Maintained Oral Intake and Swallowing Exercise Adherence During Radiation Therapy Improve Long-Term Swallowing Outcomes for Pharyngeal Cancer Patients
In a study reported in JAMA Otolaryngology Head & Neck Surgery, Hutcheson et al assessed the effects of maintained oral intake and adherence to swallowing exercises during radiation therapy or chemoradiation therapy for pharyngeal cancer. They found that both practices contributed independently to improved long-term swallowing outcomes.
Study Details
This retrospective observational study involved 497 patients treated with definitive radiation therapy or chemoradiation therapy for pharyngeal cancers (458 of the oropharynx, 39 of the hypopharynx) between 2002 and 2008 at The University of Texas MD Anderson Cancer Center. Oral intake status at the end of therapy (no oral intake, partial oral intake, or full oral intake) and adherence to a swallowing exercise regimen were assessed. Patients had a median age of 56 years and most were male (87%), had oropharyngeal primary tumors (92%), node-positive disease (81% ≥ N2), and T2 or T3 disease (60%), and received intensity-modulated radiation therapy (91%) and chemotherapy (77%, 47% concurrent with radiation therapy).
Effects of Maintained Intake and Exercise Adherence
At the end of radiation therapy or chemoradiation, 26% of patients had no oral intake and 74% had maintained oral intake, including 34% with partial intake and 40% with full intake. Adherence to swallowing exercises was reported by 58% of patients.
Overall, 81% of patients returned to a regular diet after conclusion of therapy. Greater proportions of patients who maintained oral intake throughout radiation therapy or chemoradiation or performed swallowing exercises had a regular diet in long-term follow-up (P = .01; median follow-up, 22.2 months).
The proportions of patients returning to a regular diet in long-term follow-up consisted of 65% of those who neither maintained oral intake nor were adherent to swallowing exercises, 77% to 84% who maintained some swallowing goals (eating or exercising), and 92% of those who maintained full oral intake and were fully adherent to swallowing exercises.
Multivariate Analysis
On multivariate analysis adjusting for T classification, age, and baseline diet, maintenance of full oral intake during treatment (odds ratio [OR] = 2.0, P = .045) and full adherence to swallowing exercises (OR = 4.0, P < .001) were independently associated with return of full oral intake. On multivariate analysis of gastrostomy dependence adjusting for T classification, age, and baseline diet, duration of gastrostomy dependence was significantly reduced among patients maintaining partial oral vs no oral intake (median, 120 vs 183 days, P < .001) and among those who were adherent vs nonadherent to swallowing exercises (median, 68 vs 113 days, P = .007).
The investigators concluded, “The data indicate independent, positive associations of maintenance of oral intake throughout [radiation therapy] or [chemoradiation therapy] and swallowing exercise adherence with long-term swallowing outcomes. Patients who either eat or exercise fare better than those who do neither. Patients who both eat and exercise have the highest rate of return to a regular diet and shortest duration of gastrostomy dependence.”
Stephen Y. Lai, MD, PhD, and Jan Lewin, PhD, of The University of MD Anderson Cancer Center, are co–senior authors for the JAMA Otolaryngology Head & Neck Surgery article. Katherine A. Hutcheson, PhD, also of MD Anderson, is the corresponding author for the article.
The study was supported by The University of Texas Health Innovation for Cancer Prevention Research Fellowship and a grant from The University of Texas School of Public Health-Cancer Prevention, and Research Institute of Texas. The study authors reported no potential conflicts of interest.
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