Reducing Late Dysphagia for Head and Neck Cancer Survivors with Oral Gel: A Feasibility Study

Abstract

Dysphagia is a significant late morbidity following treatment with radiotherapy (RT) for head and neck squamous cell carcinomas (HNSCC). The purpose of this feasibility study was to test a gel-based saliva substitute to reduce the subjective assessment of dysphagia while eating food items varying in size and texture. Eligible study subjects treated with curative intended RT and suffering from dysphagia and xerostomia were recruited from the outpatient clinic during a two-month period. Nineteen subjects consented to participation and completed the EORTC QLQ-H&N35 questionnaire and three test meals. A Numeric Rating Scale (NRS) was used for subjective assessment of dysphagia during all test meals. All data on patient, tumor, and treatment characteristics were obtained from the Danish Head and Neck Cancer (DAHANCA) database. NRS data suggested reduction of dysphagia after application of the oral gel. The swallowing dysfunctions, discomfort while swallowing (p = 0.008), stuck food items (p = 0.02), and multiple attempts of clearing the throat (p = 0.05), improved significantly for soft and regular items. Both small-and large-sized food items were tested. EORTC QLQ-H&N35 showed improvement regarding eating problems (p = 0.03) and social eating (p = 0.02). No episodes of food aspiration were recorded during the test meals. Late dysphagia reduces QOL and is an important morbidity following RT. In this feasibility study, the oral gel was able to reduce dysphagia while eating soft and selected regular food items. Eating-related EORTC QLQ-H&N35 items also improved, indicating a beneficial reduction in dysphagia after application of the oral gel.

Quality of life in Iranian patients with head-and-neck cancer

“…Literatures showed that dental problems, pain, sensorial problems in oral cavity cancer, mouth dryness, throat pain, swallowing difficulty, sticky saliva in pharynx cancer, speech problem, and dyspnea in larynx cancer have high symptom points. [ 14 15 16 17 ]…”

“…Some other studies found that many serious complications can be omitted by therapy methods which have many modalities. [ 5 14 15 16 17 ]…”

Predictive clinical factors for penetration-aspiration in patients with nasopharyngeal carcinoma after radiotherapy

“…In contrast, two other study explained that neither tumor location nor tumor stage predicts the risk of dysphagia. It is most likely that the afferent nerves associated with the swallowing process have changes due to radiation, one of which is evidenced by the discovery of changes in taste in patients and impaired sensation of the larynx in some patients (Szczesniak et al, 2014;Kaae et al, 2020).…”

“…The severity of pharyngeal residue as assessed by YPR-SRS was found to be higher in patients with a short duration of radiotherapy. In the majority of patients, tissue inflammation and dysphagia due to radiotherapy mainly occur during and immediately after radiotherapy (Kaae et al, 2020;Langmore & Kriscuinas, 2010). As many as 60% of patients mainly experienced dysphagia in the first 1 year after radiotherapy, then decreased by 36% after 5 years and tended to experience complaints again at 8 years after radiotherapy.…”

European white paper: oropharyngeal dysphagia in head and neck cancer

“…Fibrosis of the pharyngeal constrictor muscles can lead to swallowing difficulties, symptomatic or silent aspiration and thus, often affects eating with considerable risks leading to feeding tube dependency [67][68][69]. As the salivary glands are often involved in the RT fields for oropharyngeal cancer, various degrees of xerostomia further complicate swallowing [70]. Being able to swallow following HNC treatment is one of the top functional priorities in patients and a driver for health-related quality of life (HRQOL) [71].…”