Pretreatment Swallowing Exercises Benefit Head and Neck Cancer Patients Summary For many head and neck cancer patients, treatment consists of both chemotherapy and radiation therapy given simultaneously. This type of treatment is intensive and often results in serious and sometimes permanent damage to a patient’s ability to swallow and hence, ability to eat a normal diet for the remainder of their lives. We review a recent study which suggests that enrolling patients in a pretreatment swallowing exercise program can enhance recovery and produce measurable improvements in post-treatment swallowing function in patients who undergo concurrent chemoradiation therapy. Along with appropriate nutrition support, this type of program has the potential for greatly improving outcomes and quality of life in this oncology patient population. Background Radiotherapy or surgery continue to be the mainstays of treatment for early stage head and neck cancer (1,2). For more advanced disease, options have expanded to include organ sparing protocols that incorporate chemotherapy and radiation therapy given concurrently (3-5). While these newer concurrent chemoradiation protocols have allowed for the preservation of organ structure, this type of treatment is intensive and often results in serious and sometimes permanent damage to a patient’s ability to swallow (6-10). Swallowing dysfunction can hinder ability to eat a normal diet for the remainder of life and is demonstrated to have a measurable, negative impact on quality of life in this patient population (11-15). Most commonly, swallowing dysfunction is not addressed until post-treatment (16-18). This approach can improve swallowing function, but little is known about additional possible benefits of engaging patients in pretreatment swallowing exercise programs to prevent dysfunction from developing. A study published in The Laryngoscope looked at this issue by examining outcomes in patients receiving either a pre- or post-treatment swallowing exercise program. Given the profound negative impact that long-term dysphagia can have on health and quality of life, this type of research will be valuable for identifying the maximally effective swallowing preservation program for those receiving concurrent chemoradiation therapy. What the Researchers Studied For this study, researchers matched head and neck cancer patients by cancer site, stage of disease, treatment type and dose, and timing of swallowing studies. The case group was composed of nine patients who received pretreatment swallowing exercises before beginning chemoradiation therapy. The control group included nine patients who received post-treatment swallowing exercises as swallowing problems arose, which is generally considered standard practice in this patient population. Approximately three months post-treatment completion, all patients were evaluated with videofluoroscopy to determine type and severity of swallowing dysfunction. What the Study Found When comparing those who received pretreatment swallowing exercises vs. those undertaking swallowing exercises post-treatment, only as problems arose, researchers found: The pretreatment group had significantly better tongue base position during swallow than the post-treatment group. The pretreatment group had significantly better and more normal epiglottis inversion during swallowing than the post-treatment group. There were no significant differences in other outcomes between pre- and post-treatment swallowing exercise groups. What do these results mean? If these patients are similar to other head and neck cancer patients who receive concurrent chemoradiation therapy, this study suggests that pretreatment swallowing exercises provide measurable benefits in the form of improved swallowing function after treatment. This study has several limitations, including small sample size and non-randomized design. Larger, randomized trials will be required to validate these findings and determine additional potential benefits of pretreatment swallowing protocols in this patient group. The authors of this paper indicate that a lack of significant differences in other outcomes, including PEG tube removal time, likely are due to small sample size and lack of statistical power. On a positive note, there are few downsides to initiating pretreatment swallowing protocols. Furthermore, beyond the physical benefits of this type of dysphagia prevention model, there may be benefits to quality of life as well (20). Given the high rate of post-treatment dysphagia and the high medical and emotional costs of this complication, prevention must become a high priority. A particular need for preventive rather than rehabilitative strategies has been noted in the literature, supporting this approach as well (18). Advice to Patients Post-treatment detriments in swallowing function can be devastating and are documented to have profound and negative impacts on long-term quality of life for individuals who have received concurrent chemoradiation therapy. Patients should be engaged in their own care to minimize risk of complications and referral to speech pathology before treatment begins is one way to accomplish this goal. It is important to discuss these issues with patients, make referrals to speech pathology, and encourage patients to follow through with exercises consistently and throughout their entire treatment period for best possible outcomes. In addition to the potential long-term benefits of pretreatment swallowing exercises, benefits to nutrition status, an important component of care, also can be realized. In some clinical settings, placement of feeding tubes in the chemoradiation therapy head and neck cancer patient population may be delayed due to fear of exacerbating deterioration in swallowing function. With the initiation of pretreatment swallowing exercises, the medical care team can be confident that patients will both preserve swallowing function and get the nutrition they need through an enteral feeding route (21-23). Review of Laryngoscope. 2008;118(1):39-43. Our Source: www.p4healthcare.com Acupuncture and Saliva Production seen on fMRI BMC Complement Altern Med 2008, (7/08) Vitamin E Improves Salivary Flow Rate in Oral Cavity Ca Pts Indian J Dent Res, 2008; 19(3): 213-8. Hypnosis: Postradiation Xerostomia in Head/Neck Ca Pts J Pain and Symptom Management, Feb 2009 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.