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Functional Swallowing Outcomes in Nasopharyngeal Cancer Treated with IMRT at 6 to 42 months Post-Radiotherapy

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Abstract

We sought to evaluate the swallowing function of 18 patients surviving nasopharyngeal cancer, who had been treated using an intensity-modulated radiotherapy (IMRT) protocol designed to minimise functional impairment. We compared the outcomes of a patient-reported oral function score with fiberoptic endoscopic examination of swallow (FEES), Australian Therapy Outcome Measures (AusTOMs) and a measure of trismus. While all patients returned to a fully oral diet, there was ongoing swallow dysfunction characterised by bolus residue and delay, but no aspiration. Dysphagia was of mild or moderate severity on all measures, generally because of the need for texture modification, impaired bolus transit or dysgeusia. There was xerostomia on self-reported measurement combined with reports of behaviours adaptive to xerostomia on AusTOMs; however, salivary functioning was less impaired on FEES. There was no trismus in this cohort. Our cohort lacked the morbidity experienced by cohorts reported in earlier studies, potentially due to the use of IMRT.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Royal North Shore Hospital, St Leonards, NSW, 2065, Australia

    Margaret Patterson, Rowena Brain, David Veivers, Michael Back, Andrew Wignall & Thomas Eade

  2. University of Sydney, Camperdown, NSW, 2050, Australia

    Michael Back & Thomas Eade

  3. Nepean Hospital, Kingswood, NSW, 2747, Australia

    Ronald Chin

  4. University of Sydney, Camperdown, NSW, 2006, Australia

    Ronald Chin & David Veivers

Authors
  1. Margaret Patterson
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  2. Rowena Brain
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Corresponding author

Correspondence to Rowena Brain.

Appendix

Appendix

AusTOMs for speech pathology [22, 40].

The Swallowing scale incorporates all disorders of the structure and/or function of the swallowing mechanism, and/or feeding in both adults and children. Issues of safety and alternative feeding may be rated under the activity limitation domain.

IMPAIRMENT of either Structure or Function (as appropriate to age): Impairments are problems in body structure (anatomical) or function (physiological) as a deviation or loss.

ACTIVITY LIMITATION (as appropriate to age): Activity limitation results from difficulty in the performance of an activity. Activity is the execution of a task by the individual.

PARTICIPATION RESTRICTION (as appropriate to age): Participation restrictions are difficulties the individual may have in the manner or extent of the involvement in their life situation. Clinicians should ask themselves: “given their problem, is this individual experiencing disadvantage?”

DISTRESS/WELLBEING (as appropriate to age): The level of concern experienced by the individual. Concern may be evidenced by anger, frustration, apathy, depression, etc.

0 Profound.

1 Severe.

2 Moderate/Severe.

3 Moderate.

4 Mild.

5 No.

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Patterson, M., Brain, R., Chin, R. et al. Functional Swallowing Outcomes in Nasopharyngeal Cancer Treated with IMRT at 6 to 42 months Post-Radiotherapy. Dysphagia 29, 663–670 (2014). https://doi.org/10.1007/s00455-014-9559-0

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