates. The most common bacterial isolates were Klebsiella pneumoniae (25.50 %), Pseudomonas aeruginosa (16.77 %) and Haemophilus influenzae (15.43 %). Levofloxacin was the most effective antibiotic with excellent activity against both gram positive and gram negative isolates. Most patients with aspiration had laryngeal cancer (34.89 %). Aspiration pneumonia was present in 14 (9.39 %) patients. Gram negative bacteria are common etiologic agents in head and neck cancer patients presenting with features of aspiration. Levofloxacin should be started as empirical antibiotic in these patients while awaiting sputum culture sensitivity report. As aspiration in head and neck cancer is an underreported event such institutional antibiotic sensitivity studies should be encouraged for prompt initiation of antibiotic that is most likely to be effective against etiologic pathogens.

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Pretreatment swallowing assessment in head and neck cancer patients

Cited by 53 publications

References 14 publications

Persistent tracheostomy after primary chemoradiation for advanced laryngeal or hypopharyngeal cancer

Persistent tracheostomy after primary chemoradiation for advanced laryngeal or hypopharyngeal cancer

Rick Factors Associated with Aspiration in Patients with Head and Neck Cancer

Aspiration in Head and Neck Cancer Patients: A Single Centre Experience of Clinical Profile, Bacterial Isolates and Antibiotic Sensitivity Pattern

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