Swallow therapy combats post-radiotherapy dysphagia

Sep 20 2013

By Joanna Lyford, Senior medwireNews Reporter

Swallowing exercises can help to minimize the risk for dysphagia in patients undergoing radiotherapy (RT) for head and neck cancer, a case study suggests.

The research found that patients who followed a “swallow preservation protocol” (SPP) were less likely to be tube-fed or to change their diet during and after radiation therapy.

“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,” said study co-author Marilene Wang (David E Geffen School of Medicine at UCLA, Los Angeles, California, USA), in a press statement.

Researchers led by Victor Duarte, also from David E Geffen School of Medicine at UCLA, identified 85 patients who had participated in the UCLA SPP over a 5-year period. Patients received either RT (n=18) or chemoradiation (CRT; n=67) for head and neck cancer.

The SPP exercises comprised gargling liquid, effortful swallowing, the Mendelsohn maneuver, chug-a-lug 3 ounces at once, tongue protrusion, tongue press, and Shaker head lift. Exercises were typically performed three times daily throughout receipt of RT/CRT.

Fifty-seven patients were compliant with the SPP, meaning that they completed the full schedule of exercises, report Duarte et al in Otolaryngology-Head and Neck Surgery.

One month after completing therapy, 54.4% of patients who were compliant with SPP were eating a “regular chewable diet” and just 22.8% were dependent on a gastrostomy tube; among noncompliant patients the figures were 21.4% and 53.6%, respectively. Both differences were statistically significant.

At the 2-month follow-up, 71.9% of compliant patients were on an oral diet (chewable, purees, or liquids) compared with 50.0% of noncompliant patients. Compliant patients were also significantly more likely than noncompliant patients to have maintained or improved their diets at 1 month as compared with pretreatment.

Compliant and noncompliant patients did not differ with regard to weight change over the treatment period, or in levels of pain, or incidence of dry mouth, disordered sense of taste, or painful swallowing. However, the incidence of esophageal stenosis was significantly lower among patients who were compliant with SPP than those who were noncompliant, at 7.0% versus 32.1%.

Duarte and study authors conclude: “Swallow preservation exercises before and during RT and CRT for head and neck cancer appear to maintain swallow function…. [S]wallowing exercises and encouragement to continue oral intake during RT and CRT should still be emphasized to every patient for optimal maintenance and recovery of swallow function.”

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