Prophylactic Swallowing Exercises in Head and Neck Cancer Radiotherapy

Abstract

Many head and neck cancer (HNC) survivors experience reduced quality of life due to radiotherapy (RT)-related dysphagia. The aim of this prospective randomized trial was to evaluate the impact of prophylactic swallowing exercises on swallowing-related outcomes in HNC patients treated with curative RT. Patients treated with primary RT for HNC were candidates for this randomized protocol. Participants in the exercise group were instructed to perform swallowing exercises at home. Participants in the control group were given standard care. Patients were evaluated with modified barium swallow and several other secondary outcome measures at four and nine different time points, respectively. Data were analyzed according to intention-to-treat analyses. A total of 44 consecutive patients were included; 22 in each group. In general, there was no difference between the two groups regarding any of the dysphagia outcomes during and after treatment. Adherence to exercises was poor and dropouts due to especially fatigue were very frequent in both groups. Systematic swallowing exercises had no impact on swallowing outcomes within the first year after RT. Despite repeated supervised sessions, adherence to exercises was a major issue and dropouts were frequent in both the intervention and control group.

Improving swallowing outcomes in patients with head and neck cancer using a theory-based pretreatment swallowing intervention package: protocol for a randomised feasibility study

“…27 30 In a Danish study of a similar intervention to the current study, an average of 35% of patients reported doing their exercises at least once a day between 1 month and 11 months after treatment. 22 We have therefore selected 35% as the minimum target adherence for our study.…”

“…Recognising the poor patient adherence reported in previous studies of swallowing exercises, 22 24 30 we paid specific attention to optimising patient adherence during the development phase by drawing on theoretical frameworks and tools (The Behaviour Change Wheel, Behaviour Change Technique Taxonomy v1) from the field of behavioural science. 33 34 The new SIP-Swallowing Intervention Package: Self-Monitoring, Assessment, Rehabilitation Training (SIP SMART) was devised using current best evidence of swallowing assessment, 35 as well as insights from our earlier studies exploring the behavioural dimensions of this complex intervention; a systematic review of the literature 36 and a patient interview study (submitted manuscript).…”

“…21 Any pretreatment intervention package will need to address often poor patient adherence to swallowing exercises. 22 24 30 Improved adherence may be achieved by facilitating a change in patient behaviour. A new intervention will also need to be compatible with the broader cancer care pathway as detailed in figure 1.…”

Impact of Compliance on Dysphagia Rehabilitation in Head and Neck Cancer Patients: Results from a Multi-center Clinical Trial

“…Not all studies comprehensively delineate their interventions, and often do not report (or only partially report) compliance, which limits the interpretability of their data[25-29]. Among the studies that completely or partially report compliance, the dose and type of interventions vary widely making comparisons on efficacy or dose effect difficult or impossible[30-33]. Coupled with the fact that no dysphagia rehabilitation intervention has been proven efficacious in this patient population, no “acceptable” or “target” dose or frequency of dysphagia rehabilitation therapy exists.…”

Development and feasibility of a Swallowing intervention Package (SiP) for patients receiving radiotherapy treatment for head and neck cancer—the SiP study protocol

“…However, not all trials have had positive results [12–14], and a number of questions remain, including the optimal timing, selection and duration of exercises, the achievement of intervention fidelity and, importantly, the support necessary to improve adherence [10]. Only 13–14 % of participants practise swallowing exercises as recommended [15, 16].…”