Dysphagia Treatment for Patients With Head and Neck Cancer Undergoing Radiation Therapy: A Meta-analysis Review.

Int J Radiat Oncol Biol Phys

Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.

Published: June 2018

Purpose: Patients undergoing radiation therapy with or without chemotherapy (C/RT) for head and neck cancer (HNC) often develop dysphagia. Interventions from speech-language pathologists aim to maintain or improve swallow physiology and function. However, it is unclear which interventions provide the greatest benefit. We performed a systematic review to assess the benefit of exercise therapy on swallow physiology, function, and related quality of life (QOL).

Methods And Materials: We searched 7 electronic databases up to July 12, 2017, for all primary studies of any language or design that included the following: a behavioral swallowing intervention for patients with HNC treated with curative C/RT, a comparison group, and outcomes related to swallow physiology, function, and/or QOL. Two blinded raters judged the abstracts and full articles, with discrepancies resolved by a third rater. Critical appraisal was completed using the Cochrane Risk of Bias. Descriptive analyses were conducted for all outcomes and meta-analyses for outcomes that were identical in type and time relative to C/RT.

Results: Of 1937 unique abstracts retrieved, 20 studies qualified. Of these, 12 were randomized controlled trials. Across the studies, dysphagia treatments varied by exercise type and start time (ie, before or during C/RT, n = 14; immediately after C/RT, n = 1; >3 months after C/RT, n = 5). After treatment, the outcomes measured varied by domain, tools, and follow-up schedule (ie, immediately after, n = 6; within 3 months after, n = 9, >3 months after, n = 12). All articles had risks of bias and most often lacked report of sample size calculations (n = 18), controlled clinician-participant interaction time across groups (n = 13), and treatment details to allow duplication (n = 9). The meta-analysis revealed physiological or functional, but not QOL, benefits after interventions with early and late start times.

Conclusions: Given that benefit was identified with both early and late interventions, future high-quality trials are needed to clarify the most effective time, type, and intensity of behavioral dysphagia interventions for these HNC patients.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijrobp.2018.01.097DOI Listing

Publication Analysis

Top Keywords

swallow physiology
12
physiology function
12
head neck
8
neck cancer
8
undergoing radiation
8
radiation therapy
8
dysphagia interventions
8
early late
8
c/rt
5
interventions
5

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!