Lynn Acton, MS, CCC (SLP)
Patients with head and neck cancer who undergo intensity-modulated radiation therapy (IMRT) are likely to experience difficulties swallowing. However, the use of swallowing exercises can drastically improve the muscle movement for these patients both during and after radiation therapy (RT) for optimal long-term swallowing function, according to Lynn Acton, MS, CCC (SLP).
In a study conducted by researchers at Dana-Farber Cancer Institute and Brigham Women’s Hospital, patients with head and neck cancer who underwent RT in a 2-year period were evaluated for swallowing difficulty with a video swallow to score stricture and aspiration. Of the 96 patients evaluated who received IMRT once daily, 32% had some aspiration after therapy, while 37% had evidence of stricture following RT.
Studies are currently ongoing to explore the utility of swallowing modalities for these patients. For example, an interventional, randomized, multicenter phase III trial is comparing early-active swallowing therapy versus nonspecific swallowing management (NCT02892487). Researchers are conducting the study to determine that early-active swallowing therapy can improve the quality of life of patients undergoing RT for head and neck cancer.
Additionally, a behavioral questionnaire is evaluating adherence to preventative swallowing exercises and the reasons why patients choose not to follow them (NCT03010150). Patients will complete the questionnaire at baseline and again at 6 months following RT that will discuss adherence to swallowing exercises.
Acton, a lecturer in surgery (otolaryngology) and speech pathologist at Yale School of Medicine, discussed the significance of swallowing modalities for patients with head and neck cancer during and after RT in an interview at the 2017 OncLive
State of the Science Summit on Head and Neck Cancer.
OncLive: What is the benefit of doing these swallowing exercises for this patient population?
: I spoke about prophylactic exercises for swallowing for patients with head and neck cancer who are undergoing RT. We have found that if we keep the muscles mobile during the treatment, there is less fibrosis of the muscles. If the patients don’t have fibrosis, they are able to move better and have better swallowing function. During the treatment, patients will have some pain. We try to manage that and do things like a mouthwash to numb the area before they do these exercises.
It is more important to keep the muscles mobile because, when a joint like your jaw becomes immobile, the cartilage becomes thinner and the joints becomes inflamed and painful. If we keep the muscles moving, then the function is much greater. We like to [continue] to do the exercises after treatment, because RT can continue to contract the muscles over time. Therefore, patients do the exercises several times during the day and after treatment, too.
Have there been any advancements in this field that have increased the quality of life for these patients even further?
It is basically a lifelong thing at this point. For young patients, they say they feel relief after doing the exercises. Some of them [are simple] neck exercises, [such as] neck rolls. I do try to tag it in with something that they are already doing during the day. On their smartphone, I’ll put an [alarm] that reminds them to do their exercises on the way to work, or maybe [while] they are reading a newspaper. I [put the written exercises] in the memos section [of their phone] to explain the exercises. Doing those things makes it a positive result. For the patients who do the exercises, we notice that they’re able to maintain their oral opening. Normally, you should be able to put 3 fingers in your mouth.
When I started, I was seeing patients after RT because we didn’t know it was important to keep these muscles mobile [during treatment]. They would be at a 1-finger opening and then we would have to work to stretch the muscles. I’ve also talked to patients after completing their [swallowing exercises] and they no longer have food sticking in their throat. They do work.
What impact does prophylactic swallowing exercises have on patients?
Well, not everybody is compliant, so we tell them what the negative effects are of not doing the exercises. Some patients have to get a feeding tube because they are not maintaining hydration.