Impacts of a Group-Based Intervention To Mitigate Concurrent Chemotherapy and Radiotherapy-Induced Dysphagia: A Retrospective Cohort Study.

Abstract

Oropharyngeal dysphagia is a prevalent and clinically significant toxicity in patients with head and neck cancer undergoing concurrent chemotherapy and radiotherapy (CCRT). Preventive swallowing interventions, including exercise-based programs initiated during CCRT, are increasingly adopted in clinical practice to minimize CCRT-induced dysphagia. However, maintaining consistent therapeutic adherence remains a major clinical challenge, potentially limiting the effectiveness of these interventions. This study aimed to examine the impacts of a group-based prophylactic swallowing intervention in patients with head and neck cancer (HNC) treated with concurrent chemotherapy and radiotherapy (CCRT). We conducted a retrospective cohort study examining (a) swallowing-related outcomes, (b) therapy attendance and (c) health-related quality of life (HRQOL) outcomes in patients who participated in either (1) an individual prophylactic swallowing intervention (I-PSI), or (2) a group-based prophylactic swallowing intervention (GB-PSI) using Bayesian regression models. Data from 188 medical charts (I-PSI: n = 101; GB-PSI = 87) were included for analysis. Patients in the GB-PSI cohort had a significantly lower probability of reactive nasogastric tube placement compared to the I-PSI cohort (-0.14 [-0.27, -0.06]). They presented with significantly lower dysphagia toxicity grades during CCRT (-0.48 [-0.32, -0.71]) and at treatment completion (-0.44 [-0.27, -0.63]), along with a lower probability of experiencing grade dysphagia at the end of CCRT (-0.2 [-0.07, -0.32]). The GB-PSI cohort attended more therapy sessions during CCRT (1.76 [1.18, 2.1]) but needed fewer swallowing therapy sessions following treatment completion (-0.52 [-0.92, -0.09]). The small sample size for HRQOL did not allow for statistical analysis. Results suggest that a group-based prophylactic swallowing intervention may be a valuable option for patients undergoing CCRT for HNC. Prospective studies are needed to further explore its impact on therapeutic adherence and a broader range of swallowing-related outcomes.