Skip to main content

Advertisement

SpringerLink
Log in

Swallowing, nutrition and patient-rated functional outcomes at 6 months following two non-surgical treatments for T1–T3 oropharyngeal cancer

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Altered fractionation radiotherapy with concomitant boost (AFRT-CB) may be considered an alternative treatment for patients not appropriate for chemoradiation (CRT). As functional outcomes following AFRT-CB have been minimally reported, this exploratory paper describes the outcomes of patients managed with AFRT-CB or CRT at 6 months post-treatment.

Methods

Using a cross-sectional analysis design, functional outcomes of 14 AFRT-CB and 17 CRT patients with T1–T3 oropharyngeal cancers were explored at 6 months post-treatment. Clinical and instrumental swallow assessments, weight and nutritional status, and the functional impact of treatment were examined.

Results

Inferior outcomes were observed for the CRT patients on the RBHOMS (p = 0.03) which was reflected in diet and fluid restrictions with 18% of the CRT group requiring modified fluids and diets. Although a trend (p = 0.07) was noted for increased lingual deficits and aspiration risk for fluids in the CRT group, no other significant differences were observed. Both groups experienced an average of 10 kg weight loss and reported reduced general and swallowing-related function.

Conclusions

These preliminary data suggest functional outcomes following AFRT-CB and CRT were largely comparable at 6 months post-treatment. Treatment intensification in any form may contribute to impaired function which requires multidimensional intervention. Larger cohort investigations with systematic methodology are needed to further examine these initial findings.

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

Similar content being viewed by others

References

  1. Adelstein D, Li Y, Adams G, Wagner H Jr, Kish J, Ensley J et al (2003) An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 21(1):92–98

    Article  PubMed  Google Scholar 

  2. Fu KK, Pajak TF, Trotti A, Jones CU, Spencer SA, Phillips TL et al (2000) A radiation therapy oncology group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys 48(1):7–16

    Article  PubMed  CAS  Google Scholar 

  3. Jackson S, Weir L, Hay J, Tsang V, Durham J (1997) A randomised trial of accelerated versus conventional radiotherapy in head and neck cancer. Radiother Oncol 43(1):39–46

    Article  PubMed  CAS  Google Scholar 

  4. Caudell JJ, Schaner PE, Meredith RF, Locher JL, Nabell LM, Carroll WR et al (2009) Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 73(2):410–415

    Article  PubMed  Google Scholar 

  5. Logemann JA, Rademaker AW, Pauloski BR, Lazarus CL, Mittal BB, Brockstein B et al (2006) Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation. Head Neck 28(1):64–73

    Article  PubMed  Google Scholar 

  6. Yu K, Chua M, Vlantis A, Kam M, Lee W, Tsang R et al (2005) Swallowing function after altered fractionation radiotherapy for head and neck carcinoma. Journal Hong Kong College of Radiologists 8(4):207–213

    Google Scholar 

  7. Ang KK, Peters LJ, Weber RS, Maor MH, Morrison WH, Wendt CD et al (1990) Concomitant boost radiotherapy schedules in the treatment of carcinoma of the oropharynx and nasopharynx. Int J Radiat Oncol Biol Phys 19(6):1339–1345

    Article  PubMed  CAS  Google Scholar 

  8. Denham JW, Peters LJ, Johansen J, Poulsen M, Lamb DS, Hindley A et al (1999) Do acute mucosal reactions lead to consequential late reactions in patients with head and neck cancer? Radiother Oncol 52(2):157–164

    Article  PubMed  CAS  Google Scholar 

  9. Dörr W, Hendry JH (2001) Consequential late effects in normal tissues. Radiother Oncol 61(3):223–231

    Article  PubMed  Google Scholar 

  10. Pignon J, Maître A, Maillard E, Bourhis J (2009) Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 92:4–14

    Article  PubMed  Google Scholar 

  11. Machtay M, Moughan J, Trotti A, Garden AS, Weber RS, Cooper JS et al (2008) Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 26(21):3582–3589

    Article  PubMed  CAS  Google Scholar 

  12. Graner D, Foote R, Kasperbauer J, Stoeckel R, Okuno S, Olsen K et al (2003) Swallow function in patients before and after intra-arterial chemoradiation. Laryngoscope 113(3):573–579

    Article  PubMed  Google Scholar 

  13. Kotz T, Costello R, Li Y, Posner M (2004) Swallowing dysfunction after chemoradiation for advanced squamous cell carcinoma of the head and neck. Head Neck 26(4):365–372

    Article  PubMed  Google Scholar 

  14. Lazarus C, Logemann JA, Pauloski BR, Rademaker AW, Helenowski IB, Vonesh EF et al (2007) Effects of radiotherapy with or without chemotherapy on tongue strength and swallowing in patients with oral cancer. Head Neck 29(7):632–637

    Article  PubMed  Google Scholar 

  15. Goguen L, Posner M, Norris C, Tishler R, Wirth L, Annino D et al (2006) Dysphagia after sequential chemoradiation therapy for advanced head and neck cancer. Otolaryngol Head Neck Surg 134(6):916–922

    Article  PubMed  Google Scholar 

  16. Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Gaziano J, Stachowiak L et al (2008) Swallowing disorders in the first year after radiation and chemoradiation. Head Neck 30(2):148–158

    Article  PubMed  Google Scholar 

  17. List MA, Siston A, Haraf D, Schumm P, Kies M, Stenson K et al (1999) Quality of life and performance in advanced head and neck cancer patients on concomitant chemoradiotherapy: a prospective examination. J Clin Oncol 17(3):1020–1028

    PubMed  CAS  Google Scholar 

  18. Oates J, Clark J, Read J, Reeves N, Gao K, Jackson M et al (2007) Prospective evaluation of quality of life and nutrition before and after treatment for nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 133(6):533

    Article  PubMed  Google Scholar 

  19. Lee H, Havrila C, Bravo V, Shantz K, Diaz K, Larner J et al (2008) Effect of oral nutritional supplementation on weight loss and percutaneous endoscopic gastrostomy tube rates in patients treated with radiotherapy for oropharyngeal carcinoma. Support Care Cancer 16(3):285–289

    Article  PubMed  Google Scholar 

  20. Hammerlid E, Wirblad B, Sandin C, Mercke C, Edstrom S, Kaasa S et al (1998) Malnutrition and food intake in relation to quality of life in head and neck cancer patients. Head Neck 20(6):540–548

    Article  PubMed  CAS  Google Scholar 

  21. van den Berg M, Rasmussen-Conrad E, Gwasara G, Krabbe P, Naber A, Merkx M (2006) A prospective study on weight loss and energy intake in patients with head and neck cancer, during diagnosis, treatment and revalidation. Clin Nutr 25(5):765–772

    Article  PubMed  Google Scholar 

  22. Schueller P, Schaefer U, Micke O, Willich N (1999) Results of simultaneous radiochemotherapy vs concomitant boost radiation in patients with inoperable cancer of the head and neck. Eur J Cancer 35(4):S174

    Article  Google Scholar 

  23. Cartmill B, Cornwell P, Ward EC, Davidson W, Porceddu SV (2011) A prospective investigation of swallowing, nutrition, and patient-rated functional impact following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer. Dysphagia (in press)

  24. Dietitians Association of Australia and The Speech Pathology Association of Australia Limited (2007) Texture-modified foods and thickened fluids as used for individuals with dysphagia: Australian standardized labels and definitions. Nutr Diet 64(Suppl. 2):S53–S76

    Google Scholar 

  25. Ward EC, Conroy A-L (1999) Validity, reliability, and responsivity of the royal brisbane hospital outcome measure for swallowing. Asia Pacific Journal of Speech Language and Hearing 4:109–129

    Google Scholar 

  26. Huckabee M-L (n.d.) New Zealand Index for Multidisciplinary Evaluation of Swallowing (NZIMES). Retrieved March 25, 2007 from http://www.cmds,canterbury.ac.nz/documetns/nzimesa4.pdf

  27. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL (1996) A penetration-aspiration scale. Dysphagia 11(2):93–98

    Article  PubMed  CAS  Google Scholar 

  28. Ottery F (2000) Patient-generated subjective global assessment. In: McCallum P, Polisena C (eds) The clinical guide to oncology nutrition. The American Dietetic Association, Chicago, pp 11–23

    Google Scholar 

  29. Chen AY, Frankowshi R, Bishop-Leone J, Hebert T, Leyk S, Lewin J et al (2001) The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg 127(7):870–876

    PubMed  CAS  Google Scholar 

  30. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11(3):570–579

    PubMed  CAS  Google Scholar 

  31. Abdel-Wahab MMDP, Abitbol AMD, Lewin AMD, Troner MMD, Hamilton KP, Markoe AMDS (2005) Quality-of-life assessment after hyperfractionated radiation therapy and 5-fluorouracil, cisplatin, and paclitaxel (Taxol) in inoperable and/or unresectable head and neck squamous cell carcinoma. Am J Clin Oncol 28(4):359–366

    Article  PubMed  Google Scholar 

  32. Ackerstaff AH, Balm AJM, Rasch CRN, de Boer JP, Wiggenraad R, Rietveld DHF et al (2009) First-year quality of life assessment of an intra-arterial (RADPLAT) versus intravenous chemoradiation phase III trial. Head Neck 31(1):77–84

    Article  PubMed  Google Scholar 

  33. Pauloski BR, Rademaker AW, Logemann JA, Newman L, MacCracken E, Gaziano J et al (2006) Relationship between swallow motility disorders on videofluorography and oral intake in patients treated for head and neck cancer with radiotherapy with or without chemotherapy. Head Neck 28(12):1069

    Article  PubMed  Google Scholar 

  34. Trotti A (2000) Toxicity in head and neck cancer: a review of trends and issues. Int J Radiat Oncol Biol Phys 47(1):1–12

    Article  PubMed  CAS  Google Scholar 

  35. van der Molen L, van Rossum M, Burkhead L, Smeele L, Hilgers F (2009) Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review. Eur Arch Otorhinolaryngol 266(6):889–900

    Article  PubMed  Google Scholar 

  36. Mittal BB, Pauloski BR, Haraf DJ, Pelzer HJ, Argiris A, Vokes EE et al (2003) Swallowing dysfunction: preventative and rehabilitation strategies in patients with head-and-neck cancers treated with surgery, radiotherapy, and chemotherapy: a critical review. Int J Radiat Oncol Biol Phys 57(5):1219–1230

    Article  PubMed  Google Scholar 

  37. Ringash J, Lockwood G, O'Sullivan B, Warde P, Bayley A, Cummings B et al (2008) Hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer: quality of life in a prospective phase I/II trial. Radiother Oncol 87(2):181–187

    Article  PubMed  Google Scholar 

  38. Gillespie M, Brodsky M, Day T, Lee F, Martin-Harris B (2004) Swallowing-related quality of life after head and neck cancer treatment. Laryngoscope 114(8):1362–1367

    Article  PubMed  Google Scholar 

  39. Pauloski BR, Rademaker AW, Logemann JA, Lazarus CL, Newman L, Hamner A et al (2002) Swallow function and perception of dysphagia in patients with head and neck cancer. Head Neck 24(6):555–565

    Article  PubMed  Google Scholar 

  40. Logemann J, Pauloski B, Rademaker A, Colangelo L, Kahrilas P, Smith C (2000) Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men. J Speech Lang Hear Res 43(5):1264

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge the Queensland Cancer Council; Cancer Collaborative Group, Princess Alexandra Hospital; Radiation Oncology Department, Princess Alexandra Hospital; Speech Pathology Australia; and Allied Health Research Scheme, Princess Alexandra Hospital who have awarded funding for this research.

Conflict of interest

No source of funding was involved in study design, data collection, data analysis or interpretation, manuscript writing or the decision to submit the manuscript for publication. The author has had full control of the primary data which are available for review if requested.

Author information

Authors and Affiliations

  1. Division of Speech Pathology, The University of Queensland and Speech Pathology Department, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD, Australia, 4102

    Bena Cartmill

  2. Metro North Health Service District, Queensland Health, Australia, and Griffith Health Institute, Griffith University, Mt Gravatt Campus, 176 Messines Ridge Road, Mt Gravatt, QLD, 4111, Australia

    Petrea Cornwell

  3. Centre for Functioning and Health Research, Queensland Health and Division of Speech Pathology, The University of Queensland, P.O. Box 6053, Buranda, 4102, Australia

    Elizabeth Ward

  4. Dietetics Department, Princess Alexandra Hospital, Queensland Health, Ipswich Rd, Woolloongabba, Q 4102, Australia

    Wendy Davidson

  5. School of Medicine, University of Queensland, and Radiation Oncology Department, Princess Alexandra Hospital, Queensland Health, Ipswich Rd, Woolloongabba, Q 4102, Australia

    Sandro Porceddu

Authors
  1. Bena Cartmill
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Petrea Cornwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth Ward
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wendy Davidson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sandro Porceddu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bena Cartmill.

Additional information

This paper aims to inform research by providing further evidence for functional outcomes following non-surgical treatment for head and neck cancer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cartmill, B., Cornwell, P., Ward, E. et al. Swallowing, nutrition and patient-rated functional outcomes at 6 months following two non-surgical treatments for T1–T3 oropharyngeal cancer. Support Care Cancer 20, 2073–2081 (2012). https://doi.org/10.1007/s00520-011-1316-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-011-1316-4

Keywords

Search

Navigation