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Swallowing Exercises Preserve Function in Patients Receiving Radiation for Head and Neck Cancer

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Key Points

  • The study was designed to evaluate a set of prescribed swallowing exercises (swallow preservation protocol) in which patients had swallow therapy before, during, and after radiation treatment.
  • Swallow preservation exercises before and during radiation treatment appeared to maintain patient's ability to swallow.
  • Patients who were compliant with the swallow preservation protocol had a faster return to normal diet and prevented throat stenosis.

A study from UCLA's Jonsson Comprehensive Cancer Center (JCCC) has found that patients with head and neck cancer receiving radiation as part of their treatment were less likely to suffer unwanted side effects such as worsening of diet, need for a feeding tube, or narrowing of the throat passage if they complied with a set of prescribed swallowing exercises during therapy.

The 5-year study was led by Marilene B. Wang, MD, Professor-in-Residence in the Department of Head and Neck Surgery at UCLA's David Geffen School of Medicine, and published in Otolaryngology–Head and Neck Surgery.

Surgery and radiation have been the traditional treatments for head and neck cancer but with the advent of improved and targeted chemotherapy many types of this disease are treated with chemoradiation in the hope of preserving the tissue and structure. Despite the sparing of critical tissue, preservation does not always translate to normal, natural swallowing ability.

Most patients who receive chemoradiation have significant side effects during treatment and for a long time after recovery. Difficulty swallowing is one of the most common unwanted side effects of radiation therapy and chemoradiation, and is one of the main predictors of decreased patient quality of life after treatment.

Study Details

Dr. Wang's study was designed to evaluate a set of prescribed swallowing exercises, called a swallow preservation protocol, in which patients had swallow therapy before, during, and after radiation treatment. The effectiveness of the swallow preservation protocol was measured by patients' continued ability to swallow and how that affected their diets, whether they needed a feeding tube, or whether they developed stenosis, compared with a group of patients who were not compliant with the swallow preservation protocol.

Study participants had assessments made of their swallowing ability 2 weeks before their treatment, including education about their cancer and what side effects they could expect and an introduction of the swallowing exercise program. The exercises were designed to maintain the range of motion of mouth and neck muscles involved in swallowing and to counter the formation of radiation fibrosis, which contributes to loss of swallowing ability. Compliance to the swallow preservation protocol was by patient self-reporting at weekly visits to UCLA.

Outcomes

Among 85 participants from 2007 to 2012, 57 were deemed compliant with the swallow preservation protocol and 28 were noncompliant. They ranged in age from 22 to 91 years old, and there were more males (66) than females (19). Swallow preservation exercises before and during radiation treatment appeared to maintain patient's ability to swallow. Patients who were compliant with the swallow preservation protocol had a faster return to normal diet and prevented throat stenosis.

"Our results demonstrate that compliance with swallow therapy during radiation or chemoradiation treatment is beneficial to patients' retaining their ability to swallow after treatment is over," said Dr. Wang. "The real benefit of this compliance is that patients benefit immediately after treatment, and for a prolonged time afterward. Attending our weekly program, fully committing to the exercises and being monitored by our staff appears to have a significantly measurable effect for these patients."

This research was supported by the National Institutes of Health.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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