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Proactive Swallowing Rehabilitation in Patients with Recurrent Oral Cancer Receiving Salvage Treatment: Long-Term Swallowing-Related Outcomes

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Abstract

The present study aimed to evaluate the impact of proactive swallowing rehabilitation on swallowing function and quality of life in patients with recurrent oral cancer in the first 2 years after salvage treatment. Consecutive adult patients with recurrent oral cancer who received salvage surgery and free flap reconstruction were recruited prospectively, to whom proactive swallowing rehabilitation was provided. Body weight (BW); fiberoptic endoscopic evaluation of swallowing (FEES), functional oral intake scale (FOIS), and diet level; 10-item eating assessment tool (EAT-10), and MD Anderson Dysphagia Inventory (MDADI); and adherence at baseline, 1, 3, 6, 12, 18 and 24 months were evaluated. A total of 50 patients were included during May 2018 to July 2020. Compared to the baseline, significant deterioration in BW, FOIS, and MDADI was noted at one month. However, a trend of recovery was observed in BW and FOIS from one month, and in MDADI from three months. All patients were free of tube feeding at 18–24 months and tolerated diet with special preparations or compensation. Safe swallowing could be achieved in approximately 80% participants after 12 months of diet modification or compensatory maneuvers. Proactive swallowing therapy was feasible in patients with recurrent oral cancer receiving salvage treatment. Although this patient population might have pre-existing dysphagia from previous treatments, rehabilitation could facilitate safe per oral intake and maintain adequate nutrition with adaptive maneuvers or compensatory strategies. Patients who underwent proactive swallowing rehabilitation had better recovery in the functional oral intake level.

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Acknowledgements

The authors would like to thank Dr. Chin-Hao Chang (biostatistician, Statistical Center, National Taiwan University Hospital, Taipei, Taiwan) and Ms. Ling-Yun Huang (statistical analyst, Statistical Center, National Taiwan University Hospital, Taipei, Taiwan) for data analysis. We would also like to thank the physicians, nursing staff, and rehabilitation staff at our institution for their support. This study was supported by the Ministry of Science and Technology, R.O.C., 110-2314-B-002 -183 -MY3 (P.J. Lou) and 109-2314-B-002 -065-MY3 (W.H. Tseng).

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Authors and Affiliations

  1. Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, #7, Chung-Shan South Road, Taipei, 100225, Taiwan

    Tzu-Hsiang Li, Wen-Hsuan Tseng, Hsiang-Ling Chiu, Tsung-Lin Yang, Cheng-Ping Wang, Tseng-Cheng Chen, Chun-Nan Chen, Mei-Chun Lin, Jenq-Yuh Ko & Pei-Jen Lou

  2. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

    Wen-Hsuan Tseng & Tsung-Lin Yang

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Contributions

Guarantor of the article: P-JL, who was also in charge of study design, data interpretation, and manuscript revision. T-HL: drafted the manuscript, performed the study, acquired data, interpreted and analyzed the data. W-HT: drafted the manuscript, performed the study, acquired data, interpreted and analyzed the data. H-LC: acquisition of data and analysis of data. T-LY: study design, data interpretation. C-PW: study design, data interpretation. T-CC: study design, data interpretation. C-NC: study design, data interpretation. M-CL: study design, data interpretation. J-YK: study design, data interpretation. T-HL and W-HT contributed equally as the first authors to this article. All authors have approved the final version of the manuscript.

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Correspondence to Pei-Jen Lou.

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Li, TH., Tseng, WH., Chiu, HL. et al. Proactive Swallowing Rehabilitation in Patients with Recurrent Oral Cancer Receiving Salvage Treatment: Long-Term Swallowing-Related Outcomes. Dysphagia 38, 954–964 (2023). https://doi.org/10.1007/s00455-022-10521-6

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