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Swallowing exercises preserve function after radiation therapy

Sunday September 15, 2013
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Doing a set of prescribed swallowing exercises during radiation therapy for head and neck cancer made patients less likely to suffer side effects such as worsening of diet, need for a feeding tube or narrowing of the throat passage, according to a small five-year study.

The five-year study, led by Marilene Wang, MD, of the UCLA Jonsson Comprehensive Cancer Center and professor-in-residence in the department of head and neck surgery at UCLA’s medical school, was published Aug. 27 on the website of the journal Otolaryngology-Head and Neck Surgery.

“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,” Wang said in a news release. “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.”

Surgery and radiation have been the traditional treatments for head and neck cancer, but with improved and targeted chemotherapy many types of this disease are treated with chemoradiation therapy in the hope of preserving the tissue and structure. However, sparing the tissue does not always mean patients retain natural swallowing ability.

Most patients who receive chemoradiation therapy have significant side effects during treatment and for a long time after recovery. Dysphagia is one of the most common side effects of radiation or chemoradiation therapy and also a main predictor of decreased post-treatment quality of life.

The study was designed to evaluate a swallow preservation protocol, in which patients had swallow therapy before, during and after radiation treatment. The effectiveness of the protocol was measured by patients’ continued ability to swallow and how it affected their diets, whether they needed a feeding tube or whether they developed stenosis, compared with a group of patients who were not compliant with the protocol.

From 2007-12, 85 patients ages 22-91 participated in the swallow preservation protocol. The research team assessed participants’ swallowing ability two weeks before their treatments. This session included education about their cancers and expected side effects and an introduction to the swallowing exercise protocol. 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.

Based on patient self-reporting at weekly visits, 57 participants were considered compliant with the protocol and 28 were noncompliant. Researchers also tracked whether each patient’s diet was regular (chewable), puree, liquid or G-tube dependent.

Their findings showed the swallow preservation exercises appeared to maintain patients’ ability to swallow. In the compliant group, 54.4% were tolerating a regular diet, compared with 21.4% in the noncompliant group. They also were less likely to be dependent on a G-tube (22.8% compared with 53.6%) and were more likely to maintain or improve their diets (54.4% compared with 25%) than the noncompliant patients.

The research was supported by the National Institutes of Health.
Study abstract: http://oto.sagepub.com/content/early/2013/08/27/0194599813502310.abstract


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