Skip to main content

Advertisement

SpringerLink
Log in

Prophylactic Swallowing Exercises in Head and Neck Cancer Radiotherapy

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Many head and neck cancer (HNC) survivors experience reduced quality of life due to radiotherapy (RT)-related dysphagia. The aim of this prospective randomized trial was to evaluate the impact of prophylactic swallowing exercises on swallowing-related outcomes in HNC patients treated with curative RT. Patients treated with primary RT for HNC were candidates for this randomized protocol. Participants in the exercise group were instructed to perform swallowing exercises at home. Participants in the control group were given standard care. Patients were evaluated with modified barium swallow and several other secondary outcome measures at four and nine different time points, respectively. Data were analyzed according to intention-to-treat analyses. A total of 44 consecutive patients were included; 22 in each group. In general, there was no difference between the two groups regarding any of the dysphagia outcomes during and after treatment. Adherence to exercises was poor and dropouts due to especially fatigue were very frequent in both groups. Systematic swallowing exercises had no impact on swallowing outcomes within the first year after RT. Despite repeated supervised sessions, adherence to exercises was a major issue and dropouts were frequent in both the intervention and control group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Scott-Brown M, Miah A, Harrington K, Nutting C. Evidence-based review: quality of life following head and neck intensity-modulated radiotherapy. Radiother Oncol. 2010;97:249–57.

    Article  PubMed  Google Scholar 

  2. Mortensen HR, Overgaard J, Specht L, Overgaard M, Johansen J, Evensen JF, Andersen LJ, Andersen E, Grau C. Prevalence and peak incidence of acute and late normal tissue morbidity in the DAHANCA 6&7 randomised trial with accelerated radiotherapy for head and neck cancer. Radiother Oncol. 2012;103:69–75.

    Article  PubMed  Google Scholar 

  3. Jensen K, Lambertsen K, Grau C. Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: frequency, intensity and correlation with dose and volume parameters. Radiother Oncol. 2007;85:74–82.

    Article  PubMed  Google Scholar 

  4. Mortensen HR, Jensen K, Grau C. Aspiration pneumonia in patients treated with radiotherapy for head and neck cancer. Acta Oncol. 2012;52(2):270–6.

    Article  PubMed  Google Scholar 

  5. Mortensen HR, Jensen K, Aksglæde K, Behrens M, Grau C. Late dysphagia after IMRT for head and neck cancer and correlation with dose-volume parameters. Radiother Oncol. 2013;107(3):288–94.

    Article  PubMed  Google Scholar 

  6. Pauloski BR, Logemann JA. Impact of tongue base and posterior pharyngeal wall biomechanics on pharyngeal clearance in irradiated postsurgical oral and oropharyngeal cancer patients. Head Neck. 2000;22:120–31.

    Article  CAS  PubMed  Google Scholar 

  7. Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, Grande B, Kazandjian M, Dikeman K. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122:1314–21.

    Article  PubMed  Google Scholar 

  8. Kulbersh BD, Rosenthal EL, McGrew BM, Duncan RD, McColloch NL, Carroll WR, Magnuson JS. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope. 2006;116:883–6.

    Article  PubMed  Google Scholar 

  9. Hutcheson KA, Bhayani MK, Beadle BM, Gold KA, Shinn EH, Lai SY, Lewin J. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol Head Neck Surg. 2013;139:1127–34.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Shinn EH, Basen-Engquist K, Baum G, Steen S, Bauman RF, Morrison W, Garden AS, Sheil C, Kilgore K, Hutcheson KA, Barringer D, Yuan Y, Lewin JS. Adherence to preventive exercises and self-reported swallowing outcomes in post-radiation head and neck cancer patients. Head Neck. 2013;35:1707–12.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Duarte VM, Chhetri DK, Liu YF, Erman AA, Wang MB. Swallow preservation exercises during chemoradiation therapy maintains swallow function. Otolaryngol Head Neck Surg. 2013;149:878–84.

    Article  PubMed Central  PubMed  Google Scholar 

  12. van der Molen L, van Rossum MA, Rasch CR, Smeele LE, Hilgers FJ. Two-year results of a prospective preventive swallowing rehabilitation trial in patients treated with chemoradiation for advanced head and neck cancer. Eur Arch Otorhinolaryngol. 2014; 271(5):1257–70.

    Article  PubMed  Google Scholar 

  13. Virani A, Kunduk M, Mcwhorter AJ. Effects of two different swallowing exercise regimens during organ-preservation therapies for head and neck cancers on swallowing function. Head Neck. 2013;. doi:10.1002/hed.23570.

    Google Scholar 

  14. Kotz T, Federman AD, Kao J, Milman L, Packer S, Lopez-Prieto C, Forsythe K, Genden EM. Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial. Arch Otolaryngol Head Neck Surg. 2012;138:376–82.

    Article  PubMed  Google Scholar 

  15. Tang Y, Shen Q, Wang Y, Lu K, Wang Y, Peng Y. A randomized prospective study of rehabilitation therapy in the treatment of radiation-induced dysphagia and trismus. Strahlenther Onkol. 2011;187:39–44.

    Article  CAS  PubMed  Google Scholar 

  16. Carroll WR, Locher JL, Canon CL, Bohannon IA, McColloch NL, Magnuson JS. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008;118:39–43.

    Article  PubMed  Google Scholar 

  17. Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R. “Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;83:210–9.

    Article  PubMed  Google Scholar 

  18. Ahlberg A, Engstrom T, Nikolaidis P, Gunnarsson K, Johansson H, Sharp L, Laurell G. Early self-care rehabilitation of head and neck cancer patients. Acta Otolaryngol. 2011;131:552–61.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Cousins N, MacAulay F, Lang H, MacGillivray S, Wells M. A systematic review of interventions for eating and drinking problems following treatment for head and neck cancer suggests a need to look beyond swallowing and trismus. Oral Oncol. 2013;49:387–400.

    Article  PubMed  Google Scholar 

  20. Roe JW, Carding PN, Dwivedi RC, Kazi RA, Rhys-Evans PH, Harrington KJ, Nutting CM. Swallowing outcomes following Intensity Modulated Radiation Therapy (IMRT) for head & neck cancer—a systematic review. Oral Oncol. 2010;46:727–33.

    Article  PubMed  Google Scholar 

  21. Jensen K, Eriksen EM, Behrens M, Lambertsen K, Aksglæde K, Grau C. Prophylactic swallowing exercises during and after radiotherapy for head and neck cancer—results of phase I trial. EJC Supplements. 2009;7(2):489–90.

    Article  Google Scholar 

  22. DAHANCA (Internet): Danish Head and Neck Cancer Group (updated 2012; cited 19-9-2012). www.dahanca.dk.

  23. Lazarus CL. Management of swallowing disorders in head and neck cancer patients: optimal patterns of care. Semin Speech Lang. 2000;21:293–309.

    Article  CAS  PubMed  Google Scholar 

  24. Veis S, Logemann JA, Colangelo L. Effects of three techniques on maximum posterior movement of the tongue base. Dysphagia. 2000;15:142–5.

    Article  CAS  PubMed  Google Scholar 

  25. Lazarus C, Logemann JA, Huang CF, Rademaker AW. Effects of two types of tongue strengthening exercises in young normals. Folia Phoniatr Logop. 2003;55:199–205.

    Article  PubMed  Google Scholar 

  26. Lazarus C, Logemann JA, Song CW, Rademaker AW, Kahrilas PJ. Effects of voluntary maneuvers on tongue base function for swallowing. Folia Phoniatr Logop. 2002;54:171–6.

    Article  PubMed  Google Scholar 

  27. Karnell M, MacCracken E, Moran W, Vokes E, Haraf D, Panje W. Swallowing function following multispecialty organ preservation treatment of advanced head and neck-cancer. Oncol Rep. 1994;1:597–601.

    CAS  PubMed  Google Scholar 

  28. Jensen K. Measuring side effects after radiotherapy for pharynx cancer. Acta Oncol. 2007;46:1051–63.

    Article  PubMed  Google Scholar 

  29. European Organisation for Research and Treatment of Cancer. 2013. www.eortc.be.

  30. Mortensen H, Overgaard J, Jensen K, Specht L, Overgaard M, Johansen J, Evensen JF, Andersen E, Andersen LJ, Hansen HS, Grau C. Factors associated with acute and late dysphagia in the DAHANCA 6 & 7 randomized trial with accelerated radiotherapy for head and neck cancer. Acta Oncol. 2013;52(7):1535–42.

    Article  PubMed  Google Scholar 

  31. Christianen ME, Langendijk JA, Westerlaan HE, van de Water TA, Bijl HP. Delineation of organs at risk involved in swallowing for radiotherapy treatment planning. Radiother Oncol. 2011;101:394–402.

    Article  Google Scholar 

  32. Jensen K, Bonde JA, Grau C. The relationship between observer-based toxicity scoring and patient assessed symptom severity after treatment for head and neck cancer. A correlative cross sectional study of the DAHANCA toxicity scoring system and the EORTC quality of life questionnaires. Radiother Oncol. 2006;78:298–305.

    Article  PubMed  Google Scholar 

  33. Mekhail TM, Adelstein DJ, Rybicki LA, Larto MA, Saxton JP, Lavertu P. Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer. 2001;91:1785–90.

    Article  CAS  PubMed  Google Scholar 

  34. Klein J, Livergant J, Ringash J. Health related quality of life in head and neck cancer treated with radiation therapy with or without chemotherapy: a systematic review. Oral Oncol. 2014;50:254–62.

    Article  PubMed  Google Scholar 

  35. van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Rasch CR, Hilgers FJ. A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia. 2011;26:155–70.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Logemann JA, Rademaker A, Pauloski BR, Kelly A, Stangl-McBreen C, Antinoja J, Grande B, Farquharson J, Kern M, Easterling C, Shaker R. A randomized study comparing the Shaker exercise with traditional therapy: a preliminary study. Dysphagia. 2009;24:403–11.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

Marie Behrens is acknowledged for assistance with supervised training sessions. CIRRO and the Danish Cancer Society are acknowledged for financial support.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark

    H. R. Mortensen, K. Jensen & C. Grau

  2. Motility Laboratory, Departments of Gastroenterology and Radiology, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark

    K. Aksglæde

  3. Department of Occupational Therapy and Physiotherapy, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark

    E. Eriksen

  4. Department of Otorhinolaryngology, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark

    K. Lambertsen

Authors
  1. H. R. Mortensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Aksglæde
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Lambertsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Eriksen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Grau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. R. Mortensen.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mortensen, H.R., Jensen, K., Aksglæde, K. et al. Prophylactic Swallowing Exercises in Head and Neck Cancer Radiotherapy. Dysphagia 30, 304–314 (2015). https://doi.org/10.1007/s00455-015-9600-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-015-9600-y

Keywords

Search

Navigation