Most patients can speak and swallow after combination treatment for head and neck cancer

Most patients do not have ongoing speaking or swallowing difficulties following combined chemotherapy and radiation treatment for advanced head or neck cancer, but several factors may be associated with worse outcomes in these functions, according to a report in the December issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.

"Speaking and swallowing deficits are experienced by many survivors of primary cancers of the head and neck," the authors write as background information in the article. "Although it is often difficult to separate the individual contributions of the tumor and the treatment to these deficits, several studies have shown that, when compared with organ-removal surgery, chemoradiotherapy with or without organ preservation surgery can minimize post-treatment speech and swallowing deficits while maintaining excellent tumor control."

Kent W. Mouw, M.D., then of the University of Chicago and now of Brigham and Women's Hospital, Boston, and colleagues studied patients who were successfully treated with chemoradiotherapy for advanced head and neck cancer. An average of 34.8 months after completing treatment, 163 patients were assigned a speaking score of one through four and 166 patients were assigned a swallowing score of one through four at an average of 34.5 months after treatment, with increasing scores correlating with decreasing function.

Most patients (84.7 percent of those with speaking scores and 63.3 percent of those with swallowing scores) had no lasting difficulties and were assigned a score of one. Of 160 patients who had both swallowing and speaking scores, 96 had a score of one in each category.

Factors that were associated with worse speaking scores were being female, having a history of smoking, having a tumor in the hypopharynx (where the larynx and esophagus meet) or in the larynx, or having a tumor that did not respond to the initial dose of chemotherapy. Factors associated with worse swallowing scores included being older, having poor performance status (a measure of disability) before treatment and neck dissection (surgery to remove lymph nodes and surrounding tissue), with a trend toward worse scores in those with tumors in the hypopharynx and larynx.

The study involved a large enough group of patients to identify multiple factors correlating with speech and swallowing difficulties, the authors note. "However, one of the remarkable features of the data is that most of the patients experienced minimal residual speech or swallowing deficits," they write. "Although differences detected by more advanced modalities may exist between these patients and healthy subjects, it is encouraging to note that, when day-to-day activities are used as a metric, most patients experience a return to normal or near-normal function."

"Because advances in therapy have led to improved survival in these patients, understanding and controlling adverse effects of treatment should continue to be an active area of investigation," the authors conclude.

(Arch Otolaryngol Head Neck Surg. 2010;136[12]:1226-1234. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by the Robert and Valda Svendsen Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

To contact corresponding author Joseph K. Salama, M.D., call Michelle Gailiun at 919-660-1306 or e-mail michelle.gailiun@duke.edu.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.