Oral Health, Dysphagia, Distress, and Health Service Needs of Head and Neck Cancer Survivors 5 Years Post-Chemoradiotherapy

Bena Cartmill

doi:10.23937/2469-5734/1510024

Abstract

Purpose: Evidence suggests that oral health effects and dysphagia remain chronic conditions for patients who undergo radiotherapy with or without chemotherapy ([chemo]RT) following diagnosis of head and neck cancer (HNC), however, there is limited outcome data beyond 1-2 years post-treatment. The aim of the current study was to investigate the long term patient outcomes at 5-6 years post- (chemo)RT using patient-reported functional measures. A secondary aim was to examine the extent of services accessed, and desired, by this group. Methods: A retrospective audit was conducted to select patients treated curatively for HNC using (C)RT and seen by speech pathology. Twenty eligible long term HNC patients treated with (chemo)RT completed a series of patient-reported outcome measures, a quality of life (QoL) scale, a general distress tool and questions relating to services. Results: Results revealed that at 5-6 years post-treatment, over half reported moderate to severe oral health effects, and only 30% tolerated a full normal diet. Moderate to severe levels of distress were reported by 25%, though global QoL remained positive. Few had sought further services for these issues. Conclusions: Persistent oral health effects, chronic swallowing difficulties, and distress are common in this population. Clinicians need to be aware of the long-term nature of patient-reported dysfunction and tailor appropriate services and supports to patient need.

Highlights

Nonsurgical approaches to head and neck cancer (HNC) treatment, including radiotherapy with or without chemotherapyRT, can significantly affect the swallowing function of patients [1,2,3,4]
Evidence supports that many individuals will experience improved swallowing in the months followingRT, for a considerable proportion of individuals, dysphagia continues to be a persistent issue at one year post-treatment [1,3,5,6,7]
Results of the Functional swallowing status (FOIS) scores collected from pre-treatment, week 5 of treatment, and post-treatment revealed a significant (χ = 25.423, p = < 0.001) change in swallow functioning across time (Table 2)

Summary

Introduction

Nonsurgical approaches to head and neck cancer (HNC) treatment, including radiotherapy with or without chemotherapy (chemo)RT, can significantly affect the swallowing function of patients [1,2,3,4]. Evidence supports that many individuals will experience improved swallowing in the months following (chemo)RT, for a considerable proportion of individuals, dysphagia continues to be a persistent issue at one year post-treatment [1,3,5,6,7]. Many patients who have dysphagia post-treatment will continue to experience persistent swallowing difficulties a number of years later, and in some cases, present with worsening of the condition, thought to be due to the ongoing effects of tissue fibrosis causing continued functional tissue loss, leading in some instances to stiffening and hardening of tissues, and possible stricture formation [11,12]. Radiation induced neuropathy and muscle atrophy are potential causative factors for long term dysphagia and trismus, as are mucosal sensory changes following radiotherapy [11,16,17]

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