Swallowing exercises improved short term capabilities in head and neck cancer

Swallowing exercises were linked to increased swallowing capabilities among patients with head and neck cancer, but only at 3 and 6 months after chemoradiation therapy, according to study results.

Tamar Kotz, MS, CCC-SLP, of the swallowing and voice pathology, otolaryngology and head and neck surgery departments at Mount Sinai Medical Center, and colleagues conducted a randomized controlled trial at a tertiary care academic medical center to assess whether prophylactic swallowing exercises could affect swallowing function in 26 patients undergoing chemoradiation therapy for head and neck cancer.

The studied regimen included five targeted swallowing exercises throughout therapy. Participants also attended weekly swallowing therapy sessions designed to promote adherence and accurate swallowing technique.

“We had 13 control patients and 13 patients who were randomly assigned to receive the prophylactic swallowing exercises,” Kotz told HemOnc Today. “Of the 13 who received the exercises, by the end of week 5 of the chemoradiation treatment, nine of theses 13 intervention patients were no longer able to perform the exercise due to the acute side effects of the treatment. However, despite the fact that these patients were not able to continue performing the required swallowing exercises to the completion of the cancer treatment, they still benefited and exhibited better swallowing function outcomes than the control patients.”

The researchers assessed swallowing function with the Functional Oral Intake Scale (FOIS) and the Performance Status Scale for Head and Neck Cancer Patients (PSS-H&N). They were measured at baseline, immediately after chemoradiation therapy, and at 3, 6, 9 and 12 months after therapy initiation.

No statistically significant differences in FOIS scores were observed between intervention and control patients immediately after therapy, according to the results (intervention group median score, 3 vs. control group median control score, 4; P=.88).

Three-month results indicated that patients in the intervention group had significantly better median FOIS scores than controls (7 vs. 5; P=.03). A similar result was observed at 6 months, with intervention patients achieving a median score of 7, and control patients achieving a median score of 6 (P=.009).

No significant differences were observed at 9 months (P=.24) and 12 months (P=.93).

A similar pattern was observed for PSS-H&N scores, with intervention patients faring better at 3 and 6 months but not immediately after therapy or at 9 and 12 months.

“One important take-home message from this study is that prophylactic swallowing exercises do improve post-treatment swallowing outcomes in this patient population. Therefore, these patients should be referred for speech and swallowing therapy at the beginning (before they even develop dysphagia) rather than waiting until after the treatment is completed,” Kotz said. “That being said, we also need to understand that the chemoradiation treatment is difficult for many patients to tolerate, and that at some point some of the patients might no longer be able to comply with this type of rigorous swallowing exercise regimen. We need to be sensitive to that fact as well.”