Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises

Abstract

Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in HNC survivors, long-term (i.e., beyond 5 years) prospectively collected data on objective and subjective treatment-induced functional outcomes (and their impact on QoL) still are scarce. The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients. The study was conducted as a randomized controlled trial on preventive swallowing rehabilitation (2006-2008) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants. Multidimensional assessment of functional sequels was performed with videofluoroscopy, mouth opening measurements, Functional Oral Intake Scale, acoustic voice parameters, and (study specific, SWAL-QoL, and VHI) questionnaires. Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment. At a mean follow-up of 6.1 years most initial tumor-, and treatment-related problems remained similarly low to those observed after 2 years follow-up, except increased xerostomia (68%) and increased (mild) pain (32%). Acoustic voice analysis showed less voicedness, increased fundamental frequency, and more vocal effort for the tumors located below the hyoid bone (n = 12), without recovery to baseline values. Patients' subjective vocal function (VHI score) was good. Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort, originating from preventive and continued post-treatment rehabilitation programs.

Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer

“…Also in a recent prospective clinical trial from our institute, with a cisplatin-based CRT with IMRT therapy protocol, results showed minimal swallowing disorders at 6-years follow-up in patients, who were treated with preventive swallowing exercises [11]. In that study cohort, none of the twenty-two patients was dependent on tube feeding at 6-years post-treatment, and it is likely that the favourable swallowing outcomes can be attributed both to the organ-sparing IMRT and to the preventive and continued post-treatment rehabilitation programs which were applied.…”

“…More recently, the prevalence of dysphagia also has led to the development of preventive exercise programs. These exercise programs are associated with better post-treatment swallowing function, in particular on the short-term [5][6][7][8][9][10], and probably also longer-term [11]. However, since dysphagia can develop and/or progress years after CRT [12,13], long term (10-years+) prospectively collected swallowing and mouth opening data are of great importance to assess deglutition in HNC survivors [14].…”

Rising population of survivors of oral squamous cell cancer in the United States

“…Indeed, these prevalence estimates highlight the fact that resources are necessary not only for curative treatment after diagnosis among patients with OPC, but also for anticipating the projected health maintenance needs of this growing survivor population. Along with appreciation of the emerging number of young survivors of OPC is a heightened awareness of the late effects of cancer treatment that impair health‐related quality of life . As the prevalence of survivors of OPC continues to rise, an increasing percentage of patients will require care plans tailored to the late complications of treatment .…”

“…Along with appreciation of the emerging number of young survivors of OPC is a heightened awareness of the late effects of cancer treatment that impair health-related quality of life. 28,36,37 As the prevalence of survivors of OPC continues to rise, an increasing percentage of patients will require care plans tailored to the late complications of treatment. 29,38 Furthermore, to our knowledge to date, the ideal surveillance and screening plans for cancer-related and nonrelated conditions are unknown in this population.…”

Relationship between oral intake, patient perceived swallowing impairment, and objective videofluoroscopic measures of swallowing in patients with head and neck cancer

“…It is completed and scored by a health‐care provider based on medical chart review, dietary journals, and/or patient report. Although the FOIS was validated for use within the stroke population, recent clinical trials have extended its use as a primary and secondary outcome measure to patients with head and neck cancer and in some trials it serves as a primary outcome of interest to index change in swallowing function …”