A study from UCLA’s Jonsson Comprehensive Cancer Center (JCCC) has found that head and neck cancer patients 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 called a swallow preservation protocol (SPP) during therapy.
The five-year study was led by Dr. Marilene Wang, JCCC member, professor-in-residence in the department of head and neck surgery, UCLA’s David Geffen School of Medicine. The study was published online ahead of print in the journal Otolaryngology – Head and Neck Surgery on August 27, 2013.
Surgery and radiation (RT) 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 chemotherapy and radiation (chemoradiation or CRT) 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 CRT have significant side effects during treatment and for a long time after recovery. Difficulty swallowing (dysphagia) is one of the most common unwanted side effects of RT and CRT, and is one of the main predictors of decreased patient quality of life after treatment.
Wang’s study was designed to evaluate the SPP, in which patients had swallow therapy before, during and after radiation treatment. The effectiveness of the SPP was measured by patients’ continued ability to swallow and how that affected their diets, whether they needed a feeding tube, or whether they developed narrowing of the throat (stenosis), compared with a group of patients who were not compliant with the SPP.
Study participants had assessments made by Wang’s team of their swallowing ability two 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 excess tissue caused by the radiation (radiation fibrosis), which contributes to loss of swallowing ability. Compliance to the SPP was by patient self-reporting at weekly visits to UCLA.
Among 85 participants from 2007 to 2012, 57 were deemed compliant with the SPP and 28 were non-compliant. 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 SPP 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 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.