Effects of two different behavioral swallowing exercise protocols performed during radiation therapy on swallowing physiology, function, quality-of-life and weight outcomes following organ-preservation treatments for head and neck cancers

Abstract

Objective: The purpose of this study was to investigate the effects of two different prophylactic behavioral swallowing exercise regimens performed by head and neck cancer/s (HNC) patients during radiation therapy with/without chemotherapy (RT/C) on swallowing physiology, function, quality-of-life (QOL) and weight outcomes at the completion of RT/C. Feeding tube (PEG) status at 3 months post-treatment was also compared. Methods: This study was conducted via a prospective design. 50 patients diagnosed with HNC who were to undergo RT/C were recruited at pre-treatment based on the inclusion criteria: functional swallowing abilities; without prophylactic PEG tubes; ability to comprehend and perform therapy tasks and signed informed consent. Patients were assigned to the exercise group (EX: n=26) or repetitive swallow group (SW: n=24), by alternate assignment as well as matching for age, tumor site and stage. A no treatment group (NTx) of patients (n=23) was recruited retrospectively from co-facilities during identical timelines as the prospective cohort. The EX and SW treatment groups attended therapy sessions once a week and completed two different intensive exercise regimens throughout RT with maintenance of a daily home program. Outcome measures: All patients in the EX and SW treatment groups, underwent pre and post-treatment MBS studies. The following outcomes were reported: physiological (aspiration and Penetration Aspiration Scale scores); functional (PEG tube dependence and Functional Oral Intake Scale scores); QOL (MD Anderson Dysphagia Inventory Scale scores) and weight loss. At 3 months post-treatment, PEG tube dependence was assessed and compared. PEG tube dependence and weight loss in patients in the treatment and no treatment groups were compared at post-treatment and 3 months post-treatment. Results: The EX and SW groups did not statistically significantly differ on any outcomes at post-treatment. The NTx group also did not differ from the EX and SW groups in terms of PEG tube dependence and weight loss at post-treatment. However, the EX group exhibited a significantly higher rate of PEG tube elimination than the SW group at 3 months post-treatment (i.e. 16% vs. 50%). Among patients who received both radiation and chemotherapy, patients in the EX group exhibited significantly lower PEG tube dependence rates at post-treatment and 3 months post-treatment, compared to the SW and NTx groups. The EX group’s post-treatment aspiration (i.e. 18%) and PEG tube dependence (16%) rates at 3 months post-treatment were among the lowest reported in the literature. Conclusions: Performing swallowing exercises prophylactically, resulted in significantly improved rates of PEG tube elimination