The treatment for head and neck cancer (HNC) has changed over the recent years. More emphasis on organ preservation and frontline chemoradiotherapy have resulted in improved treatment outcomes. However, these achievements also resulted in incidences of impaired functional skill and quality of life in the areas such as swallowing. It is estimated that about 50-60% of head and neck cancer patients will experience some type of post chemoradiation dysphagia and may continue to have long lasting effects that may develop or progress years after completion of the treatment.

Chemoradiation induced dysphagia:

The swallowing dysfunction can be often caused by acute toxicity-related changes such as edema and mucositis to late onset changes such as fibrosis and neuropathies. Specific symptoms include:

• Odynophagia and xerostomia
• Decreased anterior-posterior transit of bolus in oral cavity
• Reduced hyolaryngeal excursion
• Pharyngeal residue
• Silent aspiration/penetration

Management of chemoradiation induced dysphagia:

Recent evidence suggests that preventive swallowing therapy during chemoradiation plays a critical role in maintaining functional swallowing skills and improving quality of life in the head and neck cancer population. Patients who participate in a swallow preservation therapy program are likely to report:

• Experience superior quality of life scores
• Have shorter duration of feeding tube placement
• Show preservation of muscle mass
• Maintain superior diet levels
• Have greater muscle movements

VMC Speech Language Pathology (SLP) Head and Neck Cancer Program:

• Based on this evidence, SLPs work closely with HNC population undergoing chemoradiation treatment. The program consists of:
• Pre-radiation consult: Swallow evaluation/modified barium swallow study, obtain quality of life measurement, introduce swallowing exercise, and provide counseling
• During chemoradiation treatment: Weekly follow-up sessions to re-assess swallow function, manage/revise swallowing exercise program, and adjust diet level as warranted
• Post-radiation follow-up: Swallow evaluation (modified barium swallow study about two months post radiation), implement maintenance program, obtain quality of life measurement, and complete telephone follow up as needed.

Contact and referrals: Rehabilitation Services at Valley Medical Center
425.690.3650 (phone), 425.690.9650 (fax)

References:

Carnaby-Mann, G., Crary, M., & Schmalfuss, I. (2012). “Pharyngocise”: Randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. International Journal of Radiation Oncology, Biology, Physics, 83(1), 210-219

Durate, V., Liu, Y., Chhetri, D., Erman, A., & Wang, M. (2013). Swallow preservation therapy during chemoradiation therapy improves patient quality of life and maintains swallow function. Otolaryngology-Head and Neck Surgery, 149(6), 878-884.

Hutcheson KA, Lewin JS. (2012) Functional outcomes after chemoradiotherapy of laryngeal and pharyngeal cancers. Curr Oncol Rep 14(2), 158-165.

Hutcheson KA, Lewin JS, Barringer DA, Lisec A, Gunn GB, Moore MW, & Holsinger FC. (2012). Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer 118(23), 5793-5799.

Landera, M, Odlum, J., & Lundy, D. (2013). Swallowing evaluation of the patient with head and neck cancer. SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 22, 53-60.

McColloch, N, Carroll, W. & Magnuson, J. (2010). Pretreatment dysphagia protocol for the patient with head and neck cancer undergoing chemoradiation. SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 19, 53-56.

Patterson, J. (2019). Psychological Interventions for the Head and Neck Cancer Population Who Are Experiencing Dysphagia.SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 5, 1049-1054.

Starmer, H. (2017) Swallowing Exercises in Head and Neck Cancer.SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 13, 21-26