Changes in the swallowing capacity of head-and-neck cancer patients during radio(chemo)therapy

Introduction:

Dysphagia belongs to the most frequent consequences of the head-and-neck tumors. However, very few studies were published on the development of the swallowing capacity during the radio(chemo)therapy. This study aimed to evaluate aspiration and limitations of oral intake, including the possible need for further intervention (NFI), during radio(chemo)therapy (RCT).

Methods:

In the years 2015 – 2018, 83 head-and-neck cancer patients (20% female, age median 64 years, UICC stages II-IV) were included in the study. The patients' swallowing functions were assessed by FEES® diagnostics thrice: before (T1), 1 (T2) and 3 months (T3) after RCT onset. The severity of penetration was determined by Rosenbek's scale (PAS), the limitation of oral intake by Crary's FOIS scale, and NFI was determined under consideration of both previous scales. Changes in these three scales between three test sessions taken together were assessed by the Friedman test, pair-by-pair comparisons by the Wilcoxon test.

Results:

Before therapy onset, 37% of patients demonstrated NFI, 15% aspirated. In 11% of cases silent aspiration was found. Limitations of oral intake were identified in 25% of the sample. After the therapy onset, all three scales demonstrated much worse results. However, these improved significantly before T3. Changes in PAS, FOIS, and NFI between three test sessions were significant (ps < 0.05). According to pair-by-pair analyses, FOIS and NFI scales changed significantly between T1 and T2 as well as between T2 and T3, PAS only between T2 and T3.

Conclusions:

The swallowing capacity of head-and-neck cancer patients, quantified by aspiration, oral intake and need for further intervention, changes significantly during RCT and, thus, needs special attention.

Publication History

Publication Date:
23 April 2019 (online)