Contrasting Two Prophylactic Dysphagia Interventions for Patients with Head and Neck Cancer Treated with Radiotherpy with or without Adjunctive Chemotherapy

Many patients with head and neck cancer (HNC) suffer from dysphagia caused by organ preserving regimens of radiation therapy with or without adjunctive chemotherapy. Prior research has shown a benefit of prophylactic dysphagia intervention; however, prior studies vary in terms of timing, dosage, and types of treatments prescribed. Additionally, compliance to prophylactic swallowing exercises (PSEs) has been poor and anecdotal evidence points towards swallowing pain as a cause of poor compliance. This prospective study investigated exercise compliance, oral intake, self-perceived swallowing function, swallowing-related quality of life, and swallowing-related pain for patients who received two different types of prophylactic swallowing interventions. A total of 18 participants partook of the study. Nine patients completed only indirect swallowing exercises (exercises that do not require swallowing; ID-PSE group). The remaining nine patients completed a combination of indirect and direct swallowing exercises (exercises that require swallowing; C-PSE group). There were no significant differences between the groups at baseline or at any point during RT/CRT. The ID-PSE group performed significantly better than the C-PSE group at one month post-RT/CRT in swallowing function, as measured by the Eating Assessment Tool, and swallowing-related QOL, as measured by the MD Anderson Dysphagia Inventory. By three months post RT/CRT these differences were not present; however, at three months post the C-PSE group reported significantly less swallowing pain than the ID-PSE group. Between-group differences were not evident at any point in compliance or oral intake. Outcomes for both groups were comparable to prior PSE studies and better than outcomes reported in the literature in HNC patients who did not receive prophylactic intervention. This study is the first to investigate and provide preliminary evidence for the efficacy of a prophylactic swallowing intervention consisting solely of indirect swallowing exercises. Study limitations, clinical implications, and future directions are discussed