Effects of two different behavioral swallowing exercise protocols performed during radiation therapy on swallowing physiology, function, quality-of-life and weight outcomes following organ-preservation treatments for head and neck cancers

Objective: The purpose of this study was to investigate the effects of two different prophylactic behavioral swallowing exercise regimens performed by head and neck cancer/s (HNC) patients during radiation therapy with/without chemotherapy (RT/C) on swallowing physiology, function, quality-of-life (QOL) and weight outcomes at the completion of RT/C. Feeding tube (PEG) status at 3 months post-treatment was also compared. Methods: This study was conducted via a prospective design. 50 patients diagnosed with HNC who were to undergo RT/C were recruited at pre-treatment based on the inclusion criteria: functional swallowing abilities; without prophylactic PEG tubes; ability to comprehend and perform therapy tasks and signed informed consent. Patients were assigned to the exercise group (EX: n=26) or repetitive swallow group (SW: n=24), by alternate assignment as well as matching for age, tumor site and stage. A no treatment group (NTx) of patients (n=23) was recruited retrospectively from co-facilities during identical timelines as the prospective cohort. The EX and SW treatment groups attended therapy sessions once a week and completed two different intensive exercise regimens throughout RT with maintenance of a daily home program. Outcome measures: All patients in the EX and SW treatment groups, underwent pre and post-treatment MBS studies. The following outcomes were reported: physiological (aspiration and Penetration Aspiration Scale scores); functional (PEG tube dependence and Functional Oral Intake Scale scores); QOL (MD Anderson Dysphagia Inventory Scale scores) and weight loss. At 3 months post-treatment, PEG tube dependence was assessed and compared. PEG tube dependence and weight loss in patients in the treatment and no treatment groups were compared at post-treatment and 3 months post-treatment. Results: The EX and SW groups did not statistically significantly differ on any outcomes at post-treatment. The NTx group also did not differ from the EX and SW groups in terms of PEG tube dependence and weight loss at post-treatment. However, the EX group exhibited a significantly higher rate of PEG tube elimination than the SW group at 3 months post-treatment (i.e. 16% vs. 50%). Among patients who received both radiation and chemotherapy, patients in the EX group exhibited significantly lower PEG tube dependence rates at post-treatment and 3 months post-treatment, compared to the SW and NTx groups. The EX group’s post-treatment aspiration (i.e. 18%) and PEG tube dependence (16%) rates at 3 months post-treatment were among the lowest reported in the literature. Conclusions: Performing swallowing exercises prophylactically, resulted in significantly improved rates of PEG tube elimination and oral intake abilities. Findings indicated substantial benefits of the EX group’s exercise regimen, encouraging its utility in the clinical setting. Although statistically non-significant, the SW group exhibited better outcomes than no therapy, warranting future investigations to explore the benefits of the SW exercise regimen