The impact of time after radiation treatment on dysphagia in patients with head and neck cancer enrolled in a swallowing therapy program

Abstract

Background Swallowing dysfunction after radiotherapy (RT) for head and neck cancer can be devastating. A randomized control trial compared swallow exercises versus exercise plus neuromuscular electrical stimulation therapy and found no overall difference in outcomes. Methods Quality of life (QOL), diet, and swallowing variables collected at discrete intervals on 117 patients were reanalyzed to test the hypothesis that shorter time between the completion of radiotherapy and beginning of the swallowing therapy program yielded improved outcomes. Results At baseline, subjects < 1 year post radiation had significantly better function than subjects >2 years post RT in several measures. Over the therapy program, the early group showed significant improvement in diet and QOL. Swallowing physiologic variables showed no difference between groups. Conclusion Beginning a swallowing therapy program within 1 year of completion of radiotherapy demonstrates more consistent improvement in QOL and diet performance compared to later periods.

The effect of the Shaker head‐lift exercise on swallowing function following treatment for head and neck cancer: Results from a randomized, controlled trial with videofluoroscopic evaluation

“…The power calculation of this study was made solely on the expected changes in PAS, which also could be considered a limitation. Moreover, the random allocation did not include time since oncologic treatment which may have had an impact on the results, since a recent study has found that swallowing therapy that was initiated within 1 year after radiotherapy resulted in better outcomes than for patients with later swallowing intervention 76 . However, no statistically significant differences were found between the groups regarding time from oncologic treatment.…”

Very late xerostomia, dysphagia, and neck fibrosis after head and neck radiotherapy

“…[16][17][18] Also, dysphagia has been found to be one of the most commonly reported late side effects after radiotherapy, 16,18 with 45% of patients reporting it 2 years after IMRT. [19][20][21][22] Motz et al observed the highest incidence of dysphagia, airway obstruction, and pneumonia in the first year after treatment but without a significant decrease in the subsequent four years. 9 Limited studies have assessed toxicity >2 years after therapy.…”

“…9 Limited studies have assessed toxicity >2 years after therapy. [19][20][21][22] Motz et al observed the highest incidence of dysphagia, airway obstruction, and pneumonia in the first year after treatment but without a significant decrease in the subsequent four years. 22 The study by Kirsh et al assessed very late dysphagia (>3 years after IMRT) and saw that 23% of the patients still required a modified diet after a mean follow-up time of 4.55 years.…”

Manual Therapy for Fibrosis-Related Late Effect Dysphagia in head and neck cancer survivors: the pilot MANTLE trial

“…QOL and diet scores improved most among those who started therapy <1 year after RT, with little improvement evident among those who started therapy more than 2 years post-RT. 20 Clinical experience supports that survivors with late-RAD almost universally present with palpable, high-grade cervical fibrosis. Fibrosis is thought to compress peripheral nerve tracts, thereby contributing to denervation of critical swallowing muscles.…”