How effective are swallowing exercises during radiation and chemoradiation in preventing post-treatment dysphagia?
Background: Post-radiation and chemoradiation (RT/CRT) dysphagia is one of the most common and feared complications, especially as there is no known cure and it is a predictor of a poor quality of life. Post-treatment dysphagia occurs in 50% to 60% of patients and leads to decreased oral intake, reliance on tube feeding, and increased utilization of healthcare services. The goal of the present study was to develop a preventive strategy and maximize a dysphagia rehabilitation program during the course of radiation.
Explore this issue:February 2014
Study design: Retrospective study involving case series with chart reviews.
Setting: David E. Geffen School of Medicine, University of California, Los Angeles.
Synopsis: Patients in this five-year study (2007-2012) were evaluated by a speech language pathologist (SLP) two weeks prior to the start of radiation. A swallowing exercise program was instituted and patients were encouraged to continue oral swallowing during the course of treatment, despite discomfort. A set of oral and pharyngeal exercises, to be performed daily, were provided. Patients were grouped as compliant or non-compliant with swallowing exercises. At each session conducted by the SLP, the patients’ dietary intakes were recorded and a statistical analysis was performed for the two groups. Swallowing assessments by measuring diet tolerance were performed during RT/CRT and monthly thereafter for two months. Of the 85 patients enrolled, 57 were compliant with the swallowing program and 28 were not. While there were no significant differences between the two groups in baseline characteristics pre-treatment, significant post-treatment differences developed between the groups in their ability to tolerate a chewable diet and in G-tube dependency. The non-compliant group also developed significantly greater stenosis. The study demonstrated that compliance with the swallow program during RT/CRT was beneficial in maintaining swallowing function. Additionally, compliance itself is an independent predictor of improved swallowing function; however, there was a high dropout rate in the compliant group, most likely because these patients were swallowing well.
Bottom line: Swallowing therapy protocols instituted before and during RT/CRT help preserve swallowing function and ensure a faster return to a normal diet. The placement of a feeding tube during therapy may in fact increase some of the dysphagia-related complications and negatively impact an individual’s quality of life after successful treatment.
Citation: Duarte VM, Chhetri DK, Liu YF, Erman AA, Wang MB. Swallowing preservation exercises during chemoradiation therapy maintains swallow function. Otolaryngol Head Neck Surg. 2013;149:878-884.