Swallowing‐Related Quality of Life After Head and Neck Cancer Treatment

Gillespie, M. Boyd; Brodsky, Martin B.; Day, Terry A.; Lee, Fu Shing; Martin‐Harris, Bonnie

doi:10.1097/00005537-200408000-00008

Cited by 219 publications

(181 citation statements)

References 19 publications

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“…This supports that even when able to resume "near-normal" oral intake consistencies, patients continue to regard their function as far less than normal. This relationship between slight texture modification and reduced patient perception of function has been noted previously by other researchers [38,39], and highlights that even small limitations to oral intake variety may translate as negative outcomes for patients. Clinicians need to be sensitive to this as they support patients through recovery and rehabilitation.…”

Section: Resultssupporting

confidence: 83%

Swallowing, nutrition and patient-rated functional outcomes at 6 months following two non-surgical treatments for T1–T3 oropharyngeal cancer

Cartmill

Cornwell

Ward

et al. 2011

Support Care Cancer

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Purpose: Altered fractionation radiotherapy with concomitant boost (AFRT-CB) may be considered an alternative treatment for patients not appropriate for chemoradiation (CRT). As functional outcomes following AFRT-CB have been minimally reported, this exploratory paper describes the outcomes of patients managed with AFRT-CB or CRT at 6 months post treatment.Methods: Using a cross-sectional analysis design, functional outcomes of 14 AFRT-CB and 17 CRT patients with T1-T3 oropharyngeal cancers were explored at 6 months post-treatment. Clinical and instrumental swallow assessments, weight and nutritional status, and the functional impact of treatment were examined.Results: Inferior outcomes were observed for the CRT patients on the RBHOMS (p = 0.03) which was reflected in diet and fluid restrictions with 18% of the CRT group requiring modified fluids and diets.Although a trend (p = 0.07) was noted for increased lingual deficits and aspiration risk for fluids in the CRT group, no other significant differences were observed. Both groups experienced an average of 10kg weight loss and reported reduced general and swallowing related function. Conclusions:This preliminary data suggests functional outcomes following AFRT-CB and CRT were largely comparable at 6 months post treatment. Treatment intensification in any form may contribute to impaired function which requires multidimensional intervention. Larger cohort investigations with systematic methodology are needed to further examine these initial findings.Keywords: swallowing, nutrition, oropharyngeal cancer, chemoradiation, altered fractionation radiotherapy This paper aims to inform research by providing further evidence for functional outcomes following non-surgical treatment for head and neck cancer.

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Section: Resultssupporting

confidence: 83%

Swallowing, nutrition and patient-rated functional outcomes at 6 months following two non-surgical treatments for T1–T3 oropharyngeal cancer

Cartmill

Cornwell

Ward

et al. 2011

Support Care Cancer

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“…pain, voice hoarseness, and dry mouth) (List et al, 1999;Wijers et al, 2002) and functional problems (e.g. speech, eating and swallowing) (Epstein et al, 1999;Gillespie et al, 2004;Rogers et al, 1999) faced by head and neck cancer patients, they are also prone to experience a variety of other problems, such as mood disorder and facial disfigurement (Dropkin, 1999;Rogers et al, 1999;Rumsey et al, 2003). Such situations often lead to the increase of psychosocial distress, anxiety and depression.…”

Section: Head and Neck Cancermentioning

confidence: 99%

Comparison of Psychosocial Outcomes in Head and Neck Cancer Patients Receiving a Coping Strategies Intervention and Control Subjects Receiving No Intervention

Vilela

Nicolau²,

Mahmud³

et al. 2006

J Otolaryngol

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“…3 Intervals without oral intake of only 2 weeks have been shown to predict poor long-term swallowing outcomes. 9 This has prompted other centers, like ours, to use an active wait-and-observe approach and recommend G-tube placement when it becomes necessary prior to or during the course of CRT. We base our decision on the degree of dysphagia and the percentage of pretreatment weight loss, as well as clinical evidence of aspiration, although the exact threshold is subjective and at the discretion of the treating physician.…”

Section: Introductionmentioning

confidence: 97%

Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: The University of Pittsburgh experience

et al. 2009

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Objectives/Hypothesis:Mucositis and dysphagia are common complications of chemoradiotherapy (CRT) for head and neck cancer that may necessitate nutritional support with a gastrostomy tube (G‐tube).Methods:We reviewed records of patients who underwent and completed CRT, which included at least one traditional chemotherapeutic, for previously untreated head and neck cancer. G‐tubes were placed as needed. The timing and duration of G‐tube placement and treatment‐related complications and risk factors for long‐term G‐tube use were analyzed.Results:A total of 91 consecutive patients who received CRT, 68 as primary and 23 as postoperative treatment, were studied. Radiation doses ranged from 59.4 to 74 Gy (median, 70 Gy). Seventy‐nine percent of patients received platinum‐based therapy during CRT. Severe mucositis occurred in 40% of patients. Forty percent of patients required G‐tube placement (15 prior to CRT and 21 during CRT). Median duration of G‐tube use was 5.8 months. Two patients who had a G‐tube placed during CRT developed a G‐tube‐related complication. At 6 and 12 months, 15 (18%) and four (6%) patients who were disease free were using G‐tubes, respectively. Patients with G‐tubes placed prior to CRT or advanced T stage had longer G‐tube dependence.Conclusions:With aggressive supportive care it is feasible to avoid G‐tubes in the majority of patients undergoing CRT for head and neck cancer. G‐tube placement prior to CRT due to pre‐existing dysphagia and advanced T stage are associated with prolonged G‐tube dependence. Laryngoscope, 2010

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Swallowing‐Related Quality of Life After Head and Neck Cancer Treatment

Abstract: The study suggests that chemoradiation may provide superior swallowing outcome to surgery/radiation in patients with oropharyngeal primary. Patients with depressed mental health and prolonged feeding tubes may be at higher risk of long-term dysphagia.

Cited by 219 publications

References 19 publications

Swallowing, nutrition and patient-rated functional outcomes at 6 months following two non-surgical treatments for T1–T3 oropharyngeal cancer

Swallowing, nutrition and patient-rated functional outcomes at 6 months following two non-surgical treatments for T1–T3 oropharyngeal cancer

Comparison of Psychosocial Outcomes in Head and Neck Cancer Patients Receiving a Coping Strategies Intervention and Control Subjects Receiving No Intervention

Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: The University of Pittsburgh experience

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