Swallow preservation exercises during chemoradiation therapy maintains swallow function

Abstract

Objective: To evaluate a swallow preservation protocol (SPP) in which patients received swallow therapy before, during, and after radiation treatment and its efficacy in maintaining swallowing function in head and neck cancer patients.

Design: Case series with chart review.

Setting: Tertiary care academic medical center.

Subjects and methods: Eighty-five patients who received radiation (RT) or chemoradiation (CRT) participated in the SPP from 2007 to 2012. Subjects were divided into 2 groups: compliant and noncompliant with SPP. At each SPP visit, the diet of each patient was recorded as regular (chewable), puree, liquid, or gastrostomy tube (G-tube) dependent, along with their compliance with the swallow exercises. Patients were stratified by age, gender, tumor stage, type of treatment, radiation dose, diet change, dysguesia, odynophagia, pain, and stenosis. Statistical analysis was performed comparing the 2 compliance groups in regards to swallowing-related outcomes at 1 month after completion of therapy.

Results: Fifty-seven patients were compliant and 28 were noncompliant with SPP during treatment. The compliant group had a higher percentage of patients tolerating a regular diet (54.4% vs 21.4%, P = .008), a lower G-tube dependence (22.8% vs 53.6%, P = .008), and a higher rate of maintaining or improving their diet (54.4% vs 25.0%, P = .025) compared to noncompliant patients.

Conclusion: A swallow preservation protocol appears to help maintain or improve swallow function in head and neck cancer patients undergoing RT or CRT. Patients who are able to comply with swallow exercises are less likely to worsen their diet, receive a G-tube, or develop stenosis.

Keywords: radiation and swallow; swallow preservation; swallow therapy.

Figures

Figure 1

Comparison of pre- and posttreatment diets for compliant and noncompliant patients. Unknown diet at 2 months is due to patient dropout from swallow preservation protocol visits.

Figure 2

Comparison of diet change for the compliant and non-compliant groups. There was a significant difference in diet change, with more of the compliant patients maintaining or improving their diet from pretreatment to 1 month posttreatment when compared to the noncompliant patients (P = .025).