One-year Swallowing Outcomes in a Head and Neck Cancer Cohort: The Impact of Adherence to Swallowing Exercises and Feeding Tube Use.

Abstract

For patients with head and neck cancer (HNC), radiation therapy is associated with short-term, chronic, and late-onset dysphagia [1-3]. Swallowing exercises and oral intake during radiation may reduce dysphagia shortly after radiation [4-6]. The purpose of this study was to explore the relationship between exercise adherence and feeding tube use and one-year swallowing outcomes. Secondary analysis of RCT of swallowing therapy during definitive radiation-based HNC treatment. Adherence was defined as completing at least 50% of prescribed swallowing exercises during radiotherapy. Feeding tube use was prospectively collected. Outcome measures included the MD Anderson Dysphagia Inventory, Performance Status Scale - Head and Neck, Functional Oral Intake Scale, Penetration Aspiration Scale, Modified Barium Swallow Impairment Profile, and Dynamic Imaging Grade of Swallowing Toxicity scores. One-year follow-up data was available for 64 participants. Adherence criteria was met by 26 participants (41%) while feeding tube use (during treatment) was present in 8/64 participants (12%); only 1 patient had a feeding tube at one year. Adherence was associated with more normal MDADI scores one-year post-treatment (91 vs. 80: p = 0.003), as well as higher PSS normalcy of diet scores (p = 0.03). Feeding tube use was associated with worse maximum PAS scores (p < 0.001), DIGEST scores (Safety p = 0.04; overall grade p = 0.01), and MBS-ImP pharyngeal composite scores (p = 0.008). Adherence to swallowing exercises during radiation therapy is associated with better patient perceived swallow function and diet scores while avoidance of feeding tube placement is associated with better physiologic swallow function one year following radiation therapy.