Swallowing disorders after treatment for head and neck cancer

Abstract

Background Dysphagia is a common consequence of treatment for head and neck cancer (HNC). The purpose of the study was to evaluate the prevalence of dysphagia in a group of patients treated for HNC in Slovenia, and to identify factors contributing to the development of dysphagia. Patients and methods One-hundred-nine consecutive patients treated for HNC at two tertiary centers were recruited during their follow-up visits. They fulfilled EORTC QLQ-H&N35 and “Swallowing Disorders after Head and Neck Cancer Treatment questionnaire” questionnaires. Patients with dysphagia were compared to those without it. Results Problems with swallowing were identified in 41.3% of the patients. Dysphagia affected their social life (in 75.6%), especially eating in public (in 80%). Dysphagia was found the most often in the patients with oral cavity and/or oropharyngeal cancer (in 57.6%) and in those treated less than 2 years ago (p = 0.014). In univariate analysis, a significant relationship was observed between dysphagia prevalence and some of the consequences of anti-cancer treatment (impaired mouth opening, sticky saliva, loss of smell, impaired taste, oral and throat pain, persistent cough, and hoarseness), radiotherapy (p = 0.003), and symptoms of gastroesophageal reflux (p = 0.027). After multiple regression modelling only persistent cough remained. Conclusions In order to improve swallowing abilities and, consequently, quality of life of the patients with HNC a systematic rehabilitation of swallowing should be organized. A special emphasis should be given to gastroesophageal reflux treatment before, during and after therapy for HNC

Emotional and Psychological Effects of Dysphagia: Validation of the Jugendwerk Dysphagia Emotion and Family Assessment (JDEFA)

“…Dysphagia is common in cerebro-vascular disease affecting 60% of all stroke patients accounting for 1.5 million victims per annum in Europe [ 1 , 2 ]. It is occurring in presbyphagia striking more than one-third of all geriatric patients [ 3 ], in up to the half of all patients with throat and neck cancer after operation [ 4 ] radiation or chemotherapy [ 5 ], in non-cancer surgery [ 6 ], in intensive care patients suffering from critical illness neuropathy [ 7 ] and children with aerodigestive disorders [ 8 ]. The economic burden is excessively high, e.g., resulting in additional cost of more than 6000 US$ per hospital case in the United States [ 9 ].…”

Rationale and design of a randomised controlled trial investigating the effect of multidisciplinary nutritional rehabilitation for patients treated for head and neck cancer (the NUTRI-HAB trial)

“…These include dysphagia (swallowing difficulties), xerostomia (dry mouth), dysgeusia (taste disturbances), and trismus (reduced mouth opening) [8]. The negative effects of eating problems on quality of life (QOL) and everyday life in patients treated for HNC have been documented in quantitative [8][9][10][11][12][13] and qualitative [5,[14][15][16][17][18][19] studies. Based on existing studies [4-7, 18, 20, 21] it is suggested that appropriate rehabilitation services can strengthen the patient's ability to cope with eating problems and thereby reduce the negative consequences.…”

Assessment of the gustatory function in patients with advanced oral cavity and oropharyngeal cancer

“…The gustatory function in general directly influences and is influenced by the person's feeding and nutrition process (8) . Changes in taste can trigger loss of appetite, poor nutrition, and even malnutrition, having in the alternative enteral feeding route its cause (if prolonged use is needed due to dysphagia) or consequence (due to malnutrition, when the person refuses to feed orally).…”

“…Changes in gustatory function resulting from the oncological treatment usually take place after radiotherapy (6,7,8) . However, head and neck tumors, due to the anatomical location of the lesion, can themselves trigger significant changes in feedingrelated functions, including taste (9) .…”

“…Although the oral phase of swallowing is voluntary, it depends on the integration of mechanical (through contact with food) and chemical stimuli (through smell and taste), which help to prepare the oral and gastrointestinal motor systems to receive the food (11) . In oncological individuals, external factors such as xerostomia and olfactory reduction can interfere with the gustatory function, with a direct impact on swallowing and repercussions on these people's nutrition and quality of life (8) .…”