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One-Year Swallowing Outcomes in Patients Treated with Prophylactic Gabapentin During Radiation-Based Treatment for Oropharyngeal Cancer

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Abstract

Recent investigations by our study team have demonstrated patients using gabapentin for pain management during chemoradiotherapy (CRT) do well maintaining swallowing during treatment with less need for narcotic pain medication, PEG dependence, weight loss, and short-term swallowing morbidity. The purpose of this investigation was to characterize the long-term swallowing function of these patients 1-year following treatment. Sequential patients receiving CRT for oropharyngeal cancer and concurrent gabapentin were evaluated 1-year following treatment for swallowing outcomes. Functional Oral Intake Scores (FOIS) were utilized to assess diet level. The MD Anderson Dysphagia Inventory (MDADI) was chosen to evaluate patient perception of swallowing function. Videofluoroscopic swallowing studies were completed approximately 1 year after treatment to assess physiologic outcomes as well as Penetration Aspiration Scores (PAS). Data from 26 consecutive participants were available for analysis. The majority of patients had advanced stage disease (Stage 3–4). No patients had a PEG tube 1-year following treatment, and the mean FOIS score was 6.83. Pharyngeal deficits were infrequent with reduced pharyngeal constriction and prominence/early closure of cricopharyngeus predominating. Mean PAS score was 1.5, indicating that the majority of patients had either no laryngeal penetration/aspiration, or transient penetration that was fully cleared. Mean MDADI score was 85.52, indicating that, in general, patients perceived their swallowing to be minimally impaired. Patients receiving gabapentin pain management as part of a comprehensive dysphagia prevention protocol during CRT have excellent long-term swallowing outcomes as reflected in diet levels, physiologic functioning, and patient-perceived quality of life.

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References

  1. Elting LS, Keefe DM, Sonis ST, et al. Patient-reported measurements of oral mucositis in head and neck cancer patients treated with radiotherapy with or without chemotherapy: demonstration of increased frequency, severity, resistance to palliation, and impact on quality of life. Cancer. 2008;113(10):2704–13.

    Article  PubMed  Google Scholar 

  2. Trotti A, Bellm LA, Epstein JB, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol. 2003;66(3):253–62.

    Article  PubMed  Google Scholar 

  3. Murphy BA, Beaumont JL, Isitt J, et al. Mucositis-related morbidity and resource utilization in head and neck cancer patients receiving radiation therapy with or without chemotherapy. J Pain Symptom Manag. 2009;38(4):522–32.

    Article  Google Scholar 

  4. Langmore S, Krisciunas GP, Miloro KV, et al. Does PEG use cause dysphagia in head and neck cancer patients? Dysphagia. 2012;27(2):251–9.

    Article  PubMed  Google Scholar 

  5. Hutcheson K, Bhayani MK, Beadle BM, et al. Eat and exercise during chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol Head Neck Surg. 2013;139:1127–34.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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(1):210–9.

    Article  PubMed  Google Scholar 

  7. Kotz T, Federman AD, Kao J, et al. Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiotherapy: a randomized trial. Arch Otolaryngol Head Neck Surg. 2012;138:376–82.

    Article  PubMed  Google Scholar 

  8. Shinn EH, Basen-Engquist K, Baum G, et al. Adherence to preventative exercises and self-reported swallowing outcomes in post-radiation head and neck cancer patients. Head Neck. 2013;35:1707–12.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Epstein JB, Wilkie DJ, Fisher DJ, et al. Neuropathic and nociceptive pain in head and neck cancer patients receiving radiation therapy. Head Neck Oncol. 2009;1:26.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bar AdV, Weinstein G, Dutta PR, et al. Gabapentin for the treatment of pain related to radiation-induced mucositis in patients with head and neck tumors treated with intensity-modulated radiation therapy. Head Neck. 2010;32:173–7.

    Google Scholar 

  11. Bar Ad V, Weinstein G, Dutta PR, et al. Gabapentin for the treatment of pain syndrome related to radiation-induced mucositis in patients with head and neck cancer treated with concurrent chemoradiotherapy. Cancer. 2010;116:4206–13.

    Article  Google Scholar 

  12. Starmer HM, Yang W, Raval R, et al. Effect of gabapentin on swallowing during and after chemoradiaton for oropharyngeal squamous cell cancer. Dysphagia. 2014;29:396–402.

    Article  PubMed  Google Scholar 

  13. Yang W, McNutt TR, Dudley S, et al. Predictive factors for prophylactic Percutaneous Endoscopic Gastrostomy (PEG) tube placement and use in head and neck patients following intensity-modulated radiation THERAPY (IMRT) treatment: concordance, discrepancies, and the role of gabapentin. Dysphagia. 2016;31(2):206–13.

    Article  CAS  PubMed  Google Scholar 

  14. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration aspiration Scale. Dysphagia. 1996;11:93–8.

    Article  CAS  PubMed  Google Scholar 

  15. Crary MA, Carnaby Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehab. 2005;86:1516–20.

    Article  Google Scholar 

  16. Chen AY, Frankowski R, Bishop-Leone J, et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the MD Anderson Dysphagia Inventory. Arch Otolaryngol Head Neck Surg. 2001;127:870–6.

    CAS  PubMed  Google Scholar 

  17. Eisbruch A, Lyden T, Bradford CR, et al. Objective assessment of swallowing dysfunction and aspiration after radiation with concurrent chemotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2002;52:23–8.

    Article  Google Scholar 

  18. Schwartz DL, Hutcheson K, Barringer D, et al. Candidate dosimetric predictors of long-term swallowing dysfunction after oropharyngeal intensity-modulated radiotherapy. Head Neck. 2010;78:1356–65.

    Google Scholar 

  19. Feng FY, Kim HM, Lyden TH, et al. Intensity-modulated chemoradiotherapy aiming to reduce dysphagia in patients with oropharyngeal cancer: clinical and functional results. J Clin Oncol. 2010;28:2732–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gillespie M, Brodsky MB, Day TA, Sharma AK, Lee F, Martin-Harris B. Laryngeal penetration and aspiration during swallowing after the treatment of advanced oropharyngeal cancer. Arch Otorhinolaryngol Head Neck Surg. 2005;131:615–9.

    Article  Google Scholar 

  21. Sharma A, Mendez E, Yueh B, et al. Human papillomavirus-positive oral cavity and oropharyngeal cancer patients do not have better quality-of-life trajectories. Otolaryngol Head Neck Surg. 2012;146(5):739–45.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11: a comparison on three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013;1:845–52.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA

    Heather M. Starmer

  2. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA

    WuYang Yang, Rachit Kumar, Todd McNutt, Sierra Cheng & Harry Quon

  3. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA

    Christine G. Gourin

  4. Department of Radiology, Johns Hopkins University, Baltimore, MD, USA

    Bronwyn Jones

  5. Stanford Cancer Center, 900 Blake Wilbur Drive, Room 3073, Stanford, CA, 94305, USA

    Heather M. Starmer

Authors
  1. Heather M. Starmer
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  2. WuYang Yang
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  3. Christine G. Gourin
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  4. Rachit Kumar
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  5. Bronwyn Jones
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  6. Todd McNutt
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  7. Sierra Cheng
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  8. Harry Quon
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Correspondence to Heather M. Starmer.

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Starmer, H.M., Yang, W., Gourin, C.G. et al. One-Year Swallowing Outcomes in Patients Treated with Prophylactic Gabapentin During Radiation-Based Treatment for Oropharyngeal Cancer. Dysphagia 32, 437–442 (2017). https://doi.org/10.1007/s00455-017-9783-5

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  • DOI: https://doi.org/10.1007/s00455-017-9783-5

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