Supportive Care in Cancer

, Volume 23, Issue 12, pp 3531–3538 | Cite as

Head and neck cancer patients’ perceptions of swallowing following chemoradiotherapy

  • Joanne M. Patterson
  • Elaine McColl
  • Janet Wilson
  • Paul Carding
  • Tim Rapley
Original Article



The study aims to describe patients’ experiences of swallowing difficulties following (chemo)radiotherapy for head and neck cancer and to explore any changes over time.


A purposive sample of patients with swallowing difficulties was selected at a range of time points, from 3 to 18 months following treatment. Ethnographic observations of 12 patients were conducted in their own homes, over a mealtime situation. Nine new patients were interviewed about changes to their eating and drinking from pre- to post-treatment. Thematic analysis was used to code and analyse the data.


Patients’ reports of swallowing function were divided into four time zones: pre-treatment, during radiotherapy, early (0–3 months) and late (6–18 months) time points following treatment. The majority reported minimal problems at diagnosis, but marked impairment during and after radiotherapy, without a return to pre-treatment functioning. The focus was on severe physical side effects and changes to food preparation during radiotherapy and in the early phase of recovery. By 6 months, side effects began to subside, but swallowing was still difficult, leading to major changes to family life, socialisation and lifestyle.


Swallowing problems after (chemo)radiotherapy are multi-faceted and highly individualised and restrict lives in the long term. Swallowing ability may improve in time, but does not appear to return to pre-treatment function. Further work is required to find ways of being able to best support patients living with this long-term condition.


Head and neck cancer Chemoradiotherapy Swallowing Qualitative 



Dr Jo Patterson is funded by a National Institute for Health Research Clinical Lectureship.

Conflict of interest



  1. 1.
    Wilson JA, Carding PN, Patterson JM (2011) Dysphagia after nonsurgical head and neck cancer treatment: patients’ perspectives. Otolaryngol Head Neck Surg 145:767–771CrossRefPubMedGoogle Scholar
  2. 2.
    Gillespie MB, Brodsky MB, Day TA et al (2005) Laryngeal penetration and aspiration during swallowing after the treatment of advanced oropharyngeal cancer. Arch Otolaryngol Head Neck Surg 131:615–619CrossRefPubMedGoogle Scholar
  3. 3.
    van der Molen L, van Rossum MA, Ackerstaff AH et al (2009) Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients’ views. BMC Ear Nose Throat Disord 9:10PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Campbell BH, Spinelli K, Marbella AM et al (2004) Aspiration, weight loss, and quality of life in head and neck cancer survivors. Arch Otolaryngol Head Neck Surg 130:1100–1103CrossRefPubMedGoogle Scholar
  5. 5.
    Edwards D, Edwards D (1998) Head and neck cancer services: views of patients, their families and professionals. Br J Oral Maxillofac Surg 36:99–102CrossRefPubMedGoogle Scholar
  6. 6.
    Pollock K, Cox K, Howard P et al (2008) Service user experiences of information delivery after a diagnosis of cancer: a qualitative study. Support Care Cancer 16:963–973CrossRefPubMedGoogle Scholar
  7. 7.
    Brockbank S, Miller N, Owen S, Patterson JM (2014) Pre-treatment information on dysphagia: exploring the views of head and neck cancer patients. J Pain Symp ManagGoogle Scholar
  8. 8.
    Lang HD, France E, Williams B et al (2013) The psychological experience of living with head and neck cancer: a systematic review and meta-synthesis. Psycho-Oncology 22:2648–2663CrossRefPubMedGoogle Scholar
  9. 9.
    Roing M, Hirsch J-M, Holmstrom I (2008) Living in a state of suspension—a phenomenological approach to the spouse’s experience of oral cancer. Scand J Caring Sci 22:40–47CrossRefPubMedGoogle Scholar
  10. 10.
    Richardson A, Lee L, Birchall M et al (2002) Learning from patients with cancer and their spouses: a focus group study. J Laryngol Otol 116:1028–1035CrossRefPubMedGoogle Scholar
  11. 11.
    Scott SE, Grunfeld EA, Main J et al (2006) Patient delay in oral cancer: a qualitative study of patients’ experiences. Psycho-Oncology 15:474–485CrossRefPubMedGoogle Scholar
  12. 12.
    Molassiotis A, Rogers M (2012) Symptom experience and regaining normality in the first year following a diagnosis of head and neck cancer: a qualitative longitudinal study. Palliat Support Care 10:197–204CrossRefPubMedGoogle Scholar
  13. 13.
    Roing M, Hirsch JM, Holmstrom I (2007) The uncanny mouth—a phenomenological approach to oral cancer. Patient Educ Couns 67:301–306CrossRefPubMedGoogle Scholar
  14. 14.
    Nund RL, Ward EC, Scarinci NA et al (2014) The lived experience of dysphagia following non-surgical treatment for head and neck cancer. Int J Speech Lang Pathol 16:282–289CrossRefPubMedGoogle Scholar
  15. 15.
    Larsson M, Hedelin B, Athlin E (2003) Lived experiences of eating problems for patients with head and neck cancer during radiotherapy. J Clin Nurs 12:562–570CrossRefPubMedGoogle Scholar
  16. 16.
    Shragge JE, Wismer WV, Olson KL, Baracos VE (2007) Shifting to conscious control: psychosocial and dietary management of anorexia by patients with advanced cancer. Palliat Med 21:227–233CrossRefPubMedGoogle Scholar
  17. 17.
    Martino R, Beaton D, Diamant NE (2010) Perceptions of psychological issues related to dysphagia differ in acute and chronic patients. Dysphagia 25:26–34CrossRefPubMedGoogle Scholar
  18. 18.
    McQuestion M, Fitch M, Howell D (2011) The changed meaning of food: physical, social and emotional loss for patients having received radiation treatment for head and neck cancer. Eur J Oncol Nurs 15:145–151CrossRefPubMedGoogle Scholar
  19. 19.
    Semple CJ, Dunwoody L, George Kernohan W et al (2008) Changes and challenges to patients’ lifestyle patterns following treatment for head and neck cancer. J Adv Nurs 63:85–93CrossRefPubMedGoogle Scholar
  20. 20.
    Patterson JM, McColl E, Carding PN et al (2015) Swallowing in the first year after chemoradiotherapy for head and neck cancer: Clinician-and patient-reported outcomes. Head Neck 2013Google Scholar
  21. 21.
    Hammersley MP A (1995) Ethnography: principles in practice. Routledge, LondonGoogle Scholar
  22. 22.
    Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3:77–101CrossRefGoogle Scholar
  23. 23.
    Sandelowski M (2000) Whatever happened to qualitative description? Res Nurs Health 23:334–340CrossRefPubMedGoogle Scholar
  24. 24.
    Neergaard MA, Olesen F, Andersen RS, Sondergaard J (2009) Qualitative description—the poor cousin of health research? Bmc Med Res Methodol (9)Google Scholar
  25. 25.
    Miles MB, Huberman AM (1984) Qualitative data analysis: a sourcebook of new methods. Sage, Newbury ParkGoogle Scholar
  26. 26.
    Wells M (1998) The hidden experience of radiotherapy to the head and neck; a qualitative study of patients after completion of treatment. J Adv Nurs 28:840–848CrossRefPubMedGoogle Scholar
  27. 27.
    Rose-Ped AM, Bellm LA, Epstein JB et al (2002) Complications of radiation therapy for head and neck cancers—the patient’s perspective. Cancer Nurs 25:461–467CrossRefPubMedGoogle Scholar
  28. 28.
    Roing M, Hirsch JM, Holmstrom I, Schuster M (2009) Making new meanings of being in the world after treatment for oral cancer. Qual Health Res 19:1076–1086CrossRefPubMedGoogle Scholar
  29. 29.
    Bury M (1982) Chronic illness as a biographical disruption. Sociol Health Illn 4:167–182CrossRefPubMedGoogle Scholar
  30. 30.
    Hutcheson KA, Lewin JS, Barringer DA et al (2012) Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer 118:5793–5799PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Joanne M. Patterson
    • 1
  • Elaine McColl
    • 2
  • Janet Wilson
    • 2
  • Paul Carding
    • 3
  • Tim Rapley
    • 2
  1. 1.Speech and Language Therapy DepartmentSunderland Royal HospitalSunderlandUK
  2. 2.Institute for Health and SocietyNewcastle UniversityNewcastle upon TyneUK
  3. 3.Speech and Language TherapyFreeman HospitalNewcastle upon TyneUK

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