Mount Sinai School of Medicine researchers have found that targeted swallowing exercises can help alleviate swallowing dysfunction - a debilitating side effect in people undergoing chemoradiation therapy (CRT) for head and neck cancer. The study, published in the April issue of Archives of Otolaryngology - Head & Neck Surgery, a JAMA Network publication, suggests that clinicians should consider giving all patients undergoing CRT an exercise regimen to improve their quality of life after treatment.
"This study provides clear evidence that aggressive swallowing therapy is an important way to improve outcomes after chemoradiation treatment," said Eric Genden, MD, Professor and Chair of Otolaryngology, Mount Sinai School of Medicine, and renowned expert on the use of minimally invasive robotic surgery to treat head and neck cancer. "Difficulty swallowing is the biggest problem people face after undergoing chemoradiation therapy, with an estimated 20 percent of patients losing their ability to swallow for the rest of their lives."
The Mount Sinai team, led by Dr. Genden and Tamar Kotz, MS, CCC-SLP, conducted a randomized controlled trial of 26 patients with head and neck cancer who were receiving CRT. Half were randomized to the intervention group, performing five targeted swallowing exercises throughout their CRT, and participating in weekly swallowing therapy sessions. The other half were randomized to the control group and conducted no swallowing exercises. They were referred for swallowing treatment after completion of CRT, if needed.
Patients were assessed using two measurement tools: the Functional Oral Intake Scale (FOIS), which measures ability to swallow food, and the Performance Status Scale for Head and Neck Cancer, which includes subscales for Eating in Public, Understandability Of Speech, and Normalcy of Diet. Patients in the intervention group showed significantly better scores on both scales at three and six months following treatment.
"CRT is a very arduous treatment regimen for patients and it is difficult for many of them to adhere to a rigorous prophylactic swallow exercise program while undergoing this type of treatment," said Ms. Kotz. "In our study, 69 percent of the patients assigned to the intervention arm were no longer able to tolerate performing the swallowing exercises after week five of the radiation treatment. However even without adherence to the swallowing exercises regimen through the completion of the CRT, these patients still showed meaningful improvements in their swallowing function after treatment. This indicates that even some exercise is better than nothing in improving swallowing outcomes after CRT."
After CRT, tissue in the neck and at the base of tongue is damaged by radiation and becomes stiff, resulting in loss of function. Strengthening the muscles around the damaged tissue may allow them to compensate for the tissue. Other research indicates prophylactic swallowing exercises may actually prevent tissue damage.
"Research showing the efficacy of swallowing exercises has been criticized in the past due to a lack of randomization in certain studies," said Ms. Kotz. "Our study is the first randomized trial to demonstrate a strong quality of life benefit at three and six months in patients undergoing CRT."
The authors plan to study the benefit of swallowing exercises at nine and 12 months using a larger sample size than the one used to study the effects after three and six months. The current study found no significant difference between the groups at nine and 12 months.
"This study demonstrates the intensive team approach required for patients to have the best possible outcome after head and neck cancer treatment," said Dr. Genden. "Mount Sinai is the only center in New York that offers minimally invasive robotic surgery to treat head and neck cancer, which can improve outcomes like swallowing difficulty. Our oncologists, surgeons, and speech pathologists work together on a tailored treatment and rehabilitation regimen for our patients, resulting in much improved quality of life."
About The Mount Sinai Medical Center
The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of the leading medical schools in the United States. The Medical School is noted for innovation in education, biomedical research, clinical care delivery, and local and global community service. It has more than 3,400 faculty in 32 departments and 14 research institutes, and ranks among the top 20 medical schools both in National Institutes of Health (NIH) funding and by US News and World Report.
The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation's oldest, largest and most-respected voluntary hospitals. In 2011, US News and World Report ranked The Mount Sinai Hospital 16th on its elite Honor Roll of the nation's top hospitals based on reputation, safety, and other patient-care factors. Of the top 20 hospitals in the United States, Mount Sinai is one of 12 integrated academic medical centers whose medical school ranks among the top 20 in NIH funding and US News and World Report and whose hospital is on the US News and World Report Honor Roll. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 560,000 outpatient visits took place.
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