dysphagia – Page 2 – Oral Cancer News

Symptom combos suggesting laryngeal cancer identified

Source: www.physiciansweekly.com Author: staff New symptom combinations that may indicate early symptoms of laryngeal cancer have been identified, according to a study published online Jan. 28 in the British Journal of General Practice. Elizabeth A. Shephard, Ph.D., from the University of Exeter Medical School in the United Kingdom, and colleagues conducted a matched case-control study of patients aged ≥40 years to examine the clinical features of laryngeal cancer with which patients presented to their general practitioner in the year before diagnosis. The researchers identified 806 patients who were diagnosed with laryngeal cancer between 2000 and 2009; the patients were matched with 3,559 controls based on age, sex, and practice. Significant associations were identified for 10 features with laryngeal cancer: hoarseness (odds ratio, 904); sore throat, first attendance (odds ratio, 6.2); sore throat, reattendance (odds ratio, 7.7); dysphagia (odds ratio, 6.5); otalgia (odds ratio, 5); dyspnea, reattendance (odds ratio, 4.7); mouth symptoms (odds ratio, 4.7); recurrent chest infection (odds ratio, 4.5); insomnia (odds ratio, 2.7); and raised inflammatory markers (odds ratio, 2.5). The highest individual positive predictive value (PPV) was 2.7 percent for hoarseness. The symptom combinations of sore throat plus either dysphagia, dyspnea, or otalgia are not currently included in the National Institute for Health and Care Excellence (NICE) guidelines; PPVs for these combinations were >5 percent. “These results expand current NICE guidance by identifying new symptom combinations that are associated with laryngeal cancer; they may help general practitioners to select more appropriate patients for referral,” the authors write. Abstract/Full [...]

Oral Cancer Foundation News Team - A2019-02-05T21:00:05-07:00February, 2019|Oral Cancer News|

What University of Toronto researchers are doing to help ‘devastating’ swallowing problems

Source: www.utoronto.ca Author: Jim Oldfield We swallow about 600 times a day, mostly without thinking about it. But swallowing involves dozens of muscles and nerves in the mouth, throat and esophagus, and for people who struggle with the process, the results can be devastating. Malnutrition, dehydration and social isolation are common in people with swallowing trouble. So is depression and aspiration of food that leads to pneumonia. Occasionally, swallowing issues cause choking and sudden death. And a recent U.S. study of hospitalized patients with serious illnesses found that more than half said needing a feeding tube to live was a state equal to or worse than death. Many conditions can cause swallowing problems: stroke, neurodegenerative diseases such as Parkinson’s, and congenital or developmental conditions such as cerebral palsy and cleft palate. People treated for head and neck cancer often develop problems, sometimes years later; and their numbers are growing as cancer survival rates improve. Estimates on the global prevalence of swallowing disorders, which collectively are known as dysphagia, are about eight per cent – almost 600 million people. But there is good news. Before 1980, most patients with complex dysphagia got feeding tubes; today, clinicians can offer videofluoroscopy and other bedside tests to better assess swallowing problems, and less invasive therapies that emphasize exercise and posture. And at the University of Toronto, scientists in the department of speech-language pathology and related fields are starting to answer long-standing questions such as how best to give dysphagia screening tests, which interventions work [...]

Oral Cancer Foundation News Team - A2018-04-11T10:46:01-07:00April, 2018|Oral Cancer News|

Head, Neck Cancer Patients May Be at Higher Risk for Suicide: Study

Source: www.health.usnews.comAuthor: Robert Preidt THURSDAY, Nov. 12, 2015 (HealthDay News) -- Head and neck cancer patients may be at raised risk for suicide, new research suggests. However, the overall risk is still small, the findings showed. The study included over 350,000 patients in the United States diagnosed with head and neck cancer between 1973 and 2011. Of those patients, 857 died by suicide. The investigators found that the suicide rate among head and neck cancer patients was three times higher than in the general population. And suicide rates were higher among patients treated with radiation alone compared to surgery alone. Suicide rates were highest among those with cancers of the lower part of the throat, including the larynx ("voice box") and hypopharynx, at five times and 12 times higher, respectively, than in the general population. "This may be linked to these anatomic sites' intimate relationship with the ability to speak and/or swallow. Loss of these functions can dramatically lower patients' quality of life," Dr. Richard Chan Woo Park, of Rutgers New Jersey Medical School, and colleagues wrote. "It is possible that the increased rates of tracheostomy [breathing tube] dependence and dysphagia [difficulty swallowing] and/or gastrostomy [feeding] tube dependence in these patients are . . . factors in the increased rate of suicide observed," the authors added. The study was published online Nov. 12 in the journal JAMA Otolaryngology--Head & Neck Surgery. "While there is a considerable body of research that examines survival outcomes for patients with head and neck cancer, additional [...]

Charlotte Parker2015-11-13T15:34:55-07:00November, 2015|Oral Cancer News|

A Disorder That’s Hard to Swallow

Source: www.usnews.comAuthor: Anna Medaris Miller Ed Steger’s last meal was a bowl of soup in Las Vegas. “I remember it all too clearly, as if it were yesterday,” he says. But it wasn’t yesterday – it was 2006. “Life is very different” now, says Steger, a 63-year-old former program manager in Houston. Steger was diagnosed with head and neck cancer in 2005. In addition to 36 rounds of radiation and eight regimens of chemotherapy, he underwent six surgeries, including one that replaced a portion of his pharynx and removed parts of his left jawbone, tongue, epiglottis and soft palate. “The part that makes it odd is that I’m alive after having four recurrences,” Steger says. The part that makes it distressing is that he can’t eat solid foods. “There are many case studies I’ve seen where patients have said [their] swallowing disorder is the worst part of their disease – and I believe this to be true,” says Steger, who’s president of the National Foundation of Swallowing Disorders. His daily diet consists of four 8-ounce cans of the nutritional drink Boost Plus, along with two to four bottled Starbucks Frappuccinos, which he buys at his local supermarket. “It’s a very boring diet that allows me to maintain my weight,” says Steger, who’s 5 feet 10 inches tall and 155 pounds. It’s unknown how many people have dysphagia, or difficulty swallowing, but the condition can be caused by any one of 30 diverse health events, Steger says. While his dysphagia is a result of surgery, other people [...]

Oral Cancer Foundation News Team - A2015-06-02T16:23:17-07:00June, 2015|Oral Cancer News|

Internal lymphedema underlies swallow dysfunction in head and neck cancer

Source: www.oncologynurseadvisor.com Author: Bryant Furlow Treatment-related dysphagia symptoms are likely caused by internal lymphedema among patients with head and neck cancer, according to research presented at the 2014 American Society of Clinical Oncology (ASCO) Annual Meeting. “Internal lymphedema (correlated with subjective and objective measures of swallow dysfunction,” said lead author Leanne Kolnick Jackson, MD, at the Vanderbilt University Medical Center, Nashville, Tennessee. “Most of the time patients have silent aspiration, which is most dangerous. So if a patient ever says they have dysphagia, it warrants an exam” including imaging as well as endoscopy, Jackson said. External lymphedema is visible and recognizable, but internal lymphedema—which occurs in up to 90% of cases of external lymphedema—can go undetected, the coauthors noted. “External lymphedema is just the tip of the iceberg,” said senior author Barbara A. Murphy, MD, of Vanderbilt University Medical Center. “Only 10% of patients with lymphedema have only external lymphedema.” Secondary lymphedema and fibrosis are “ubiquitous and underreported” late effects among patients with head and neck cancers, Jackson reported. Using the Vanderbilt Head and Neck Symptom Survey (VHNSS) version 1.0, the researchers collected patient-reported swallow dysfunction among study participants undergoing treatment for head and neck cancer. They subsequently studied patients' swallow function and internal lymphedema, using endoscopic assessments, modified-barium videofluoroscopy, the Dysphagia Outcome and Severity Scale (DOSS), and National Outcomes Measurement System (NOMS). Endoscopy does not detect internal lymphedema well “for every site,” Jackson noted. “Some sites are not well evaluated by endoscopy.” At 18 months posttreatment, VHNSS swallow/nutrition scores [...]

Oral Cancer Foundation News Team - A2014-06-02T05:16:19-07:00June, 2014|Oral Cancer News|

Effects of Chemoradiation on Voice and Speech Quality of H&N Cancer Patients

Source: Med Page TodayPublished: February 23, 2014By: Charles Bankhead SCOTTSDALE, Ariz. -- Patients with oropharyngeal cancer reported significant voice and speech impairment for up to 2 years after chemoradiation therapy, but most of their doctors saw no evidence of it, data from a prospective study showed. Two years after treatment, a fourth of patients said their voice and speech remained below baseline levels, whereas none of their clinicians noted any impairment. At no time did as many as 10% of clinicians report patients with speech and voice issues, whereas the proportion of patients reporting problems ranged as high as 56%. The likelihood of patient-reported difficulties with oral communication increased with the radiation dose to the glottic larynx, reported Jeffrey M. Vainshtein, MD, and colleagues at the Multidisciplinary Head and Neck Cancer Symposium. "Our findings highlight the critical role of patient-reported outcomes in identifying areas of improvement of our current therapies, which may ultimately translate into improvements in quality of life for our patients," Vainshtein, of the University of Michigan in Ann Arbor, said during a press briefing. Dysphagia and xerostomia are recognized adverse effects of chemoradiation for head and neck cancer and have been studied extensively in recent years. In contrast, a paucity of information exists relative to the effects of chemoradiation on voice and speech quality, Vainshtein said. To examine the issue, investigators assessed voice and speech outcomes in 93 patients who underwent chemoradiation for oropharyngeal cancer, using intensity-modulated radiation therapy (IMRT). At baseline, and then every 3 to [...]

Charlotte Parker2014-02-24T17:36:33-07:00February, 2014|Oral Cancer News|

Swallowing exercises shown to preserve function in head and neck cancer patients receiving radiation

Source: www.healthnewsdigest.com Author: staff 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 [...]

Oral Cancer Foundation News Team - A2013-09-01T15:54:22-07:00September, 2013|Oral Cancer News|

IMRT plus chemotherapy offers high locoregional control in advanced nasopharyngeal carcinoma

Source: www.healio.com Treatment with intensity-modulated radiotherapy and concurrent weekly chemotherapy improved xerostomia and dysphagia in patients with advanced nasopharyngeal carcinoma, according to study results presented at the WIN Symposium. Researchers in China recruited 310 patients with stages III to IVb nasopharyngeal carcinoma. All patients received curative IMRT plus weekly chemotherapy with cisplatin (40 mg/m2). Patients received doses of 66 to 70.4 Gy to the gross tumor volume, 60 Gy to the first clinical target, and 54 to 56 Gy to the second clinical target. “The medial group retropharyngeal nodes were never contoured as clinical target volume, aiming to spare the pharyngeal constrictors unless they were involved,” the researchers wrote. “[The] level 1b node was selectively contoured as clinical target volume in order to spare the submandibular glands and oral cavity.” Patient-reported and observer-related scores assessed swallowing and salivary gland function at baseline and periodically up to 3 years after treatment. Median follow-up was 39 months. At 3 years, researchers reported a local RFS rate of 93.6%, a regional RFS rate of 95.8% and a distant metastases-free survival rate of 80%. Researchers reported no marginal or out-of-field relapses. Patients’ dysphagia and xerostomia worsened during late courses of treatment, as well as after treatment, yet scores gradually improved after therapy. Dysphagia was minimal or absent at 9 months post radiotherapy, whereas xerostomia improved from 3 to 15 months post radiotherapy and remained steadily until the conclusion of follow-up. “IMRT concurrent with weekly chemotherapy aiming to reduce xerostomia and dysphagia can be safely [...]

Charlotte Parker2013-07-19T07:42:19-07:00July, 2013|Oral Cancer News|

SSRI Prevents Depression in Head, Neck Cancer

Source: MedPage TodayBy Salynn Boyles, Contributing WriterPublished: June 21, 2013 Prophylactic escitalopram cut the incidence of depression in head and neck cancer patients by more than 50% and improved quality of life, a clinical trial showed. Significantly fewer patients taking the antidepressant developed depression, when compared with those on placebo (10% vs 24.6%; stratified log-rank test, P=.04), according to a study in the June 20 issue of JAMA Otolaryngology Head and Neck Surgery. "Depression is very common among patients with this disease, but it is not easy to predict who will become depressed at the beginning of treatment," University of Nebraska Medical Center professor of head and neck oncology William Lydiatt, MD, told MedPage Today. "That's why the prevention paradigm may offer considerable benefit at an acceptable risk." As many as half of head and neck cancer patients develop clinical depression within months of their diagnosis and suicide rates are among the highest in patients with a medical illness, Lydiatt noted. "The burden of treatment is extensive and frequently includes dysphagia, disfigurement, voice alterations, mucositis, need for tracheostomy and feeding tubes, fatigue and depression," the researchers wrote. They chose the generic version of the popular SSRI Lexapro for the trial to give patients an affordable treatment option that's well tolerated in the elderly. The randomized, double-blind trial included 148 newly diagnosed head and neck cancer patients entering treatment who did not yet have a diagnosis of depression. The patients were stratified by sex, site of disease, stage, and primary modality of [...]

Charlotte Parker2013-06-21T14:10:07-07:00June, 2013|Oral Cancer News|

Dysphagia after definitive radiotherapy for head and neck cancer

Source: Strahlentherapie und Onkologie Authors: L. Deantonio MD, L. Masini MD, M. Brambilla PhD, F. Pia MD, M. Krengli MD Background Dysphagia is a complication of head and neck cancer patients undergoing radiotherapy (RT). We analysed frequency and severity of swallowing dysfunction and correlated these findings with dose–volume histograms (DVHs) of the pharyngeal constrictor muscles. Methods A total of 50 patients treated by radical RT were enrolled. DVHs of constrictor muscles were correlated with acute and late dysphagia and with the items of three quality of life questionnaires. Results Mean dose to superior and middle constrictor muscles (SCM, MCM), partial volume of SCM and MCM receiving a dose ≥ 50 Gy dose to the whole constrictor muscles ≥ 60 Gy and tumour location were associated to late dysphagia at univariate analysis. Mean dose to the MCM was the only statistically significant predictor of late dysphagia at the multivariable analysis. Conclusion The study shows a significant relationship between long-term dysphagia and mean doses to SCM, MCM, whole constrictor muscles, and oropharyngeal tumour. This finding suggests a potential advantage in reducing the RT dose to swallowing structures to avoid severe dysphagia. This article was sourced by The Oral Cancer Foundation and vetted for accuracy and appropriateness.

Charlotte Parker2013-01-14T20:58:52-07:00January, 2013|Oral Cancer News|