dysphagia – Oral Cancer News

UC trial tests tongue exercises to improve swallowing function after stroke

Source: www.uc.edu Author: Tim Tedeschi Up to three-quarters of all stroke survivors have some form of difficulty swallowing (dysphagia) after a stroke. Dysphagia frequently leads to entry of food or liquid into the lungs and has significant impacts on patients’ overall health and quality of life. In the most severe cases, patients are no longer able to eat or drink at all or can die from aspiration pneumonia. Because eating and drinking are pivotal to participating in life socially, dysphagia can also lead to depression. A new trial at the University of Cincinnati Gardner Neuroscience Institute, funded by a $660,000 National Institutes of Health (NIH) grant, will test an at-home tongue endurance exercise to improve patients’ swallowing function. Research background Speech language pathologist and trial principal investigator Brittany Krekeler, PhD, said swallowing issues can sometimes be a “hidden” disorder, because it is usually secondary to other diseases. “You hurt for these patients when they can’t enjoy eating and drinking, and swallowing disorders can be a burden on family members as well,” said Krekeler, assistant professor and clinician-scientist at the UC College of Medicine’s Dysphagia Rehabilitation Laboratory. “From working with these patients clinically, we see how much it means for patients to be able to eat and drink again.” Krekeler said research into improving swallowing function is relatively new, as historically the problem was addressed by giving feeding tubes to patients with post-stroke dysphagia. But feeding tubes can fall out, can get infected and prevent patients from being able to enjoy [...]

Oral Cancer Foundation News Team - A2024-01-10T15:03:25-07:00January, 2024|Oral Cancer News|

Trial results support ‘new gold standard’ for head and neck cancer radiotherapy

Source: medicalxpress.com Author: Institute of Cancer Research Phase III trial results on a precision radiotherapy technique support a "new gold standard" for treating head and neck cancer patients. The research suggests the new approach can reduce the risk of swallowing problems after radiotherapy, without impacting the success of treatment. The Dysphagia-Aspiration Related Structures (DARS) trial compared dysphagia-optimized intensity-modulated radiotherapy (DO-IMRT) with standard IMRT. Reducing radiation to muscles involved in swallowing DO-IMRT optimizes IMRT to reduce the risk of swallowing difficulties, known as dysphagia. This common side effect of radiotherapy for head and neck cancer can, in some cases, leave patients needing a permanent feeding tube. DO-IMRT lowers the risk of dysphagia by reducing radiation to the pharyngeal muscles, which support swallowing. The DARS study included 112 newly diagnosed participants with oropharyngeal and hypopharyngeal cancers (tumors of the throat) from centers across the U.K. and Ireland. Half received standard IMRT and half received DO-IMRT for six weeks. Final results from the trial, which were published in The Lancet Oncology, revealed that: After two years, patients treated with DO-IMRT were more likely to report better swallowing function than those treated with IMRT. After a year, around three-fifths (62%) of DO-IMRT patients reported high normalcy of diet—meaning they were still able to eat at least some foods that require chewing—and more than 8 in 10 (85%) said they felt comfortable eating in public, compared with just under 45% and 75% of those treated with standard IMRT respectively. After just over three years of [...]

Oral Cancer Foundation News Team - A2023-11-26T15:49:43-07:00November, 2023|Oral Cancer News|

Dysphagia-optimized IMRT for head and neck cancer beneficial to swallowing function

Source: www.oncologynurseadvisor.com Author: Vicki Moore, PhD Treatment with dysphagia-optimized (DO) intensity-modulated radiotherapy (IMRT) improved patient-reported swallowing function in patients with pharyngeal cancer compared with standard IMRT. These results of a phase 3 study were published in the journal Lancet Oncology. Dysphagia-optimized IMRT was found to reduce radiation dose to the throat structures, thereby improving dysphagia and aspiration function compared with standard IMRT. Source: Getty Image “Our findings suggest that reducing dose to the pharyngeal constrictor muscle translates into patient benefit through improved swallowing function,” the study investigators wrote in their report. The phase 3 DARS study (ISRCTN Registry Identifier: ISRCTN25458988) was conducted across radiotherapy centers in the UK and Ireland. Enrolled patients had biopsy-confirmed squamous cell carcinoma of the oropharynx or hypopharynx in addition to meeting certain eligibility criteria. Patients were randomly assigned 1:1 to receive either DO-IMRT or standard IMRT over 6 weeks. The radiotherapy target dose was 65 Gy to the primary and nodal tumor, while the remaining tumor subsite and nodal regions considered at risk of occult microscopic disease had a target dose of 54 Gy. With DO-IMRT, there was a 50-Gy mean dose constraint for the superior and middle pharyngeal constrictor muscle or inferior pharyngeal constrictor muscle residing beyond the high-dose target volume. The primary endpoint of the study was the MD Anderson Dysphagia Inventory (MDADI) composite score at 12 months following treatment in the modified intention-to-treat population, which included patients completing this assessment. In this study, 112 patients were assigned to treatment, with [...]

Oral Cancer Foundation News Team - A2023-07-30T06:27:06-07:00July, 2023|Oral Cancer News|

Doctor reveals best way to swallow pills without gagging – including correct head position

Source: www.mirror.co.uk Author: Freya Hodgson, Online Reporter The expression that something is ‘a hard pill to swallow’ isn’t just a metaphor. Many people have difficulty swallowing tablets, and this can be particularly distressing if you need to take medication on a daily basis. We naturally chew food before swallowing, but tablets and capsules require a conscious override to the normal chew and swallow reflex. According to Harvard, this causes one in three people to gag, vomit or choke. But one NHS doctor has shared the best way to swallow your medicine smoothly, without gagging. Taking to TikTok, Dr Karan Rajan responded to a post in which a user had found a hack to help swallow medicine. They put the capsule on their tongue, took a gulp of water but didn’t swallow. Then they put their head forward before swallowing the medicine, a method which Dr Rajan said works well. He explained: "Now the best way to swallow capsules is with the head tilted forwards. See youtube video describing technique. "This may seem strange, but capsules are light and float in water, so when the head is tilted forward, capsules float towards the throat. "But when the head position is neutral or slightly tilted back, the capsules float towards the teeth, making swallowing a bit more difficult. "Now, when it comes to tablets and pills, you want your head tilted slightly back. "This is because tablets and pills can be slightly heavier and denser - so the focus needs to be [...]

Oral Cancer Foundation News Team - A2022-09-25T10:59:23-07:00September, 2022|Oral Cancer News|

Head and neck cancer survivors with dysphagia prone to anxiety, depression

Source: www.oncologynurseadvisor.com Author: Jennifer Larson Symptoms of anxiety and depression are increased in patients with head and neck cancer (HNC) who experience symptoms of dysphagia, according to researchers from the University of Pittsburgh and the University of Pittsburgh Medical Center (UPMC). These findings were published in Oncology Nursing Forum. For this cross-sectional analysis, 228 survivors of head and neck cancer were recruited between October 2018 and January 2020. Participants completed questionnaires that assessed for outcomes such as swallowing dysfunction and symptoms of anxiety and depression. Patient-reported symptoms of dysphagia were measured with the 10-item Eating Assessment Tool (EAT-10), which assessed issues such as difficulties with consistencies, food sticking, coughing, and swallowing-related weight loss. Participants also completed the Generalized Anxiety Disorder-7 (GAD-7) to assess for recent symptoms of anxiety and the Patient Health Questionnaire-8 (PHQ-8) to assess for recent symptoms of depression. Patients who self-reported symptoms of dysphagia were also more likely to report symptoms of anxiety and depression. Overall, 23% of the participants reported symptoms of anxiety and 29% reported symptoms of depression. “When comparing anxiety and depression levels in survivors who reported symptoms of dysphagia versus those who did not, statistical analysis showed a substantial positive correlation between increased swallowing dysfunction and more severe symptoms of anxiety and depression,” the researchers reported. The study was limited by its cross-sectional nature, and a causal association between patient-reported symptoms of dysphagia and psychological distress cannot be inferred by these data. Self-report questionnaires are intended to screen for certain symptoms, not diagnose [...]

Oral Cancer Foundation News Team - A2022-01-05T21:49:39-07:00January, 2022|Oral Cancer News|

Calls grow for treatment deintensification of HPV-positive OPC

Source: ww.pharmacytimes.com Author: Bryan Fitzgerald, PharmD, BCOP Health-System Edition, July 2021, Volume 10, Issue 4 Oropharyngeal cancer (OPC) is a type of head and neck cancer that affects structures in the back of the throat, including the base of the tongue, the posterior pharynx, the soft palate, and the tonsils.1 In the United States, rates of OPC are increasing each year, with an estimated 54,010 new cases in 2021.2 Well-established risk factors include alcohol abuse; exposure to tobacco, including chewing tobacco, cigarettes, and pipes; and infection with human papillomavirus (HPV). With an estimated 43 million infections in 2018, HPV is the most common sexually transmitted infection in the United States.3 HPV infection is causally linked with cancers of the anogenital region, including anal, cervical, penile, vaginal, and vulvar cancers. When HPV is spread orally, infections can also lead to the development of OPC. In the United States, more than 70% of OPC cases are caused by HPV.4 HPV is a group of more than 100 viruses, including certain high-risk strains associated with the development of cancer. The HPV-16 strain is responsible for causing the majority of HPV-positive (HPV+) OPC cases, with HPV-18, HPV-33, and HPV-35 also contributing, albeit significantly less than HPV-16.1 In these high-risk HPV strains, the viral genome encodes several oncogenic proteins that inhibit tumor suppressor proteins, leading to chromosomal instability and malignancy in infected cells. HPV+ OPC is considered a genetically distinct form of OPC. Compared with HPV-negative (HPC–) OPC cases, HPV+ OPC is associated with a [...]

Oral Cancer Foundation News Team - A2021-07-21T10:05:34-07:00July, 2021|Oral Cancer News|

Common causes of dysphagia in seniors may differ by sex, study finds

Source: www.mcknights.com Author: Alicia Lasek Common causes of swallowing problems may differ significantly between older men and women, according to physician researchers. In a two-year swallowing clinic study, neuromuscular and esophageal problems were the most frequent causes of dysphagia among 109 study participants, reported Jeremy Applebaum, M.D., from Johns Hopkins University. Many patients (16%) had either diverticula (a soft pouch in the esophagus that can collect food particles), reflux (14%) or scarring caused by radiation treatment (8%). These problems also were associated with significant quality-of-life burden, the researchers added. Causal differences were also found between the sexes. Men were more likely to have oropharyngeal dysphagia, a difficulty with initiating swallowing as food is introduced to the pharynx and esophagus from the mouth. In contrast, women were more likely to present with esophageal dysphagia, which can have several causes and is typically associated with the sensation of food sticking in the throat or chest after starting to swallow. Higher rates of smoking and head and neck cancer may explain the prevalence of oropharyngeal problems found in male participants, whereas the esophageal problems in women likely were due to the high prevalence of reflux disease among that cohort, the authors surmised. They did not find significant differences in cause between older age cohorts. Up to 33% of people age 65 and older are known to have swallowing problems due to physical changes, yet dysphasia also may be the result of underlying disease, the investigators said. “A complaint of dysphagia in older adults [...]

Oral Cancer Foundation News Team - A2020-07-28T10:27:19-07:00July, 2020|Oral Cancer News|

Ask the Doctors: Dysphagia common in elderly

Source: journalstar.com Author: [email protected] Dear Doctor: Why do the elderly often have a hard time swallowing, and sometimes experience a feeling that food is stuck in their throats? I heard there's a procedure to stretch the throat. Does it help? Dear Reader: The condition you're asking about is known as dysphagia, which refers to difficulty in swallowing. Patients may have trouble starting a swallow, or problems with the esophagus, which is the muscular tube that connects the throat with the stomach. The origins of the disorder fall into several basic categories. There are neurological causes, such as stroke, Parkinson's disease, multiple sclerosis, dementia and head injury. Certain muscular conditions can affect the proper functioning of the esophagus. So does obstruction, which can result from a narrowing of the esophagus, or from inflammation. These can be caused by head and neck cancers, radiation therapy, tuberculosis and chronic acid reflux. Although dysphagia can affect people of all ages, you're correct that it's seen more often in older adults. This is commonly due to age-related changes in the body, such as loss of muscle tone, mass and strength, and changes to nerve function. Still, dysphagia is not considered to be a normal sign of aging. Understanding dysphagia starts with the mechanics of swallowing. We tend to think of it as the "gulp" that empties the mouth. But that's just the first step of a complex process. A successful swallow moves the contents of your mouth through the throat, and all the way down [...]

Oral Cancer Foundation News Team - A2020-01-20T19:32:29-07:00January, 2020|Oral Cancer News|

Which feeding tubes do head and neck cancer clinicians prefer to use in patients undergoing radiotherapy?

Source: www.oncologynurseadvisor.com Author: Susan Moench, PhD, PA-C A study of the perceptions of health care professionals involved in the care of patients with head and neck cancer undergoing radiation therapy regarding optimal feeding tube practices showed no consensus; however, feeding tube placement was considered important for some patients. This study was published in JPEN Journal of Parenteral Enteral Nutrition. Patients with head and neck cancer frequently undergo intensive treatment that may include a long course of radiation therapy in addition to surgery and chemotherapy. Treatment-related toxicity can involve severe dysphagia and mucositis, as well as reduced food intake and unintentional weight loss; these clinical sequelae can also lead to treatment delays and an increased risk of hospitalization. Clinical practice guidelines include recommendations for early enteral feeding in patients with stage IV disease or hypopharyngeal tumors who are receiving chemoradiotherapy, as well as other patients with head and neck cancer, “depending on factors including their treatment, nutrition status, dysphagia, social support, and food intake.” However, there is no conclusive evidence as to which of the most commonly used feeding tubes — a nasogastric tube (NGT) placed when additional nutritional support is needed or a prophylactic gastrostomy tube (PGT) placed before radiation therapy — is preferable. In this qualitative study, in-depth interviews were conducted with interdisciplinary health care professionals from 4 radiation therapy departments (2 in the United States and 2 in Australia) to evaluate their perspectives and experiences regarding feeding tube practices in patients with head and neck cancer. Of the [...]

Oral Cancer Foundation News Team - A2019-09-14T09:13:13-07:00September, 2019|Oral Cancer News|

Suspect laryngeal cancer in patients with sore throat and hoarseness, GPs urged

Source: www.pulsetoday.co.uk Author: Isobel Sims GPs should suspect laryngeal cancer and consider urgent referral in patients who present with a persistent sore throat and hoarseness, according to a new study. A recurrent sore throat in combination with symptoms such as hoarseness, difficulty swallowing or ear pain increases the likelihood that a patient has laryngeal cancer and may warrant urgent referral, the authors said. The study, published in the British Journal of General Practice, was carried out by researchers at the University of Exeter and looked at primary care data for just over 800 patients diagnosed with laryngeal cancer, as well as just over 3,500 controls. The researchers found hoarseness carried the greatest individual risk, with those presenting with the symptom having a 2.7% likelihood of having laryngeal cancer – just under the NICE (National Institue for Health & Care Excellene) threshold of 3% for urgent referral. Patients presenting with a recurrent sore throat in combination with hoarseness had a 12% likelihood of having laryngeal cancer. The likelihood of cancer was also increased above the NICE threshold when recurrent sore throat presented with dysphagia, recurrent dyspnoea, ear pain and raised inflammatory markers, the researchers said. They found that, ‘unexpectedly’, neck lumps were not associated with laryngeal cancer. The authors said the findings back up the NICE recommendation to consider referring patients with persistent unexplained hoarseness, but that GPs should also be vigilant about symptoms not currently listed in the NICE guidance. The paper said: ‘This evidence supports some of the recommendations [...]

Oral Cancer Foundation News Team - A2019-03-06T15:03:59-07:00March, 2019|Oral Cancer News|